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09-0153 (RER)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Tiht4'4Q" Application Number: 09-00000153 Property Address: 54235 AVENIDA DIAZ APN: 774-194-024-12 -000000- Application description: REMODEL - RESIDENTIAL Property Zoning: COVE RESIDENTIAL Application valuation: 15000 Applicant: Architect or Engineer: 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 fSec. 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 70001 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 ) 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.). (_ I I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (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 contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). ( ) I am exempt under Sec. , B.&P.C. for this reason Date: �O OG Owner: CONSTRUCTION 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: LQPERMIT Owner: BARBARA KLEIN 54235 AVENIDA DIAZ LA QUINTA, CA 92253 Contractor: Owner VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 4/16/09 ----------------------------------------------- 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 1 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, 1 shall forthwith comply with those provisions. Date: Applicant: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION 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. 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 enter upon the above-mentioned property fo inspection urposes. Date: Signature (Applicant or Agent): Application Number . . . . . 09-00000153 ------ Structure Information REMODEL TO ENTIRE RESIDENCE/VB/RES-3 ----- Other struct info . . . . CODE EDITION 2007CODES # BEDROOMS 2.00 --------------------------------------------------------------------------=- Permit. . . BUILDING PERMIT Additional desc . . Permit Fee . . . . 162.00 Plan Check Fee 105.30 Issue Date . . . . Valuation . . . . 15000 Expiration Date . . 10/13/09 Qty Unit Charge Per Extension BASE FEE 45.00 13.00 ---------------------------------------------------------------------------- 9.0000 THOU BLDG 2,001-25,000 117.00 Permit . . . ELECT - ADD/ALT/REM Additional desc . Permit Fee . . . . 50.18 Plan Check Fee 12.55 Issue Date Valuation '. 0 Expiration Date 10/13/09 Qty Unit Charge Per Extension BASE FEE 15.00 1005.00 ----------------------=----------------------------------------------------- .0350 ELEC NEW RES - 1 OR 2 FAMILY 35.18 Permit . . . MECHANICAL Additional desc . . Permit Fee . . . . 39.00 Plan Check Fee 9.75 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 10/13/09 Qty Unit Charge Per Extension. BASE FEE 15.00 1.00 4.5000 EA MECH VENT INST/ DUCT ALT 4.50 2.00 6.5000 EA MECH VENT FAN 13.00 1.00 ---------------------------------------------------------------------------- 6.5000 EA MECH EXHAUST HOOD 6.50 Permit . . . PLUMBING Additional desc . Permit Fee . . . . 94.50 Plan Check Fee 23.63 Issue Date . . . . Valuation . . . . 0 Expiration Date 10/13/09 Qty Unit Charge Per Extension LQPERA11T r Application Number . . . . . 09-00000153 Permit . . . . . . PLUMBING Qty Unit Charge Per Extension BASE FEE 15.00 9.00 6.0000 EA PLB FIXTURE 54.00 1.00 15.0000 EA PLB BUILDING SEWER 15.00 1.00 7.5000 EA PLB WATER HEATER/VENT 7.50 1.00 3.0000 EA PLB WATER INST/ALT/REP 3.00 ---------------------------------------------------------------------------- Special Notes and Comments REMODEL TO ENTIRE RESIDENCE/VB/RES-3/CL A -FR [CONVENTIONAL) CONVERT EXISTING LAUNDRY TO 2ND BATHROOM BY RELOCATING LAUNDRY/WATER HEATING EQUIPMENT TO GARAGE. WINDOW REVISIONS AND ADDITIONAL LIGHTING FIXTURES THROUGHOUT RESIDENCE. THIS PERMIT DOES NOT INCLUDE ALTERATIONS TO THE HVAC SYSTEM OR ADDITIONS TO THE BUILDING OR CONDITIONED SPACE. 2007 CALIFORNIA BUILDING, MECHANICAL, ELECTRICAL, PLUMBING AND ENERGY CODES. April 16, 2009 10:37:03 AM AORTEGA ---------------------------------------------------------------------------- Other Fees . . . . . ... . BLDG STDS ADMIN (SB1473) 1.00 ENERGY REVIEW FEE 10.53 Fee summary Charged Paid Credited --------------------------------------------------------- Due Permit Fee Total 345.68 .00 .00 345.68 Plan Check Total 151.23 .00 .00 151.23 Other Fee Total 11.53 .00 .00 11.53 Grand Total 508.44 .00 .00 508.44 LQPERMIT Bin# City of La nuinta Building a Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # �,� G, 0 / Project Address: 54•,23 lAvenl.4Ja Owner's Name: A. P_ Number: •1 , 4'1 C1 4 0 -2,t* Address: i1 `"okc-A- 01 A- 7z - Lori 2 K z-5to Iv�Q o 1v 1 L U 0%q Legal Description: CC N (� T v f}l_i� ,d, Ci ST, Zi ty, p: LA- 0 V (v C' O z, L53 Contractor:- Telephone: - Address: Project Description: 1 QUsh Ar City, ST, Zip: P �A�li` '1'0 QY'A. Z) GoY�V�.c� et<I'S� Y► �A�hQ� Telephone: City Lic. #: 3, mown o IA " vs. m1� �a� ►� : 3 �d� State Lic. # : ,e�t`��� X Ib It ha0� 1V` 4 f-@ N1DVC' Ick 'AC t? Arch., Engr., Designer: `,\ V i broom W ; 5 Address: '1'ja1Y1 dOdr 5SI 2./ AIi12 2 �e-',5 it?I'V� City, ST, Zip: Telephone: State Lic. #: Name of Contact Person: 0 Q-e,Yivie. Qi2 act d In m mom Wf i'ldgo " AAA C w Construction Type: Occupancy: Project type (circle one): New Add'n Alter Repair Demo Sq. Ft.: k 00 2 # Stories: 1 # Units: Telephone # of Contact Person: Estimated Value of Project: 0 () C) , oo APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd- TRACKING PERMIT FEES Plan Sets Plan Check submitted b8 Item Amount Structural Cales. Reviewed, ready for corrections Plan Check Deposit Truss Cales. Called Contact Person Plan Check Balance Energy Calcs. Plans picked up a� Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2- Review, ready for o rec ' sfissue Electrical Subcontactor List Called Contact Person Plumling Grant Deed Plans picked ups S.M.I. H.O.A. Approval Plans resubiyri"tted o Grading IN HOUSE:- ''' Review, ready for correctio iss I Devel3per Impact Fee Planning Approval Called Contact Person A.I.PB. Pub. Wks. Appr Date of permit issue School Fees Tota, Permit Fees �`2 Zook . N6lope 2. A. �aa� • �°'"' (c _ �s i s A COACHELLA VALLEY WATER DISTRICT P.O. BOX 1058, COACHELLA, CALIFORNIA 92236 (760) 398-2651 INVOICE Date: 4/10/2009 SUBJECT: 54-235 AVENIDA DIAZ, LA QUINTA 606132,215.0.2 BARBARA KLEIN Project: 9-954 52-855 AVENIDA DIAZ Project Date: 4/10/2009 Amount Due: $3,995.00 LA QUINTA, CA 92253 GEO: 06-06-13-2 Planner: REBECCA MILWARD TO INSURE PROPER CREDIT, PLEASE RETURN THIS PORTION WITH REMITTANCE AND INCLUDE THE PROJECT ON YOUR CHECK 1.00 SCC -COLLECTION $1,658.00 $1,658.00 1.00 SCC -TREATMENT $2,337.00 $2,337.00 $3,995.00 APR 10 ZM COACHELLA VALLEY WATER DISTRICT SUBJECT: 54-235 AVENIDA DIAZ. LA QUINTA 606132,215.0.2 COACHELLA VALLEY WATER DISTRICT P.O. BOX 1058, COACHELLA, CALIFORNIA 92236 (760),398-2651, Pagel 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 IMPORTANT! NOTICE TO PROPERTY OWNER Dear Property Owner: An. application for a building ermit has been submitted in your name listing yourself as the builder of the .property improvements specified at 5 2 35 Aye.I, » Ok L la,, L G,, 0 u i'h%y._, We are providing you with an Owner -Builder Acknowledgment 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. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION DIRECTIONS: Read and initial each statement below to signify you understand or verify this information. 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 for injuries to workers on my property. pI understand building permits are not required to be signed by property owners unless they are responsible for the uction and are not hiring a licensed Contractor to assume this responsibility.I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect f from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my 4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on ermits and contracts. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value my construction is at least five hundred dollars ($500), including labor and materials, I. may be considered an "employer" under state and federal law. I understand if 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. kI understand under California Contractors' StateLicense Law, an Owner -Builder who builds single-family residential ctures 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 financial or personal. injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. . I understand I may obtain more information regarding my obligations as an "employer" 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 (CSL.B) at 1- JtO-121-CSLB B(2752) or www.cslb.ca.gov for more information about licensed contractors. 0.I am aware of and consent to an, Owner -Builder building permitapplied for in my name, and understand that I am the legally and financially responsible for proposed construction activity at the following address: 1. I agree that, as the party legally and financially responsible for this proposed construction activity, .I will abide by all ible laws and requirements that govern Owner=Builders as well as employers. Ta l2. I agree to notify the issuer of this form immediately of any additions; deletions, or changes to any of the information I ve 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 iwcivil 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 copy of the property owner's driver's.lkensei 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. Signature of property owner Date: 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: