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10-0010 (ELEC)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: ' Application description Property Zoning: Application valuation: Brio -000000 o -' 46645 WASHINGTON ST 643-182'-014-71 –2117 – ELECTRICAL LOW DENSITY RESIDENTIAL 750 4 Qum VOICE (760) 777-7012 FAX (760) 777-7011 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT D 1/05/10 - Owner: MARTIN NORIEGA J 46645 WASHINGTON STREET JAM r i LA QUINTA, CA 92253 ----------------------------C�,�� r�fl!at� JUfiVrA V x, --––––––-––––––––––––––––––––––––––––––––-–––– LICENSED CONTRACTOR'S DECLARATION - - WORKER'S COMPENSATION DECLARATION_ I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter'9 (commencing with I hereby affirm under penalty of perjury one of the following declarations: v - Section 70001 of Division 3 of the Business and Professionals Code, and my License is in full force and effect. —.1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided License Class: License No.: ,. for by Section 3700 of the Labor Code,for the performance of the work for which this permit is - .. issued. .. Date: Contractor: - _ .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 OWNER -BUILDER DECLARATION . • - insurance carrier, and policy number are: I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier Policy Number following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to c=at, in the performance of the work for which this permit is issued, I shall not employ any .- construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the -. person in any manner so as to become subject to the workers', compensation laws of California, permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State -- and agree that, if I .should become subject to the workers' compensation provisions of Section License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3700 of the Labor Code, I shall forthwith comply with those provisions. that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by Ol OS Ip anyppplicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:te: • (�[) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and plicant: ". -- , -� the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAG S LAWFUL, AND SHALL Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED. THOUSAND . and who does the work himself or herself through his or her own employees, provided that the DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. 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.). APPLICANT ACKNOWLEDGEMENT (_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application. r property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed 1. Each person upon whose behalf this application is made, each person at whose request and for .pursuant to the Contractors' State License Law.l• whose benefit work is performed under or pursuant to any permit issued as a result of this application, (_ 1 1 am exempt under Sec. , B.&P.C. for this reason 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. ate: O 1 O 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 CONSTRUCTION LENDING AGENCY permit to cancellation. I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify that I have read this application and state that the above information is correct. I agree to comply with all work for which this permit is issued (Sec. 3097, Civ. C.). city and county ordinances and state laws relating to building construction, and hereby authorize representatives • of t ' county to enter upon a above-mentioned property for inspection purposes. Lender's Name: ' Date: of OS I gnature (Applicant or Agent): Lender's Address: LQPERMIT Application Number . . . . . 10-00000010. Permit . . . ELEC-SERVICE CHANGE Additional desc . Permit Fee . . . . 33.50 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 0 Expiration Date 7/04/10 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 18.5000 EA ELEC SVC <=600V/<=200A 18.50 -- - - ------ Special Notes and Comments UPGRADE EXISTING 50 AMP PANEL TO 200 AMP PANEL. -------------------_-------------------------------------------------- Other Fees . . . . . .' BLDG STDS ADMIN (SB1473) ------ 1.00 Fee summary Charged Paid Credited Due Permit Fee Total 33:50 00 :00 33.50 Plan Check Total .00 .00 .00 .00 Other Fee Total 1.00 •.00 .00 1.00 Grand'Total 34.50 .00 .00 34.50 . LQPERMIT I' p P•O. BOX 1504 LA QUINTA CALIFORNIA 92247-1504. 78-495 CALLE TAMPICO BUILDING & SAFETY DEPARTMENT LA QUINTA, CALIFORNIA 92253 (7'60) 777-7012 FAX (760) 777-701 ROPERTy �;,NER, Disclosures & S rACj�AG , Forms for. owner -Builders A PPjYing for Construction Permits . Dear Pm OSCE ..O RR ERTY .O WNEE Perty Owner. An. appLcation—for-.a buildin 'improvements g Permit has been submitted in specified at your. n We are providing you with an Q' S W AS N I N TON . Sr. name Iistin LA Qut NTA hyo��5 s the builder of the property weer_ uil es and Owner -Builder Acknowled owner B possible risk you gment and Information Ve 3 wilder. We Y incur by having nfication Forret to make you aware of your signed, �il1 not issue a buildin .. ilds'. rmit-issued g ,and returned this form, to , g permit until m your Warne as the unless you, the grope us. at- our�official.addr ou -have read, initialed your understanding of Property owner, obtain the ess indicated. An agent of the owner cannot execute erosion, prior approval of the permitting authority. ' 0-"E �'S this notice ACINWLEDG . DfRECTlONS: Read and � MEN')(' A1�iD cnitia! V—ER—M O eac/r stateme»t below tv siO MAON understand a gn 'You understand or veriA tyu iR jo anon. buildingfrequent practice of unlicensed Permit that erroneouslyimp Persons is "to have the an Owner -Builder lies that the property owner -isproviding his oP op own labor and to an « and his or here > may held liable and subject to serious financial risk for an iOwner-Bwlder" inJ�ies. I am �yees while working on my property. material personauy..i, as on my progas an Owner -Builder My hom�wner's imsuran�msustained by an unlicensed person willfully actin � y and am awe Of the limits of rayi. Y not provide coverage for those in coverage for injuries to workers understand building construction and are permits are not required to be Signed b . Y Property owners unless they are responsible for the understand assume this respons„bility.. myself from l an "Owner -Builder” I am the re Potential financial risk by hiring s onsible.Partyof record on the e °�` g a licensed Con Permit_ I tractor and having understand that I may protect g me Permit tied in his or her name instead of my xrait I understand Contractors permits and contracts. are required by law to be licens ed and bonded in California and to list their license numbers on /�5. I understand if I employ °f my construction is at or otherwise engage an east five hundred doll Y Persons, other than California Licensed Contractors, and the total value under state and federal law. �s ($500), including labor and materials, I may be considered 6 I understand if I ran "employer" v'ernment airs considered an " g° , if payroll taxes employee, under state and federal law, I isk. ensation for each "employee.;, ' Provide workers' compensation disability ins must register with the state and federal . nskI also understand my failure to abide by theses ace, and contribute to unemployment Y subject me to serious financial understand under California , SUucttures cannot .le Contractors State License subcontractors and gaily build them Law, an Owner -Builder who builds single-family residential me number of s� the intent to offer them for sale under contract with a licensed tructure, does not exceed four within any calendar yelar, or general building Performed by licensed g Contractor. the work is . performed 'j, . %, "418. 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. botuies sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. r!'!**? 9. I understand I may obtain more information regarding my obligations as an ,employee, 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 (CSLB) at 1- 800-321-CSLB (2752) or www_csib.ca.gov for more information about licensed contractors. 10. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the following address: 4�5 wraS N iN s7-: t Qv r �. cP: X22 S'S X11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner -Builders as well as employers. n?�'A 2. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information 1 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'civil 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'slicense, form notarmadvn; 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: O 1 S / 1 a 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, l hereby authorize the following person(s) to act asmy agent(s) to apply for, sign, and file the documents necessaryto 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: Bin # City of La Quinta Building 8L Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # \ Project Address: +6&45 W90 taToN St L Wtk)rA 92253 Owner's Name: Mqr}'% A N o f c o. A. P. Number: Estimated Value of Project: 1 S O Address: 46645 W 0,% V.0 S� 'Legal Description: Rec'd City, ST, Zip: Lo. CX 1225-1 Contractor: p . . t3 � 'Telephone: '�''`'�°`'��:��°x: � ���..;;���:�: Address: Item Amount Project Description: City, ST, Zip: _ uP4!►sa�� �.t �e.. a �n Sr�wo Telephone: State Lie. # Arch., Engr., Designer. Address: City, ST, Zip: Telephone: State Lie. #: Name of Contact Person: Telephone # of Contact Person: # Submittal Plan Sets Structural Calcs. Truss Caics. Title 24 Cales. Flood plain plan Grading plan Subcontactor List Grant Deed H.O.A. Approval IN HOUSE: - Planning Approval Pub. Wks. Appr School Fees Lie. #.: Ser 0 Total Permit Fees ,s . �f4,�/ -911i Construction Type: Occupancy: Project circle one : New Add'n Alter Repair Demo j `J )e Sq. Ft.: # Stories: # Units: P11,11 {T 1 ;:: 7t {Z % '• Estimated Value of Project: 1 S O APPLICANT: DO NOT WRITE BELOW THIS LINE I'd Rec'd TRACMG PERMIT FEES Pian Check submitted Item Amount Reviewed, ready for corrections Plan Check Deposit Called Contact Person I' Plan Check Balance Plans picked up Construction ' Plans resubmitted Mechanical 2" Review, ready for correction&/issue Electrical Called Contact Person Plumbing Plans picked up S.M.I. Plans resubmitted Grading Review, ready for correctionstiissue Developer Impact Fee Called Contact Person A.LP.P. Date of permit issue Total Permit Fees ,s .