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12-0080 (ELEC)P.O. BdX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 12-00000080 Property Address: 50775 EL DORADO DR APN: 777-290-014- - Application description: ELECTRICAL Property Zoning: LOW DENSITY' RESIDENTIAL Application valuation: 100 Applicant: Tuvl44Q" 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 (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 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.). (_ 1 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.). (_ 1 I am exempt under Sec. & , B.&P.C. for this reason Date: / �/ ner. 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: BICK MICHAEL D & SHARON VOICE (760) 777-7012 , FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 1/27/12 --------------------------------- F,r Q i Contractor: U Owner BAR ! E 2612 -------------------------- - WORKER'S COMPENSATION DECLARATION 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 1 should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith c thoserowsions. Date: ��� Applicant: Yg 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. ' 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 enter upon the above-mentioned pr rty for inspecti ,. Date: ( ��?��3lgnature (Applicant or Agent): Application Number . . . . . 12700000080 Permit . . . ELEC-MISCELLANEOUS Additional desc . Permit Fee . . . . 16.50 Plan Check Fee 4.13 Issue Date . . . . Valuation 0 Expiration Date 7/25/12 Qty Unit Charge Per Extension BASE FEE 15.00 2.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20 1.50 ---------------------------------------------------------------------------- Special Notes and Comments ELECTRICAL WIRES PULLED. THROUGH UNDERGROUND CONDUIT FROM GARAGE TO FEET TWO LIGHTS ON TOP OF NEW COURTYARD WALL. ---------------------------------------------------------------------------- Other.Fees . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary -- - - - - - - - - - - -- - -- Charged Paid Credited ---- - - - - ------ - - - - -- ---- - - - - ---- Due -- -_ - - - - Permit Fee Total 16.50 .00 .00 16.50 Plan Check Total 4.13 .00 .00 4.13 Other Fee Total 1.00 .00 .00 1.00' Grand Total 21.63 .00. .00 21.63 LQPERMIT CITY OF LA QUINTA BUILDING & SAFETY DEn. APPROVED FOR CONSTRUCTION _ DATE -off .2 BY 19 pr Q i .2 lop .w LL- i P.O. BOX 1504 ' LA QUINTA, .CALIFORNIA 92247-1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 PROPERTY OWNER'S PACKAGE (760) 777-7012 FAX (760) 777-7011 Disclosures & Forms for Owner -Builders Applying for Construction Permits P l .�lY'I1 I�IQTICE T() PRt7PRRTV OWI�TEIt Dear Property Owner .An. application for a building permit has been subttw m yo . name listing ��u�rs�el as the builder of the property impr�ovennents specified at Sa - 77 < r qc%ZA U-41" Vice are providing you with an Owner -Builder Acknowledgment -and Information Verification Fort- 6 make you awara:of your responsibilities and possible risk you may incur by having thispermit,issned in your name. as the Ovt M -Builder. We will not issue a building. permit until yeu have read, initialed your. understanding of each'providen, signed, and returned this form,te us at our official address indicated. An agent of the owner cannot execute tltis:notice unless you, the property owner, obtain the prior approval of the permitting authority. 0WNVWS Ae�:ED0WU AND 'uE CATION a) IIqWQRNAWN DIRRECITONS., head and kitial each statement-betow'-to signify you undsemwnd`or ver.�fy this inforrnation. t • 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 personaft. 1, as an Owner -Builder, may be held liable and subject to rious_f nmciaLrisk_foLamy 4uries_sustained_lzy_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- understand iny 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. _L'F u "nderstand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. --, 1 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. 0,6 I understand if I am considered an "employee, under.state and federal law,.1 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. " 7. 1 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. 8. I understand as an Owner-Buildev if °l sell the property for which this per it is issued; I.. may. be held liable for any . . financial. or personal. ines.sustained; by any subsequent owners) that result from any latent construction defects. in the . worlamanship.or materials Lt4li' understand'l may obtain, more information regarding: my obligations as an "employee, from the' Internal Revenu@ ';, 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= 800.32.1-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. 10 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the p legally and fnancially responsible . for proposed construction activity at the following address: (agree that, as the party legally and famacially responsible for this proposed construction activity,.I will abide by all applicable laws d requirements that govern Owner -Builders as well as employers. l � t agree to notifythe issuer of this form immediately of an additions;deletions,or, to. any of the information I Y Y 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'6vik court. It is also, important for you to: understand that if an urltimnsed.Contractor or employee of that individual or firm is Wured while working • on your property, you may be held liable for damages. If you obtain. a permit as Owner -Builder and wish to Dire Contractors, you will be responsrbio for verlij+iag whether or not those Contractors are property licensed and the status of their workers' compensation insurance coverages. 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 issaing.tw:p?ermit. Now A copy of the property owner's dciver.'s[ioertsei form noft*adan; or other verijrcation acceptable to the agency is required to be presented whenthe permit is issued toverify 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 BMW 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 ariOwner-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: ::. Crty. of La Qurnta Building &r Safety DevIsion P.O. Box 1504,'78-49S Calle Tampico La.Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Pe,intt # QQ U�.. Project Address: 2 �7 %!�— d(/ Owner's Name:. h1l l A. P. Number. Address: Legal Description: Contractor. City, ST, Zip: Z Z ' Telephone: Address: Project Description: City, ST, Zip: Telephone:1 -- . vC_ /` cC State Lic. # : City Lic, fR W Arch4 Engr., Designer. Address: City., ST, Zip: Telephone: Construction Type:. Occupancy: State Lie. #: Project type (circle one): New Add'n Alter Repair Demo R Name of Contact Person: c S9• Ft.:#Stories: #Units: Telephone # of Contact Person:Estimated Value of Project j/1-3 O APPLICANT: DO NOT WRITE BELOW THIS UNE N Submittal Req'd'Rec'd TRACKING PERMIT FEES Plan Sets PIan Check submitted Item Amount Structural Cafes. Reviewed, ready for corrections Plan Check Deposit. . Truss Cates. Called Contact Person Plan Check Balance• Title 24 Calcs. Plana picked up Construction Flood plain plan Pians resubmifted Mechanical Grading plan 2" Review, ready for correctionstissue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Pians picked up SALL ILO.A. Approval Plans resubmitted Grading IN MOUSE:- ''d Review; ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.LP.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees