14-0478 (AR)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
c&t!t 4 4 Q"
Application Number:14-0
0000478^ ]
Property Address:
79"527—DANDELION DR
APN:
604-453-006-5 -29623 -
Application description:
ADDITION - RESIDENTIAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
9513
Applicant: Architect or Engineer:
o�� / &,� K*
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
---------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with .
Section 7000) of Division 3 of the Business and'Professionals Code, and my License is in full force and effect.
License Class: License 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 sighed 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 (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.).
(_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business andProfessionsCode: 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.).
(_ 1 I am exempt under Sec. , BAP.C. for this reason
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/22/14
Owner:
TINGZHI WILLIANS
79-527 DANDELION DR.
LA -QUINTA CA 92253
LA QUINTA, CA 92253
Contractor: !A �� r�
Owner N n ^'
f_
ctrrQ,Cr.,a
------------------
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
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 woorrkkkerrs'''compensation provisions of Section
3700 of the labor Code, I shall forthwith mply with th/ provisions.
t--'
APPl
Date:_ f _ic�a5 /)
WARNING: AILURE TO SECURE WORKER COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PE ALTIES 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 construction, and hereby authorize representatives
of this county to enSer upon the above-mentioned property for inspection purposes.
Date: ���1101_ `Signature (Applicant oAgent): t
J
LQPERMIT
Application Number . . . . . 14-00000478
Permit ROOM ADDITION 2013
Additional desc .
Permit Fee . . . . 181.61 Plan Check Fee
.00
Issue Date Valuation
0
Expiration Date 10/19/14
Qty Unit Charge Per
Extension
1.00 120.1200 LS MISC ROOM ADDN, 1ST 100 SF
120.12
1.00` 61.4900 EA MISC ROOM ADDN, ADDL 500 SF
----------------------------------------------------------------------------
61.49
Permit . ... ELECTRICAL 2013
Additional desc .
Permit Fee . . . . 23.83 Plan Check Fee ..
y _.00
Issue Date . . . . Valuation
0
Expiration Date 10/19/14
Qty Unit Charge Per
Extension
1.00 23.8300 LS ELEC FIXTURES, FIRST 20
----------------------------------------------•-------------------------------
23.83
Permit . . . MECHANICAL 2013
Additional desc .
Permit Fee . . . . 11.92 Plan Check Fee
.00
Issue Date . . . . Valuation . . .
. 0
Expiration Date 10/19/14
Qty Unit Charge Per
Extension
1.00 11.9200 EA MECH APPL REP/ALT
11.92
----------------------------------------------------------------------------
Special Notes and Comments
CONVERT 3RD. GARAGE TO A/C OFFICE.
April 22, 2014 8:48:35 AM jjohnson.
-=---------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
-----------
1.00.
PLAN CHECK, ELECTRICAL
23.83
PLAN CHECK, ROOM ADDITION
185.90
PLAN CHECK, MECHANICAL
4.77
STRONG MOTION (SMI) - RES
.95,
Fee summary Charged Paid Credited
---------- --- - ----------
Due
- -----
----------------- ----------
Permit Fee Total 217.36 .00 .00
217.36
Plan Check Total .00 .00 .00
.00
Other Fee Total 216.45 .00 .00
216.45
Grand Total 433.81 .00 .00
433.81
LQPERMIT
Residential Addition 500 Sq Feet or Less
EXEMPT
This certifies that school facility fees imposed pursuant to
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $0.00 X 253 S.F. or $0.00 have been paid for the property listed above and that
building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued.
Fees Paid By Exempt - Tingzhi Williams Check No.
Bank Name/Recipient of Certificate Telephone 760-774-1028
Funding Exempt
By Dr. Gary Rutherf rd
Superintendent
Fee collected /exem e y Sha c ey Payment Recd
Offer/.Und;�r 1-
Signature
NOTICE: Purs nt to Government Code Sectio 020(d)(1), th' will erve to notify you that the 90 -day approval period in which you may protest the fees
or other payment identified above will begin to run from the date ich the building or installation permit for this project is issued, or from the date on
which those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID without embossed seal
Embossed Original - Building Department Applicant Copy - Applicant/Receipt Copy - Accounting
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District o��tsc�o
47950 Dune Palms Road ¢ BERMUDA DUNES
Date 4/22/14
1) RANCHO MIRAGE
La Quinta, CA 92253 %�A INDIAN WELLS r
No. 32061
M
PALERT
(760) 771-8515 `yam
�QIN0
SO
0
Owner Tingzhi Williams
APN # 604-453-006
Address 79527 Dandelion Dr
Jurisdiction La Quinta
City La Quinta Zip
Permit #
Tract #
No. of Units 1
Type Residential Addition
Lot # No. Street
S.F. Lot # No. Street S.F.
Unit 1 79527 Dandelion Dr
253 Unit 6
Unit 2
Unit 7
Unit 3
Unit 8
Unit 4
Unit 9 9
Unit 5
Unit 10
qN�
Comments Convert 3rd Car Garage to Office `�
�v 14
MAY
At the present time, the Desert Sands Unified School District does not collect fees on garage �f >�✓ atios/walkways, residential additions under
500 square feet, detached accessory structures (spaces that do not contain facilities for living, sleepin ,�i6ting or sanitation) or replacement mobile
Su
homes. It has been determined that the above-named
owner is exempt from paying school fees at this timollowing reason:
Residential Addition 500 Sq Feet or Less
EXEMPT
This certifies that school facility fees imposed pursuant to
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $0.00 X 253 S.F. or $0.00 have been paid for the property listed above and that
building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued.
Fees Paid By Exempt - Tingzhi Williams Check No.
Bank Name/Recipient of Certificate Telephone 760-774-1028
Funding Exempt
By Dr. Gary Rutherf rd
Superintendent
Fee collected /exem e y Sha c ey Payment Recd
Offer/.Und;�r 1-
Signature
NOTICE: Purs nt to Government Code Sectio 020(d)(1), th' will erve to notify you that the 90 -day approval period in which you may protest the fees
or other payment identified above will begin to run from the date ich the building or installation permit for this project is issued, or from the date on
which those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID without embossed seal
Embossed Original - Building Department Applicant Copy - Applicant/Receipt Copy - Accounting
P.O. BOX 1504
LA QUINTA, CALIFORNIA 92247-1504 BUILDING &SAFETY DEPARTMENT
78-495 CALLE TAMPICO. , (76'0) 777-7012
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011
IP1W ERTY OWNER'S PACKAGE
Disclosures &Forms for Owner -Builders Ap:pl`yiug for Co>astructio.a. Permii
1 �(NT! l�IC1T)[CE TO )PROE�TX 0�4'NEIt
Dear Property Owner
An. application- for ,a buildingg permit has been Ubmi in your name listing` yourself 'as° -the builder of thc'pt+operty
improvements spocified At m . _. ?2 , 3
We am providing youvwidr an Owner- uilAi r Acknowledgement -and Infos nation-Veriflcatioa Form to make you aware of your
responsibilities and possible risk you may .incur by haiving1his'permit isv.W'iwyour mine"as the
Owwr Builder. 'We wiUl not.issue-a buildlag:peermit until;you-hive read; initialed your. undarsfandirig of eack'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.
ll�xZil►}n�u�c A/�!7I. AT!•1.iSJY:'*7T/`lt�7Tvnn �..ilt�:t.ir'tirinr� .....r.��: �.r� i�',t��a�:r;'i iewriliil .: - .
Read ate€ ini[lal each'stalenrent belov'!o signify you iiiiiferstand or verify this imfbiiiaMon.
a� 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. I, 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 forinjuries to workers
'on my, property
I�W 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..
1 �w 3- I 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 naive 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
permits and contracts.
V�L5. 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 "employer"
under state and federal law.
6. I understand if I am considered an "employer" understate. 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. o
I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential
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.
rY
(J 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
financial or personal,uljaries sus4ained..by any subsequent owner(S) that"result from any latent construction defects in the
worlananship or materials.
-liq VX
9. I understand I may obtain more information regarding my obligations as an "employee' from the Intenial 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 (CSLB)'at 1-
800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors.'
�� V v 10. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I arra the
party legally and financially responsible . for proposed construction activity at the following address:
I a9.= that, as .the patty legally and ftnaucially responsible for this proposed, construction activity,.1 will abide by all
applicable laws and requirements that govern Over er-Builders as well a§ employers.
12. I agree to notify the issuer of this form immediately of any.additions; 'deletions, or changes to any of the-infornAtioit 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 •haive a license,. die Contractors' State. License.Boardraray.be unable to assistA5eu-urtlasy-ftrinarial loss .
you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be inlavitcourt :it is also
important for .you to: understand. that: if an unlicamdd Contractor or eaiployce.of that individual or firm is injured'while-.woddng
on your property; you maybe held liable. for damages..If you obtain a permit, as .Owner -Builder and wish to hire:Contraetors,
you. -wiIl•-be.responsrble for.: verifying. whomgr not those Contractors are pmpcdy licensed,and.the status of..their. workers'
compensation insuranoe.eoverage.
Before it building permit can be issued, this form must be completed and signed by the property owner and returned to
the agency responsible for,issu.hk t ►c;- ermi - Nola: A copy ojticeproperYy,owner's driver'sAbewset forrn,nvta nr- or
other verification acceptable M. Ae agency is iegrt' Id to .be prese ited when the: permit is, issued ;o rerijy:tfie'prop"
... .
owner's signature. i
Signature of property owner '�/ /i/ �(/ �� Date: `� l
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 ACTON 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 pe 6(9) io act as'myageit(s) to apply for, sign, and file the documents necessary io.obtairi an Owner -Builder
Permit for my project
Scope of Construction Project (or Description of Work):
Project Location or Address:
Name of (kuthorized 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 bepresented when the permit is issued to verify the property owner's signature.
Property Owner's Signature: Date:
SUNFLOWER MAINTENANCE ASSOCIATION
do J. & W. Management Co.
P.O. Box 1398
Palm Desert, CA 92261
(760) 568-0349
April 22, 2014
Tingzhi Williams
79-527 Dandelion Dr.,
La Quinta, CA 92253
Dear Ms Williams:
Please be advised the Architectural Review Committee of Sunflower Mainteance Association has
approved your request for the installation of a Garage Conversion at your property at 79-527 Dandelion
Way, La Quinta, CA 92253
This approval should not be considered a building permit. All necessary approvals and permits must be
obtained from the City of Palm Desert Building & Safety Department before any construction begins. All
rules and regulations pertaining to construction must be adhered to during course of construction.
If you have any questions, please call me.
Sincerely
SUNFLOWE"TENANCE ASSOCIATION
Jim
!'M
ager
Rrk WO
APR 2 3 2.014
CM OF LA QyINTA
COMMUNM DEVELOPMENT
♦ � t
Bin #
City of La Q uin to
Building &r Safety Division
Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #P.O.
d ' r
Project Address: K� '
40wneisN 7111, q Z
A. P. Number:
Ad"dress: 7
Legal Description:
(City; ST, p u u M
Contractor:
c<<s``>
T lcphone.J
Address: til✓ i u G1
—Proje`cfDescription:
City, ST, Zip:
C ? Q. (, f A �.
Telephone,
To o ` —I (- S85 C
State Lic. # :
City Lie. #c
Arch., Engr., Designer:
Address:
City., ST, Zip: .
Telephone:
............:.........................................
Construction Type: Occupancy:
State Lic. #'
Project one):: New Add'n Alter Repairair Demo
N„ ame of.Contact.Person:
2
Units:
Telephone # of Contact:Person:
stimated Value of Projcct: ! 000
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss C21eS.
Called Contact Person
Plan Check Balance.
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
god Review, ready for correction/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
II.O.A, Approval
Plans resubmitted
Grading
IN IiOUSE:-
'"' Review, ready for correctionsCssue
Developer Impact e
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
IF i �i \ agim
�
.
CITY OF LA QUINTA S 613 -CONTRACTOR LIST
JOB ADDRESS 7 Es -,7 , ?1017d'ellp PERMIT NUMBER OWNER .'141-1 ~�0R At? /14/,/-Z 16w-1
~ '_-_
014,114
This form shall be posted on the job with the Building Inspection Card at all times in a cons6icuous place. O4persons appearing onthis list ortheir employees are/uthonzadtowork
on this 'ob. Any changes to this list must be approved by the Building Division prior to oonnrhanobrnent of work. Failure to comply will result in a stoppage of work and/or the voidance
of building itFor h applicable trade, U information be completed by applicant. "On File" is not an acceptable response.