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10-0029 (ELEC)(;&4t 4 Qumm P.O. BOX 1504 VOICE (760) 777-7012 .78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT O Date: 1/12/10 Application Number: .-10=00000029 ?: Owner: Property Address: 52770 AVENIDA VILLA KOCHELL STEVE M J� \ APN: 773-334-001-26 -000000- P O BOX 882 Application description: ELECTRICAL LA QUINTA, CA 922 Property Zoning: COVE RESIDENTIAL-----------------�� Application valuation: 200 t, Contractor: :���t���� v Applicant: Architect or Engineer: Owner / `) IPir --------------------------------- -------------------------------------------------- LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that 1 am licensed under provisions of.Chapter9 (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 doesnot 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 thatheor 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 _1 'I am exempt under Sec. B.&P.CZfor this reason 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: - r, LQPERMIT 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 I should become subject to the workers' compensation provisions of Section 3700 of th abor Code, I shall forthwith comply with those provisions. te:, u , pplicant:. S WARNING: -FAIL RE 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 unty to enter upon the bove-mentioned property for inspection purposes.' ; te•.,� Si ure (Applicant or Agent): Application Number . . ... . 10-00000029 Permit ELEC-SERVICE CHANGE .Additional.desc _. Permit Fee -33.50 Plan Check Fee.." 00 Issue'Date Valuation 0 ' Expiration Date 7/11/10 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 18.5000 EA ELEC SVC <=600V/<=200A 18.50 ---------------------------------------------------------------------------- Special Notes and Comments. CHANGE OUT E -PANEL FROM 100 AMP TO 200 AMP SERVICE: 2007 CODES ---------------------------------------------------------------------------- Other Fees. . . . . . . . . . BLDG STDS ADMIN (SB1473). 1.00 Fee summary -,Charged Paid Credited Due ----------- - Permit Fee Total. 33.50 .00 .00 31.50 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 P.O. BOX 1504 LA QUINTA; CALIFORNIA 92247-1504', 78-495 CALLE TAMPt.CO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT PROPERTY OWNE R �q -PAI-1, (760) 777-7012. FAX (760) 777-7011 Disclosures�G� • &Forms for Owner -Builders A _ Po W,T, AP[Ying for Co>�struction Permits Dear Pro NOTXC petty Owner. O R ERTY .OWNER An: application-..fof.a building Permit has been submitted in We are Prvvid� specified at Your name listing g You with an Owner_Builder Aclrnowled Yourself as the builder of the responsibilities and PrOPenY Owner -Builder. Possible risk you may incur b gment and Information Verification Form to make You aware We mill not issue a building y haying this ~signed, and return Permit•issued in your name as'the Y are of your ed this form to us at our (ficial address unless you, the You'have read, initialed Property °Wner, obtain the indicated, Ana Your understanding of each provision, Prior approval of the permitting authorityt of the owner cannot execute this notice OWMER'S AC"O.W DfRECTlON : MENT AND VE.: 1 S Read and initial each statement below to CATION QE INFQ.)MATION I understand a rIYYou understand or verify this injor nQnon. building permit that erronequent practice of unlicensed eO l)'implies that persons is to have the property owner obtain an an Owner Builder the Property owner is providing his or her own labor and and his or here > may held liable and subject to serious financial risk for an re Owner -Builder injuries. I II7Ployees while working on m material Personally. 1, as arrr willfully acting as an O y Property. M. Y juries sustained by an unlicensed oln my Property. Owner -Builder Y homeowner's insurance may person and am aware of the limits of my insurance overage for injuries to workers �/ coverage for those 1• I the build' eons ction and are g Pe�'ts are not required to be signed / not hiring a licensed Contractor to b Fume this responsibility,.y Property owners unless they are respo,�sible for the I 1 understand rriyself from as an "Owner -Builder" I am the potential financial risk b responsible Party of record on the permit. I understand y hiring a licensed Contractor and having the a that I may protect permit filed in his or her name instead of my Pe�understand Contractors are required by haw to and contracts: be licensed and bonded in California and to list their understand if I em err license numbers on of my construction is at le Ploy or otherwise engage least five hundred doll y Persons, other than California licensed Contractors, and the total value un�r state and federal law. ($500), including labor and materials, h may be considered an "employer" understand if I am considered an " • gov�rnmenf, withhold payroll taxes, employer' under state and federal law I coo =pen�.sation for each "emp10 eC_„ Provide Workers' compensation disability i urmus fegister with the state and federal Tisk- Y I also understand my failure to abide by these laws e, and contribute to unemployment Y subject me to serous financial 7.1 understand under ctures ca California Contractors' State License S lrcmntractorsnot legally build them with the intent to Law, an Owner -Builder who builds single-family residential su and the number of s offer them for sale, unless all work is performed b under- contract with a lice structures does not exceed four within any calendar rased general building Contractor. Year, or all of the work is Y licensed • performed � 8. 1 understand as an Owner -Builder if I sell the property for which this permit is issued, *1 may be held liable for any financial or personal. avuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. /9. 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 (CS LB) at 1- 800- 1-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. 10. 1 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: 11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applica a laws and requirements that govern Owner -Builders as well as employers. 12.1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information 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 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 issuitig.the. permit Note: A copy of the property 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. Signature of property owner _,5'Z— kw,:e� Date: %_1.2 -10 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 agents) 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: Bin # City, Of %a. 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 # D i Project Address: l> Owner's Name: l U _ _c G A. P. Number: / l Address: 5 -71-2 �fL (/ Legal Description: City, ST, Zip:L �z Contractor: -Telephone: 51, Address: Project Description: City, ST, Zip: Telephone: State Lic. # ; City Lic. Arch., Engr., Designer Address: City., ST, Zip: Telephone: : �.�a:: f fi• s_f {'.»s -� �„?h. Construction Type: Occupancy: Project type (circle one): New Add'n. Alter Repair Demo Sq. Ft.: # Stories: #Units: State Lic. #: Name of Contact Person: Tele : Telephone # of Contact Person: P Estimated Value of Project: � �. 6U - � APPLICANT: DO NOT WRITE BELOW THIS LINE N Submittal Req'd Rec'd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amonnt Structural Calcs. Reviewed, ready for corrections Pian Cimck Deposit Truss Calcs. Called Contact Person Plan Check Balance Title 24 Calcs. Plans picked up Constriction Flood plain plan Plans resubmitted Mechanical Grading plan 2" Review, ready for correction0issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- ''' Review, ready for correctionstiissue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. - Pub. Wks. Appr Date of permit issue School Fees Total _Permit Fees A)