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11-0903 (SOTB)lk" . . r P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Tiht BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Application Number: �� _11.00000903 Property Address: 50640 SPYGLASS HILL DR APN: 770-320-021-.21 -25389,- Application description: STRUCTURES -OTHER THAN BUILDINGS Property Zoning: MEDIUM DENSITY RES Application valuation: 3000 Applicant: Architect or Engineer: LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 70001 of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License Class: B C29 LicenseNo.: 303125 Date: Contractor: OWNER -BUILDER DECLARATION . I hereby affirm under penalty of perjury that-) am exempt from the Contractor's State License Law for the following reason (Sec- 7031.5, Business and Professions Code: Any city or county that requires a permit to construct,, alter,.improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State ' License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: 1 _ 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale ISec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the. improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner-builder.will have the burden ofprovingthat he or she didnotbuild or improve for the purpose of sale.). - (� 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. •7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State Li se Law.). 1 _ 1 I am exempt under Sec. for this reason ate: � wner: , ONSTRUCTION LENDING AGENCY hereby affirm under penalty of perjury that th re is a construction lending agency for t to performance of the. work for which this permit is issued (Sec. 309 Civ. C.). Lender's Name: t sic Lender's Address:. LQPERMIT Owner: STEVE & BARBARA SEIDEL 50640 SPYGLASS HILL.. LA QUINTA, CA 92253 Contractor: BLAICH, MARKO 2386 DEBORAH ROAD PALM SPRINGS, CA 92262 (760)323-1526 Lic. No.: 303125 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 8/22/11 tf �Al'�C'2Z�i1 ! GPS �� it 'TA WORKER'S WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier EXEMPT Policy Number EXEMPT I certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so to become subject to the workers' compensation laws of California, ' and agree that, if I ou le subject to the workers' co ensation provisions of Section an 0 of the Labor s II forthwith to the tho p visions. 85te: licant: / WARNING: F (LURE TO SECURE WO KERS' COMPENSATION COVERAGE IS LAWFUL, AND SHALL. SUBJECT AN EMPLOYER TO CRIMIN L PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. - - APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application. 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 permit issued as a result of this application, 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 performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days' from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read.this application and state tha a ab a information is correct. I agree to co ply with all city and cou ty ordinances and state laws relating to uildin onstruction, and hereb thorize rep sentatives of u toe ter upon the above-mentioned pro rt r in ction purpos S. , Date: SigAature (Applicant or Agent): Application Number .. . . 11-00000903 Permit . . . . BUILDING PERMIT Additional desc . Permit Fee . . . . 54.00 Plan Check Fee 35.10 Issue Date . . . Valuation . . . . 3000 Expiration'Date Qty Unit Charge Per Extension BASE FEE 45.00 1.00 9.0000 ------------------------------------------------------------ THOU BLDG 2,001-25,000 9.00 ------------ Permit . . . ELEC-MISCELLANEOUS Additional desc . Permit Fee . . . . 15.75 Plan Check Fee 3.94 Issue Date . . . Valuation . . . . 0 Expiration Date 2/18/12 Qty Unit Charge Per Extension BASE FEE 1 15.00 1.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20 .75 Permit PLUMBING Additional desc . Permit Fee . . . . 18.00 Plan Check Fee 4.50 " Issue Date Valuation 0 .Expiration Date 2/18/12 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS 3.00 ---------------------------------------------------------------------------- Special Notes and Comments CONSTRUCT.FREESTANDING.BBQ.ISLAND, INCLUDES GAS & ELECTRIC,NO SINK. 2010 CODES. ---------------------------------------------------------------------------- Other Fees . . . . . BLDG STDS ADMIN (SB1473) 1.00 ENERGY REVIEW FEE 3.51 Fee summary Charged Paid Credited ---------------------------------------- Due ----------------- Permit Fee Total 87.75 .00 .00 87.75 Plan -Check Total 43.54 .00 .00 43.54 Other Fee Total 4.51 .00 .00 4.51 Grand Total 135.80 .00 .00 135.80 LQPERMIT P.O. Box f 504 LA QUINTA, CALIFORNIA 92247-1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT PROPERTY OWNER'S PACKAGE (7 60) 777 -7012 - FAX (760) 777-7011 Disclosures & Forms for Owner -Builders Apply nglor Construction Permits WHIM 'ANT! NOTICE TO >PROFERTX OWNER Dear Property Owner. An. application for a building permit has been submitted in your name listing yourself as the builder of the property 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 may incur by having this permit issued in your nam* as the Owner -Builder. We will not issue a building. permit 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. OVMEWS ACKNOWLEDGMNT AND VERIFICATION OF.INFORKATION DIRECTIONS: Read and initial each statement below to signify you understand or'Verify this information. 1. 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 and 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 may not provide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers on my,propeny. 2. I understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility.. 3. I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that 1 may protect myself 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 permits and contracts. '5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor.and materials, I may be considered an "employee' under state and federal law. 6. d understand if I am considered an "employer" under state and federal law, I must register with the state and federal government, 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. 7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residentia structures cannot .legally build them with the intent to offer them for sale, unless all work is performed by licensee subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performs under contract with a licensed general building Contractor. 8. I understand as an Owner -Builder if.1 sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owners) that result from any latent construction defects in the workmanship or materials. 9. I understand I may obtain more information regarding my obligations as an "employer' from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand 1 may contact the California Contractors' State License Board (CSLB) at I- 800-32 1 -CSLB -800-321-CSLB (2752) or www.csib.ca.gov for more information about licensed contractors. t0. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that 1 am the party legally and financially responsible for proposed construction activity at the following address: 11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner -Builders as well as employers. 12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the -information 1 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 firm is injured while working on your property; you may be heldliable 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 properly licensed and the status of their workers' compensation insurance coverage. Before a building permit can be issued, this form must be completed and signed by the property.owner and returned to the agency responsible for issuing; the permit. /Vote: A copy of the property owner's driver' s.licetrse; form notarrza6en•, or other verification acceptable to the agency is required • to be presented when the permit is issued to verify the property owner's signature. Signature of property owner ANAZO�4Date: Note: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner -Builder. AUTHORIZATION OF AGENT TO ACT ON PROPERTY OVi'NEWS 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 11 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 t e presented w en t ermit is issued to verify the pro erty owner's signature. Property Owner's Signature: Date: / NOTE: THE DEVELOPER/GONTRACTOR/OHNER IS RESPONSIBLE FOR THE VERIFICATION OF EXISTING CURBS (OR EDGE OF STREET PAVING IF NO CURBS EXIST) FROM PROPERTY LINE(5) WITH THE PUBL I G HORK5 DEPARTMENT. VICINI'T'Y MAP NOT TO 5GALE Q SITE z 0 z AVE 50 5Om640 SPYGLASS HILL DR. LA QUINTA , CA GENERAL, NOTES 1.- VERIFY GONNEGTION POINTS FOR POWER GAS SYSTEMS PRIOR TO GONSTRUGTION 2.-GOMPLY WITH ALL UTILITY GOMPANY REQUIREMENTS. PROVIDE ALL RELATED GONDUIT5, PULL BOXES AND RISERS. 3. -IF ANY ERRORS, D 15GREPANG I E5 OR OM 1551 ON5 APPEAR IN THE DRAWINGS, 5PEGIFIGATION5 OR OTHER GONTRAGT DOGUMENTS, THE GENERAL CONTRACTOR SHALL NOTIFY THE DE5I GNER IN HR I TI NG OF SUCH ERROR OR OMISSION. IN THE EVENT THAT THE GENERAL GONTRAGTOR FAILS TO GIVE 5UGH NOTIGE BEFORE GONSTRUGTION AND/OR FABRIGATION OF THE HORK, THE GENERAL GONTRAGTOR HILL BE HELD RESPONSIBLE TO THE RESULT OF ANY ERRORS, "DISGREPANGES OR OMISSIONS AND THE G05T OF REGTIFYING THE SAME. SPECIFICATIONS N.T.5. PROFESSIONAL GILLS Mode! A B C D E F G H UD 29 241-0 CMVI LEMENM%-R17 PRCDUMS modoF A B c D E F G H ACCESS DOORS 1C1R3d2 - - 341k - - SIDE BURNERS LSB2 r. 12L241n - 10% UTILaY DRAINERS LUDX� L � — ----_24""171m-9E+e,a-----•— OUTDOORIINDOOR REFRIGERATOR OVERAL DIMENTION5 —" 23j"344"-34j°23j° CITY Or -LA QUINTA AMPS ®120 VOLTS BUILDING & SAFETY DEPT. 26�° DEEP APPROVED FOR CONSTRUCTION DAT "Z2-!( gY �A Bin # . City of La Quinta Building 81: Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # �}, 17 ✓ ,t Project Address: Owner's Name A. P. Number: Address: Legal Description: City, ST, Zip: 2 Contractor: ,/ Telephone: Address: a3 Y Project Description: City, ST, Zip: Tele hone1: 2 — A 3 I/JIG 4 - State Lic. #:13_V473) 2j-j� ity Lia'#::: Arch., Engr.,igner Address: City, ST, Zip: ' i iJ:}:$}.ti ?j:;:;}v: :•':::r :vim. ti:ri.'?? y%l i'•`v`'6t:''•:.?.ii}:vr:: Telephone: •� < v':.};};iiiiii<•<:�;::}}:.:s::;:.,}::.};:. State Lic. :.:....ProJect Name of Contact Person: Construction Type: Occupancy: tYPa circle one): New Add'n Alter Repair Demo Sq. Ft.: #Stories: #Units: Telephone # of Contact Person: Estimated Value of Project: 111:5W APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2'" Review, ready for correctionsfissue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted- Grading IN HOUSE:- M Review, ready for correctionsfissue Developer Impact Fee Planning Approval Called Contact Person I A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees 4'