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10-1362 (RER)j'P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 10-00001362 Property Address: 50245 VIA AMANTE . APN: 772-390-034- - Application description: REMODEL - RESIDENTIAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation. 12000 Titit 4 4 w Applicant: Architect or Engineer: bu�lal�K �R ----------------- LICENSED CONTRACTOR'S DECLARATION BUILDING & SAFETY DEPARTMENT BUILDING PERMIT I hereby affirm under penalty of perjury that I am licensed u rovisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Pr ovals Code, and my License is in full force and effect. �—•�.License Class: License No.: - Date: Contr '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 7631.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: 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 prove for the purpose of sale.). .y. �I s oner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. w 1044, 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 contractors) licensed pursuant tot he Contractors' State License Law.). am exempt under Sec. , B.&P.C. for this reason Date: {owner: � t CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a cons ucnon lending agency for the performance of the work for which this permit is issued (Sec. 3097, Ci .. ' Lender's Name: Lender's Address: - LQPERMIT VOICE (760) 777-7012 FAX (760)-777-7011 INSPECTIONS (760) 777-7153 Date: 12/13/10' Owner: _ FRAISSE J.O./FRAISSE THERESE 50245 VIA AMANTE LA QUINTA, CA 9225 i Contractor:` - Owner ------------------ WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: - veand 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 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 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 forthwith com I with those ro i ' Date: IA ntr _ WARNIN . FAILURE TO SECUR l COMPENSATION COVERAG��ISUNLAWIURL. D SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINEHOUSAND DOLLARS($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN t, 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 nulland 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 construction, and hereby authorize re re of -this county to ter upon,the above-mentioned r - Date:) 13 natureIAPPlicant or Agent): Application Number . . . . . 10-00001362 ------' Structure Information INTERIOR REMODEL ----- Other struct info . . - ---------------------------------------------------------------------------- . . . CODE EDITION 2007/2008 Permit BUILDING PERMIT Additional desc . Permit Fee 135.00 Plan Check Fee 87.75 Issue Date Valuation . . . . 12000 Expiration Date 6/11/11 Qty Unit Charge Per Extension BASE FEE 45.00 10.00 9.0000 ---------------------------------------------------------------------------- THOU BLDG 2,001-25,000 90.00 Permit. . . ELECT - ADD/ALT/REM Additional desc . Permit Fee 16.50 Plan Check Fee ... 4.13 Issue Date . . . . Valuation . . . . 0 Expiration Date 6/11/11 Qty Unit Charge Per Extension BASE FEE 15.00 2.00 .7500 =--------------------------------------------------------- PER ELEC DEVICE/FIXTURE 1ST 20 ------------------ 1.50. Permit . . . . . . PLUMBING Additional desc . Permit Fee 34.50 Plan Check Fee 8.63 Issue Date Valuation .0 Expiration Date 6/11/11 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 6.0000 EA PLB FIXTURE 6.00 1.00 7.5000 EA PLB WATER HEATER/VENT 7.50 1.00 3.0000 EA PLB WATER INST/ALT/REP 3.00 1.00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS 3.00 Special Notes and Comments INTERIOR REMODEL AT LAUNDRY, LIVING AND KITCHEN AREAS - TANK LESS WATER HEATER. CHANGE.OUT, REVERSE -LAUNDRY TO OPPOSITE SIDE OF WALL; DEMO FIREPLACE AND MEDIA NICHES, DEMO WET BAR, DEMO NON-BEARING WALL AT DINING ROOM, DEMO NON-BEARING WALL AND RELOCATE PLUMBING AT KITCHEN , LQPERA11T Application Number . . . . . 10-00001362 ; ---------------------------------------------------------------------------- Special Notes and Comments AND ADD GAS STUB TO EXTERIOR AT EXISTING RANGE LOCATION. ***ALL WORK DONE PREVIOUSLY WITHOUT PERMITS. IF REQUIRED THE REMOVAL OF EXISTING CONSTRUCTION MAY BE NECESSARY IN ORDER TO VERIFY PROPER INSTALLATION. IF DEFICIENCIES ARE OBSERVED A -PROPERLY LICENSED CONTRACTOR SHALL BE OBTAINED FOR THEIR CORRECTION PRIOR TO FINAL INSPECTION*** 2007/2008 CALIFORNIA BUILDING CODES' December:13, 2010 2:42:21 PM AORTEGA ---------------------------------------------------------------------------- Other'Fees . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 -- ENERGY REVIEW FEE 8.78 Fee summary Charged Paid Credited Due Permit Fee Total 186.00 00 .00 186.00 . Plan Check Total 100.51 .00 .00 100.51 Other Fee Total 9.78 .00 .00 9.78 Grand Total 296.29 `.00 .00 296.'29 LQPERMIT ' Bib # 'City of La Quinta Bugding 8r Safety Dl ion P.O. Box 1504, 78-495 Cade Tampico La Quinta, CA 92253.(760) 777-7012 Building Permit Application and Tracking Sheet Permit # ►3b2- Project Addrrss: �� `j Owner's Name: , A. P. Number. Address: SU Z Legal Description: Contractor: U W Y) c -r City, ST, Zip: qZ 25 3 Telephone: 766 — 2 T6— 33' Address: Cl S zb 0 J V.— Project Description: City, ST, Zip: 2 -11,*. YL N qq Telephone: 76 U — L — 3 31Purno0e*-),�11j�'k,,- State Lic. #: City Lic. C�, 11-eillev 10 Af, I Arch., EaV., Designer to Lo h e rnernii'dr- Address: City, ST, Zip: 2b� h� R2 I a c r f J980,0tA, c4 Telephone: State Lic. #: Construction Type. cy: I Project type (circle one): New Add'nAlter Repair Demo S. Ft: #Stos:w # Units: i Name of Contact Person: O Telephone # of Contact Person: 7A n —,L9 6 — 3 31 Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS UNE o 0 # Submittal Req'd Recd TRACKING PERMIT FEES Plan Set Plan Cheek submitted ,� Itan Amoaat Structural Ales.+ Reviewed, ready for corrections Plan Check Deposit Truss Cales. i Called Contact Person Plan Cheek Balance Mile 24 CsIcL Plans picked up • Construction Flood plain plan Plans resubmitted Mechanical �--� Grading pian 2'! Review, ready for correctioas/iaue Electrical j3 b?�� Subcontaetor Ust Grant DeedPlans Called Contact Person picked up Plumbing MIL 103 yam. . H.O.A. Approval Plans resubmitted Grading IN HOUSE:- ''' Review, ready for correctionsAwne Developer impact Fee Planning Approval Called Contact Person A.LP.P. Pub. Wks. Appr Date of permit issue e� School Fee: Total Permit Fen 29 R -A t 0. t 1 ' qrl ;! I L#=3 / I P.O. Box 1504. LA QUINTA, CALIFORNIA -92247-1504 78-495 CALLE TAMPICo LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT (760) 777-7012 FAX (760) 777-7011 PR- OPR 01' S ACIAG .. Disclosures & Forms for Owner-Bnff¢ers App lying for Construction Perm is AMMMATI NOT Dear Property Owner. .Ari. application.for -a. budding permit bas bees submitted your Wing yoursetf as the bof the .pmperty -improvements specified at L 0° hZ . Z 2 S Me are providing you wtith an Owner- .udder Ackna vladgcrreat and 'On Vet�eativn.Forns toy nWm your awam of your des and passible risk you may incur by having thispermitissa®d.in your name as the Owner -Builder. We wM not issue a building -permit until you have read, hiNded your undmteading of each. -Provision, signed, and returned this form to as at our ofQeial address indicated. An agent of the owner cannot execate "—Motice unless You, the Property owner, obtain the prior approval of the permitting authority. 0 3 AiCKNOWLE ('ftUM AM -VTnn1kV-AVFnW:nV Read aradkkiat o=h. statement Mew W signify you aiz!Wsraad'orday this h#brmadm . 4V4'understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder" Permit that erroneously implies that the property owner is providing his. or her own labor and wMerial phi. I, as an Owner -Builder, may be held liable and subject to serious. financial ciskfor any injuries sustained by an urilioeused person and his or her employees while working on my property. My homeowner's insurance may not provide covet'age for those injuries. I am willfully acting as.anOwuer-Builder and am aware o€file limits of my insurance coverage for in to workers on my property understand building permits are not required to be signed by property owners unless they are responsible for the etion acid are not.hiring a Licensed Contractor to. _assume this responsibility. '`understand as an "Owner -Builder" I am the responsible:party of record ori the permit. I understand that I may protect from potential financial risk by hirin_g_a_licensed Contras fhe permit filed in his or her name instead of my own. ``ug -Pe understand Contractors are required by law to be licensed and bonded in California and to list their licepse numbers on is and contracts. ftimnderstand if I employ or otherwise engage any persons; other than California licensed Contractors, and the total value y_�Connstruction is at least five hundred dollars' ($500), including labor and materials, I may be considered an "employer" under state and.federal law. t understand if I am considered an "employer" under state and federal law, I must register with .the state . and federal overnment, withhold payroll taxes,. provide workers' compensation disability insurance, and' contribute to unetm cloyment compensation for each "employee." I also understand my failure to abide by these laws may subject me- to serious financial risk understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential 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. I understand as an Owner -Builder if I.sell the property for which this permit is issued, I may be held liable for any uncial or personal, ituriea tined by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. FaI may obtain more information regarding my obligations as an "employe" front the taWrnal Revenue e oe, the United States Small Business Administration, the California Department of..Benefit Payment, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1- 800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. 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: agree that, as the party. legally and Wmacially responsible for this proposed. construction activity, .1 will abide by all pplicabte taws and tegirireimtits that govern Owner -Builders as well at employers. agree to notify the issuer of this form immediately of any additions; deletions, br ci9 to, any of the in�oh I ve provided on this form. Licensed contractors are regulated by taws designed to protect the public. If you contract with ,someone who. does not have a lieenw, the Contractors' State Lioprtse Board may be unable to-assM`yoq with any iina=W loss you may sustain as a result of a coMplaint.. Your only remedy against unlicensed Contractors may be itivivil court- It is also .impJmpomo for. you tan inderstand "if sa unliee ssed Contractor of employee of that individual of fbw is work w�iag on your property, you may be held Kaf"rle fos damages. If you -obtain a permit as Owner -Builder and wish to hire Corfaaastors, You will be .resporisUo fvr vwWyire v4tedw of not those Cont€actom are praopedy Iteesnsed and tine stator of iheii wo&efs' compea S"I t iusurmroe voverage. 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 issalttg,-tha:pwmtt, Now A copy of dw p vperoroo?# W's 4*a;'s*w0vi fam rut nv or other verification aw4t4k to theagency Fs mquired to be presented whentide pqis i to. uMjj► the popery owner's signature. . Signatuae of property owner Date.�. �. Note: The following Authorization Form is. required to be comp et the property owner only when designating an agent of the property owner to applyfor a construction permit for the Owner -Builder. Excluding the Notice to Property Owner, .the exec phon of which I understand is nay personal res o€rsibility, I hereby authorize the fallowing pemon(s} to act as my agent(s) to apply for, sign,. and fife the docurue nts f. to obWn ars Ownea-Builder Penrut. for wy-grojsct— Scope of Construction Project (or Description of Work): Project Location or Address: Name of rAuthorized Agent: Address of Authorized Agent: Tel No I declare under penalty of perjurythat 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 ofthe owner's driver's license, form irotaxiaation, or other ver tcation 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: CITY OF LA.QOINTA BUILDING & SAFETY D K. APPROVED e- - - FOR CONSTRUCTION ic - • . ' DATE :� dw mob co ct wad • -- �. I I yY14 20 ., t IE 16 43 ' _..L e • SLA® !.i • aa, opt. I 44 - �; REMOVE 't FOR 017. CART i CITY OF LA QUINTA BUILDINO & SAFETY DEPT. . FOR CONSTRUCTION r W DATEmm h ` 1 �► 1 44 wa �'� roo m J y , _ Li u . , �� , - ' it 3 • �. .. - •. .A,:2 f1A8 Tjyy t SiAF] Ei@muOJ % 4 ' ' TA3FO . . 95T8A.M. MOOR M0011036 CITY OF LA QUINTA A BUILDING &`SAFETY DEPT. " ' �Y""3 APPROVED-, MOOR FOR CONSTRUCTION DATE B 5a a 1 P. A r �r i '* ofov'%'P. tv 4t ff it • . b , �� ��