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09-0409 (ELEC)ToyP.O. BOX 1504 VOICE (760) 777-7012 78-495 CALLE TAMPICO, FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 BUILDING.& SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 ` ^ = BUILDING PERMIT 4 Date: 5/01/09 Application Number: 09-00000409 Owner: Property Address: 78880 SUNBROOK LN JESUS CONTRERAS APN: 604-291-010-10 -23995 - 78880 SUNBROOK LANE Application description: ELECTRICAL LA QUINTA, CA 92253 Property Zoning: LOW DENSITY-RESIDENTIAL --------------- Application valuation: 80 Contractor: — t Applicant: Architect or Engineer: Owner -=--- ------ ---------- l /T CI Y OF LA QV14�Tp► FIN t3�QT —-'--—----——----------------------------------------------------—------------------------------—- LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION , I hereby affirm under penalty of perjury that 1 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. - �� 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 OWNER-BUILDER DECLARATION - insurance carrier and policy number are: - I hereby affirm underpenalty of perjury that I am exempt from the Contractor's State License Law for the Carrier Policy Number following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to certify that, in the performance of the work for which this permit is issued, I shallnot 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 I ct to be 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 thToould becomes iect th rkers' compensation provisions of Section License Law (Chapter 9 (commencing with,Section 7000) of Division 3 of the Business and Professions Code) or - 3700o the de, I shall f hwith o ose provisions.that he or sheis 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 15500).: e: '' �1• ica - () 1, 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 (Sec. 7044, Business and Professions Code: The WARNING: FAILURE TO SEC E WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER T RIMINAL 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 improvements 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 improve for the purpose of sale.). APPLICANT ACKNOWLEDGEMENT - (_) I, 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 contractorls) licensed. 1. Each person upon whose behalf this application is made,.each person at whose request and for pursuant to the Contractors' St License Law.). whose benefit work is'performed under or pursuant to any permit issued as a result of this application, - • ( ') I am exempt under Sec. - .&P. . for this. re 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. /Date: .� - wnec 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 • - - CONSTRUCTION LENDING AGENCY - permit to cancellation. - hereby affirm under penalty of perjury at 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 ' corr .ee to comply with all work for which this permit is issued 1 c. 3097, Civ. C.). • city and county ordinances and state laws relating t ilding construction, n her authorize representatives of this county to enter upon the above-mentioned rop , y for inspection urp se _ Lender's Name: � - � n 1 - Da/ Signa a (Applicant or Agent . Lender's Address: - LQPERMIT ' F Application Number' 09-00000409 'Permit ELEC-SERVICE CHANGE.INV FEE Additional desc y ; _ Permit,Fee 67.00 Plan•Check Fee .00 Issue Date Valuation 0 Expiration Date 10/28/09 r • Qty Unit Charge 1., Perr Extension �` BASE FEE 30.00 ' 1.00 ,37.0000 EA ELEC SVC <=6-00V/<=200A'- 37.60 --- -------------------------------------------------------- - Special -Notes' and Comments , ' - -------------.- - . $ INSTALL 125 AMP. METER PANEL. INVESTIGATION --FEE ASSESSED PER 1997 ,UNIFORM ADMINISTRATIVE CODE §304.5 FOR zs WORK BEGUN WITHOUT BUILDING PERMIT._ ' -------- : -------------------------------------------------- ------- Other Fees BLDG STDS ADMIN (SB1473), - -- 1.00 Fee summary Charged Paid Credited "' Due -- -- -- -- , -- ----------------- --- ----- - ----------------------- Permit Fee`Total 67.00 .00 .00 67.00 r - r Plan Check -'Total 00 .00 00• .00 Other Fee Total 1.00 .0 .0 .00 1:00 Grand Total .d,` 68.00 .00 .00 68.00 LQPERMITY- .i P.O. Box 1504 LA QU[NTA, CALIFORNIA 92247-1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 4Rho BUILDING & SAFETY DEPARTMENT (760) 777-7012.. FAX (760) 777-7011 PROPERTY OWNER'S PACKAGE, Disclosures & Forums fo.r Owner=Builders Applying for Construction.Permits IMPORTANT! NOTICE.TO PROPERTY OWNER Dear Property Owner An. application for a building p rmit. has' been s mitted .in your name listing�. ou�rself as the builder of the .property improvementsspecified•at g&(j d( JR -60 (. ( /A-, �` �� .V'e are.providing you with an Owner -Builder Acknowled mentand Information Verification Forin to m1akely- u awS� f your g y .responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We will not issue a building permit until yow 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. OWNER'S ACKNOWLEDGMENT AND-VERWICAT ON OF INFORMAT ON DIR'E'CTIONS: Read and initial each. statement below to sign you understand`orwerify this information. I understand a :Gequent. 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. I, as an Owner -Builder, may be held liable and subject to serious frnanciat' 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 property. - �"*'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 re risible of recoil on the permit: I understand that I may protect if from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. %4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on pe�mits and contracts. C 5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value 6my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" IN der state and federal law. 6. I understandif 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. �J 7. 1 understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential slI rctures cannot .legally build them with the .intent to offer them for sale, unless -all work is performed by licensed sa1contractors 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. 8. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any f ancial or personal. injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. ti9. I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue ce, the United States Small Business Administration, the California Department of Benefit Payments, and the California g.�� p yin ivision of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1- 800-321-CSLB (2752) or www.csib.ca.gov for more information about licensed contractors. 10. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the following address: I. I agree that, as the party. legally and financially responsible for this proposed construction activity,.I will abide by all a licable laws and requirements that govern Owner-Builders'as well as employers. 12. ['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 firm 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 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. Note: A cop. y of tire, property, owner's driver's lkensei form notarization; or other verification acceptable too theagency is require�to be presented.when the permit is issued to verify the property owner's signature. r� Signature of property owner i"114( !� Date: S� I ,, 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 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 permit is issued to verify the property owner's signature.. Property Owner's Signature: Date: gin # City of LaQ uinta Building &r Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet i Permit # 40 1 O Project Address: Owner's Name: - �V A. As A. P. Number: Address: - .� 1 N, Legal Description: Contractor: City, ST, Zip: LA QA,,te/ a �� telephone, 7 v — Address: Project Description: City, ST, Zip: .�� LZ Telephone: State Lic. # `. City Lic. #; r n /. 2iC.. Arch., Engr., Designer: Address: City., ST, Zip: Telephone: v Construction Type: Occupancy: P State Lic. #: ProJect hPe (circle one): Add',n Alter RP air Demo Name of Contact Person: Sq. Ft.: #Stories: #Units: Telephone # of Contact Person: Estimated Value of Project: APPLICANT: DO NOT WRITE. BELOW THIS LINE # Submittal Req'd Recd 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 2nd Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up. S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- '"' Reyiew,.ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees