Loading...
11-0172 (ELEC)P"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 _ Date: 2/17/11 Application Number: X11-0000-01 2' Owner: Property Address:. 51140 AVENIDA VALLEJO ' CHITWOOD W H ' APN: 773-063-006-17 000000- 51.140`AVENIDA VALLEJO '• Application description: ELECTRICAL r LA QUINTA, CA 92253^ Property Zoning: - COVE RESIDENTIAL (760) 887-8888 Applicationyaluation: 1000 Contractor: Applicant: Architect or Engineer: Owner fAll � , LICENSED CONTRACTOR'S DECLARATION - - " 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: 'r 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. • ' D Date: Contractor: . _ 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 under penalty 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 apermit to " I certify that, in.the performance of the work for which this permit is issued, 1 shall not employ any construct, alter, improve, demolish, or repair any structure, prior gto its issuance, -also requires the applicant for the person in any manner so as t? be me subject to the workers' compensation laws of California, permit to file a signed statementtnat -he or she is licensed pursuant to the provisions of the Contractor's State t and agree that, if I should be'om 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 C d 11 fo hwith comply with those provisions. 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).: +.�-� Date' 11 - Applicants "'-1 i • 1 — 1 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 SECURE W KERS' 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 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 (000,000). -IN-ADDITION-TO THE COST OF COMPENSATION, DAMAGES.AS PROVIDED FOR IN -- - - improvements are not intended or offered for; sale. If, however, the building of 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 . 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. a . property who builds or.improves thereon, and who contracts for the projects with a contractor(s) licensed 1 . Each person upon whose behalf this application is made, each person at whose request and for. w. • , pursuant to the Contractors' State License La.).. - whose benefit work is performed under or pursuant to any permit issued as a result of this application, 1 _ 1 I am exempt under Sec. 6.&P:C. for tFi r s n 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 \A performed under or following issuance of this permit. -Owner: " - - 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 dayswill subject C U TI N LENDING AG Y - permit to cancellation. I hereby affirm under penalty of perjury that there i a construction lendin gency for the performance of the; _ I certify tha I hav read this application and state that th above information is correct. I agree to comply with all work for which this permit is issued (Sec. 3097, Civ. C.). - - _ city and co my o cd ces and state laws relating to bu'I' nstruction, and hereby authorize representatives of this cou y to nter upon the above-mentioned r p f i s c oses. ,. Lender's Name:-- - - . • Date: �I Signature (Applicant or Agen Lender's Address: • -VT LQPERMIT - Application Number 11-00000172 ' Permit . . . ELEC-MISCELLANEOUS Additional desc Permit Fee' 15.75 Plan Check Fee 3.94 Issue Date, Valuation . . . . 0 Expiration Date 8/16/11 Qty Unit -Charge Per Extension BASE -FEE 15.00 1.00 .7500 PER ELEC DEVICE/F.IXTURE 1ST 20 .75 --------------------------------------------- ------------------------------ Speci'al Notes and Comments ELECTRICAL PERMIT'82' LN FT RUN (3.) EXTERIOR LITE AND (1)MOTOR FOR GATE, .APPROVED PER PLANNINING & SUPPLEMENTAL TO PERMIT #146. _.----------------------------------. -- - -- Other Fees . . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged Paid Credited Due Permit Fee Total 15.75 .00 .00 15.75, Plan'Check Total 3:94 .00. 00 3.94 Other Fee. Total1..00 .00 .0°0 1.00 Grand Total 20..69; .00 .00 20.69 ' P.O. BOX 1504 LA QUINTA, CALIFORNIA 92247-1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT PROPERTY OWNER'S PACKAGE (760) 777-7012 FAX (760) 777-7011 Disclosures & Forms for Owner -Builders Applying for Construction Permits ItMDM! NOTICE TO >° OPERTy 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 name 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. OV R'S AC1CN0WLEDQMWM AND VERiFmCATION OF MFORM-1WN DfREOTONS: Read and initial each statement below to signify you understand or verify this information. tI understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder" u!d�ing 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/party G�Z. 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 - understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I 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. understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. 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 "employer" un er state and federal law. [ understand if I am considered an "employer" under state and federal taw, 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 ris 7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential 0 structures cannot legally build them with the intent to offer them for sale, unless all work is performed 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. ►S�or stand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any Vinancialrso construction defects in the nal. triunes sustained by any subsequent owner(s) that result from any latent korkmanship or materials. 9. I understand [ may obtain more information regarding my obligations as an ,employee, 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 I may contact the California Contractors' State License Board (CS -LB) at 1- 800-321-CSLB (2752) or www.csib.ca.gov for more information about licensed contractors. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the e10._l parlegally and financially responsible for proposed construction activity at the following address: 1. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all able laws and requirements that govern Owner -Builders as, well as employers. VY " 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 tounderstand that if an unlicensed Contractor or employee of that individual or firm is injured while working on yourproperty, 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 permit can be issued, this form must be completed and signed by the .property owner and returned to the agency responsible for issuing. the.peradt. Note: A copy of the property owner's drwer'sIkensei form no"*""Vn; or other ve rttcation acceptable to the e /�igKrre��e presented when the permit is issue! to reify the property owner's signature. Signature of property owner �Z" 1 r Date: 2--17-11 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 persons) to act as. my agents) 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: Tel No Address of Authorized Agent: 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: Bin # Qty of La Quinta Building & Safety Division P.O. Box 1504, 7&495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # Project Address: Owner's Name: !� A. P. Number: Address: Legal Description: --- City, ST, Zip: G Cr 2 yJ j Con -tractor: ��� QW Telephone: Address: Project Description: .z ke74�1 CL, City, ST, Zip: Telephone: £)Cit r7. State Lic. # : City Lic. Arch., Engr., Designer: Address:.i City., ST, Zip: Telephone: h • , >.w:,:.;.,t::> .. . P :�" �;:.<;,:��.A:n�:.��.,.•;: <�: State Lic. #: �r#s# .y: Name of Contact Person: ,Construction Type: Occupancy: Project type (circle one): New Add'n Alter Repair Demo Sq. Ft.: # Stories: ` # Units: Telephone # of Contact Person: Estimated Value of Project: P� . APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'd TRACKING PERMIT FEES Plan Sets Pian Check submitted Item Amount Structural Cales. 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 correctious/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.L. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- Review, ready for correctionstissue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks- Appr Date of permit issue School Fees Total Permit Fees