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13-0145 (ELEC)V1 -4 P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253--. BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Application Number: 1_3-00000145— Property Address: 78670 AVENIDA TORRES APN: 770-171-0097156 -000000- Application description: ELECTRICAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 1195 Applicant: I Architect or Engineer: Owner: LAUREN & DENNIS PETERSON 78-670 AVENIDA TORRES LA QUINTA, CA 92253 (7 6 0)702-0454 Contractor: Owner VOICE (760) 777-1012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 r. EB 112013 LA Date: 2/08/13 7 ----------------------------------------- ------------------ LICENSED CONTRACTOR'S DECLARATION 7 ------------ I ------------------------ WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations*: Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided License Class: License No.: for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Date: 'Contractor: I have and will maintain workers' compensation insurance, as requiied by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation OWNER -BUILDER DECLARATION insurance carrier and policy number are: I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carn . er - - - - - - - - - - - - - - - - - - - - - - - Policy Number following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to I certify that, in the performance of the work for which this permit is issued, I shall not employ any construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner so as to become subject to the workers' compensation laws of California, permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I should become subject to the workers' compensation provisions of Section License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3700 of the Labor Code, I shall forthwith comply with those provisions. that he or she is exempt therefrom and the basis for the afi�ged exemption. Any violation of Section 7031.5 by a n ­ �ant or . permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: .Y-4 I' f 'I� as owner of th a property, or my employees with wages as their sole compensation, will do the work, and !YK , I ;l the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Date: Applicant: WARNING: FAILURE TO SECURE WORKERS' OMPENSATION COVERAGE IS UNLAWFUL, AND SHALL C Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND and who does the work himself or herself through his or her own employees,. provided that the DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN- improvementi are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. one year of completion, the owner -builder will have the burden of proving that he or she did not build or impro�e for the purpose of sale.). APPLICANT ACKNOWLEDGEMENT 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions set.forth on this application. —property who builds or improves thereon, and who contracts for the projects with a contraclor(s) licensed pursuant to the Contractors' State License Law.). 1 . Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permiuissued as a result.of this application, am exempt under Sec. B.&P.C. for this reason the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents and employees for any act or omission related to the work being 01 performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void it work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject CONSTRUCTION LENDING AGENCY permit to cancellation. I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify that I ' have read this application and state that the above, information is correct. I agree to comply with all work for which this permit is issued (Sec. 3697, Civ. C.). city and county ordinances and state laws relating to building construction, and hereby authorize representatives Lender's Name: Lender's Address: of this county to enter upon the above-mentioned property f inspection purposes./9 Datc.2-2 _Signature�-( licant or Agent): LQPERMIT I Application -Number . . . . . 13-06000145 Permit ELEC-SERVICE CHANGE Additional desc Permit Fee . . . . 52.50 Plan Check Fee .00 Issue Date . . . . valuation . . . . 0 Expiration Date 8/07/13 Qty Unit Charge Per- Extension BASE FEE 15.00 1.00 37.5000 EA ELEC SVC <=60QV/>200A/<=1000A .37.50 - ---------------------------------------------------------------------------- Speci al Notes and Comments, Replace 125-amp,electkical box with new 225 -amp electrical box. 2010 Codes.' - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 7 - 7 ..Other Fees . . . . . . . . . BLDG'STDS ADMIN (SB1473), 1.00� Fee summar)� Charged' Paid Credited ----------- ----- Due ---- ----------------- ---------- ---------- Permit Fee Total 52.50 .00 .7 52.50 Plan Check Total .00 .00 .00 A0 Other Fee Total 1.00 .00 .00 1.00 Grand Total 53.50 .00 .00 53.50. # Qty. Of - La Qulht'a BLqkgpg gr Saky Dhisi6n P.O. Box 1504,78-495 Calle Tampico L4.Quinta, CA 92253 -;(760) 777-7012 Building Permit -Application* and Tracldng Sheet Permit # Project.Address:78-00 Avenida La Torres Own er'sName:.6�Wterson A. P. Number* Address: 78-670 Avenida La Torres Legal Description: City,STZip; La Qui.nta,- CA 922S . 3 Z�Mqctor: Biudvik,- Inc. elephone: 760-702-04S4 -'-SK Eugene Roa Address: Project Description: City, �T, Zip: !!��>s gs, CA 92.264 Upgrade existing 2S -amp ele.ctrical Telephone: _.��3 2 0 - 4 4 482623 Lic. fk- 2 5 4 2 -- ----- to a new metered Gk-- .225 -amp electrical metered Box ,nw None Arch., Engr., Desip Address: City, ST, Zip: Tel6phone: Construction Type: Occupancy: Project type (circle one): New Add'n Alter Repair Demo StateLic.4: Naine of Contact Person: Sq. Ft: # Stories: Funits: Telephone # of Contact Person: Esffinated Value of Project Y5 - APPLICANT: DO NOT WRITE BELOW THIS LINE N Submittal ReWd Itee'd TRACMG PERMrrFEES- Plan Sets Plan Check submitted. Deal Amount Structural Cales. Reviewed, ready for corrections Plan Check Deposit. Truss Cales. F Called Contact Person Plan Check Balance Title 24 Cales. Plans picked up Construction Flood plain, plan Plans resubmitted-'. Mech2filcal Gi-ading plan 2" Review, ready for correctionstissue Electrical Subcontactor Ust Called Contact Person Plumbing Grant Deed Plans picked up S.NLL 11.0 -AL Approval Plans resubmitted Gradl lag N HOUSE- Rcylew, ready for correctionsrissue Developer Impact Fee Planning Approval. Called Contact Person AJLP.P. Pub. Wks. Appr Date of permit Issue School Fen Total Permit Fees . d- 4 P.O. Box 1504 LA QUINTA, CALIFORNIA 92247-M4 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT - PROPERTY OWNER'S PACKAGE (760) 77 7-7012 FAX (760) 777-7011 Disclosures & Forms for Owner -Builders Apllying for Construc.tion Permits IMPORTANT! NOTICE TO PROPERTY OWNER Dear Property Owner: . : - I An application - for a -building permit has b b 'tt d your name I . ting ourself as the builder of the property su mi e in improvements specified at We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you miy incur by ha ving this permit issued in your name as the Owner -Builder. We will not issue a building perrrdt until you have read, initialed your understanding of each. provision, signed, and returned this form to us at* our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. DIRECTIONS.- Read and initial each statement below to signijy you understand -or veri)� this inform2ttion. &I. I -understand a frequent practice of unlicensed persons is to have- the property owner obtain an "Owner -Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. 1, as an Owner -Builder, may be held liable arid subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance in . ay not provide coverage for those' injur.ies. I am willfully actiAg as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. 2. 1 understand building permits are* not required t . o be� signed by property' owners unless they are responsible for the t,4 cl?nyst2ruction and are not hiring a licensed Contractor to assume this responsibility. 44/ 3. 1 understand as an "Owner-Buildee, I am the responsible* party o f record on the pernift. I understand that I may protect y y s self from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name.instead of MY own. 4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on mid and contracts. .05. 1 understand if I employ or otherwise engage- any persons, other than California licensed Contractors, and the total value m m, y construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employee' under state and'federal law. Z6. 1 understand if I am considered an "employee' under state and federal law, I must register with the state and federal ZVVenunent, withhold . payroll taxes, provide workers'. compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide. by these laws may subject me to'serious financial risk. Ai7. 1 understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential —citures cannot legally build them with the intent to offer them for sale, unless all work is perform ed by licensed subcontractors and the number of structures does not -exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. r8. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any itii7cial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the Workmanship or materials. SA�19. 1 understand I may obtain more information regarding my obligations as an "employee' from the Internal Revenue O I'lice, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at I- 800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. 10. 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the 4� party legally arkid financially ns�ibl f roposed construction activi t the following address: 9e 2 11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I Will abide by all Al I 4��'tDp2DplhiCable laws and requirements that govern Owner -Builders as well as employers. �, 2. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist'you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. *It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firin is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or not those -Contractors are property licensed and the status of their workers' compensation insurance coverage. Before a building perirdt can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the agency is required to be presented when the -permit is issued to verij� the property owner's signature. ' _;,_IX - 2 C),1,2> Signature of property ownpr`�� Date: Note: Thefollowing Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to applyfor a construction permitfor the Owner -Builder. AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner -Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of Authorized Agent: Address of Authorized Agent: Tel No I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the owner's driver's license, form notarization, or other verification acceptable to the agency is required to be presented when the perrnit is issued to ver6 the property owner's signature. Property Owner's Signature: Date: