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14-0825 (ELEC)P.O. BOX 1504 1 ^ _� 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: 6/11/14 Application Number: 14-00000825 Owner: Property Address: 53430 AVENIDA VALLEJO SCOTT JOHNSON APN: 774-083-009-16 -000000- 40853 CECILIA WAY Application description: ELECTRICAL BERMUDA DUNES, CA 92203' Property Zoning: COVE RESIDENTIAL (760) 406-3646 1 D Application valuation: 1200 PP rl Contractor: Applicant: • Architect or Engineer: Owner I I ' .1 20Y) CdTyrbc QUINT V v ------------------ LICENSED CO TRACTOR DECLARATION hereby affirm under penalty of perjury that I am license n r ro isions of Chapter 9 (commencing with Section 70001 of Division 3 of the Business and Prof sion I e, and my License is in full force and effect. License Class: nse No.: Date: Contractor: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I 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 y alicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: ( 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 (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 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 of proving that he or she did not build or improve for the purpose of sale.). as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Cade: 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 License Law.). )%O I am exempt under Sec. - , B.&P.C. for.this reason - Date: 1�' u' Owner: T CONSTA"C ION.LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name: Lender's Address: 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 ---------------- - - - - -- Policy Number (:certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall fo with comply with those provisions. - Date: fn'_j_ - A Applicant: WARNING: FAILURE TO SECURE WORKE \ ' C PENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL 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 that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construc ion, and hereby authorize representatives of this county t�o� tenter upon the above-mentioned I rty forinspe tn purposes. Date:V// 1 ' 1 9 Signature (Applicant or Agent rTr—T Application Number, . . _ . 14-00000825 Permit . . . ELECTRICAL 2013 Additional desc . . Permit Fee . . . . 23.83 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 0 Expiration Date 12/08/14 Qty Unit Charge Per Extension 1.00 23.8300 EA ELEC SERVICES 23.83 ---------------------------------------------------------------------------- Special Notes and Comments ELECTRICAL - REPLACE 200 AMP SERVICE PANEL. 2010 CALIFORNIA BUILDING CODES. ------------'---------------------------------------------------------------- Other Fees . . . . . . I . . . PLAN CHECK, ELECTRICAL 11.92 PERMIT ISSUANCE M/P/E 90.57 Fee summary Charged Paid Credited Due --------------------------- Permit Fee Total 23.83 ------------------------------ .00 .00 23.83 Plan Check Total .00 .00 .00 .00 Other Fee Total 102.49 .00 .00 102.49 Grand Total 126.32 .00 .00 126.32 Bin #. Qty of La Qulnta Building 8L Safety Division P.O. Box 1504, 7B-495 Calle Tampico . La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # • �Zj Project Address:L AYe_ 14 Owner's Name: J C J pwKS��I A. P. Number: Address: '10 5,Y Cex, 14 GU Legal Description: City, ST, Zip: CA '74-1a Contractor: Telephone: %!;{�- �� :$<tisi; ;v,5 --';r s%i :.•:` ti i::: i''y:::' Address: Project Description: (_ f C City, ST, Zip: .260 A,_ Telephone: State Lic. # : City Lie. #; Arch., Engr., Designer: Address: City, ST, Zip: . Telephone: ••: ' :•::::::.:<hi:-iljii?iiiiii'::ii: ii'ii:$ < ` :'<•;::;;;:.;>:<•:;:.;:.:;::;;>:.;;::;.;::.;;:.;; :->:-><;<;•::<->,::::•::< Construction Type: Occupancy: State Lic. #: , Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person: Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: Estimated Value of Project: -$' JQQ , 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 Cales. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan god Review, ready for correctionslissue Electrical Subcontactor List Called Contact Person Plumbing Grant Decd Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN ROUSE:- '"' Review, ready for correctionsrissue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees •1 Total Permit Fees O BUILDING & SAFETY DEPARTMENT 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 PROl'ElIk'� T O r!' NEWS' PAC (760) 777-7012 FAX (760) 777-70I1 Disclosures & Forms for Owner-Bullders,A.pplying for Construction Permits Pf�tR�AND NOnCE TO PRQFERTY OWNER Dear Property Owner. An application fora building permit has been submittod in your name listing yourself as the builder of .the property improvements specified at it,1 Asle..T C, We are providing -you with an Owner -Builder Acknowl� t,and information Verification Form to make you avmo of your respdnsrbilities:and possrble risk you mayinctu by having,this permit issued in your tame as the Owner -Builder. We w i not Issue a budding,permit until you have read, inidakd your understaading of tack'prevision, signed, and returned this -form to us at our official address indicated. An agent of the owner cannot execute -tLis .notice unless you, the property owner, obtain the prior approval of the permitting authority. Uiaf Qaeii. ctatcnient belbry o signtJy you urid'ersYanci I. l .understand a frequent practice of unlicensed persons is to have the Property ownc obtain an "Q:wnert.tuilde?' b ing pem"it that cimnoously implies that the property yowner is prova"din his .or her.own tabor;at.m,.a.terial, .y' as: an. an Oxvner-Builder, mazy be held liable and subject'to serious financial nsk'for any injuries -:sustained by. an unligcts persoo:. 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 insurancc•coveragc for injuries to workers on my property. I understand building permits are not required to be signed by property owners unless They are responsible for the c traction and are not hiring a licensed Contractor to assume this responsibility- 3. l understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect m 1 f from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my Own. I - I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on pe its and contracts-. S. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of y construction is at least five hundred dollars ($500), including labor and materials, I, may be considered an "employer" un er state and federal law. 6. I understand if I am considered an an under state and fodera! law, I must register with the state and federal compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. 7understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential s tures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. gil, undrrstind as'an Owner -Builder if I sell the property for which this permit is issued, I may be held liable, for .Gial or persoiral,:V cries ;ustaisicd by any subsequent owner(s) Ihtil result from any latent construction defects in "roi lrrnasiship-br nialcrials. 9. I understand I may obtain more information regarding m' obligations as an "eirijitoycs" frgru.t., Trrierrial Revenue ice, the United States Small Business Administratio[i, the.Q lifornia Depart hint of:[icnefit..l?aymec ts, and tlic Caldoruia Division of Industrial Accidents. i also understand l may::coitfact:tile Califorriia Cotatractots' State I ice. P c ioard (O$Lt) a . i- 800-321-CSLB (2752) or www.csib.ca.gov for more information about licensed contractors. V10 - I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the 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, t will abide by all a icable laws and requirements that govern Owner -Builders as well as employers. 12.1 agree to notify the issuer of this form immediately of any additions; deletions, or cbanges to any of the tafotmatiort 1 h e 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 Bond rimy be unable to assist you with any finaneW loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be iWalvil court- It is also important for you tounderstand that if an unlicensed Contractor or employee of that individual or firm is i*rod while working on your. property; you may be held:liat te;for dam— ages:: lf:you o6tain.zz:perniil'.as Owner-Build040 wish iv: him Contractors, ou will be y responsible for vczfytng wticdxx;or:iiot iliosc Contractors arc proprxiy .li¢ans«i:sad tlre: status:o[ the it woticers' Compensation insuranoe 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 issaitt: *he..permit. Note. A copy of tke• property owner's dsiver'V Ircanset ftrrm rwta bens or other verification aeceptaMe to the agency is required to be presented when (kr permit, is issua to Verify the properly owner's signature. Signature of property owner Date: s Note: The following Authorization Form is required to be completed by' the property owner only when designaeing an agent of the property owner to apply for a construction permit for the Owner -Builder. AUTHORIZATION OYAGENI' TO ACT ON PROPFRTY OWNEWS.BEHALF Excluding the Notice to Property Owner, the exemdon of which I understandds my personal responsibility, Thereby 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 1luthorized Agent: Tel No Address of Authorized Agent: I declare under penalty of perjury that 1 am the property owner for the address listed above and I personally filled out the above tify information and cerits 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: t 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT PROPER'T'Y OWNER'S PACKAGE (760) 777-7012 FAX (760) 777-7011 Disclosures & Forms for Owner -Builders Applying for Construction Permits IWORTi AT'r NOTICE TO PROPERTY 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 _ 3 U_� t7� _A \W , V 4 (1:C ; M 1.� & y r _t C S-3-• We are providing you with an Owner -Builder Ackn,owle gmeat,and Information Verification Forret 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, iniRi ]Wd younrunderstanding of eauck prevision, 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: Rend and initial each statensent below to signify you understand or *nfy this information. 1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Buildee" b i ding 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 financial risk for any injuries.sustained by m 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. actI ion understand building permits are not required to be signed by property owners unless they are responsible for the c trand are not hiring a licensed Contractor to assume this responsibility. 43. I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect m 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 its and contracts. 5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value oT y construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" ur state and federal law. 6. I understand if I am considered an "employee" under state and federal taw, I must register with the state and federal go ernment, 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 residential s tures cannot legally build them with the intent to offer them for sate, 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.