12-0438 (ELEC)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 12-00000438
Property Address: 52811 AVENIDA VILLA
APN: 773-333-017-4 -000000-
Application description: ELECTRICAL
Property Zoning: COVE RESIDENTIAL
Application valuation: 450
Applicant:
Architect or Engineer:
4
BUILDING .& SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
SERGIO GARCIA
52811 AVENIDA VILLA
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/20/12
F"APR
Contractor:Owner 2 e3 2011
ISI"-----------------------�uINTa
FINANCE DEPT
-
-----------------------------------------------------------------------------------------------—
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 (5500).:
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 _ 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 Lic s Law.)
(_) I am exempt under Sec. , B.& .C. or this reason
Date:
Owner:
/ CONSTRUCTIO0 LENDING AGENCY
I hereby affirm under penalty of perjury tl�Kthere is a construction Tending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name: —
Lender's Address:
LQPERMIT
WORKER'S COMPENSATION DECLARATION
1 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 a to become subject to the workers' compensation laws of California,
and agree that, if 1 s ul ecome subject to the wor rs' compensation provisions of Section
3700 of the Labor C I shall forthwith comply hose provisions.
Date: Applica
WARNING: FAILURE TO SECUR ORKERS' OMPSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO IMINAL PENALTIES A IL 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 t ove information is correct. I agree to comply with all
city and county ordinances and state laws relating to bu d' g construction, and here authorize representatives
of this county to enter upon the above-mentioned proper for inspection purposes
Date: Signature (Applicantel
I
LQPERMIT
Application Number . . . . . 12-00000438
Permit . .
. ELEC-SERVICE
CHANGE
Additional desc
Permit Fee . . .
. 33.50
Plan Check Fee
.00
Issue Date . . .
.
Valuation
0
Expiration Date..
10/17/12
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
1.00 18.5000
EA ELEC
SVC <=600V/<=200A
18.50
----------------------------------------------------------------------------
Special Notes and
Comments
ELECTRICAL SERVICE
CHANGE -OUT.
----------------------------------------------------------------------------
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
TA
P.O. Box 1504
LA QUINTA, CALIFORNIA 92247-1504
.78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
PROPER'Y` O�ERS PACKAGE
(760) 777-7012
FAX (760) 777-7011
Disclosures & Forms for Owner -Randers AFFlyIng for Construction Pees
Dear Property Ownw
An. apoeation for a building permit has been submitted in year noun hstft youmeelf as the builder of the property
ft Specified at
We am providing you wfth an Ovs+ne Builder a
Form to ma
Aclawwledgment
t tgsibilities and possible risft �d Infet aatien Ve i€maf m las }non � of your
Owner -Builder. we Ym may incur by b tvi`ng thispownt.isru d in your nam as .the
got israte a balldipg.pendt anfii Yost (lave read, iaitlaled your. td of eacY`p�vidou,
and returned this form to us at Our .official address indicated. An agent of the owner cannot execute dgxi nouce
unless you, the property owner, obtain the prior approval of the permitting authority.
f I IIi I; -.rm r
m It
1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Build'
budding permit that erroneously implies that the property owner is providing his or her own labor and material pmvondly.1, as
an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed penoe
and his or her employees
injuries. I am willfully while working on my property. st My lameowoer's in -mm may not provide covexW for those
Y ting as an Owner -Builder and am aware of the limits of my inairance coverage for iq*ies to w dmn
on my property.
2. I understand budding permits are not required to be signed by property owners unless they are resporra0k for th
construction and ars not hiring a licensed Contractor to asst = this c oustbility.
4_3. I undesstand as an "Owner -Builder" I am the responsible party of record on the permit- I understand dW I may prole
myself from potential financial risk by hiring a licensed Contractor and leaving the permit fdod in itis or her name instemd of n
OVAL I
.�,Z4. I understand Contractors are required by taw to be Licensed and bonded in California and to list their licettser numbers
permits and contracts.
_C�5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total ver
Of my construction is at least five hundred dollars ($500) including tabor and materials, I may be considered an "employ
under state and federal law. '
�_6. I understand if I am considered an "employee" under state and Moat law, I must register with the state and fol
govOunent, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to untmployr
compensation for each "employee." I also understand my failure to abide by these laws may subject me. to serious fine,
risk
S 7. 1 understand under California Contractors' State License Law, an Owner -Builder who builds single-family resid,
structures cannot legally build them with the intent to offer them for sale, unless all world is performed by Iia
subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is perk
under contract with a licensed general building Contractor.
1-8. 1 understand as an Owner -builder if I sell the property for which this permit is issued, l may be beld liable for any
financial or. persona(. Juries susained by 'any subsequent owner(s) that result from any latent construction defects in the
workmanship. or materi4k ,
-9. 1 understand I may obtain.more information regarding my obligations as an "employer,. from the+ hUmad Rolmutte
Service, the United States Small Business Administration, the California Department of Benefit PaymeM. and rho California
Division of Industrial Accidents. f also understand I may contact the California Contractors' State Licenses Board (CSM at 1-
800-321-CSLB (2752) or www.cslb.c&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
ply legally and financially responsibie for proposed construction activity at the following address!
56 11. I agree that, as the party legally and ftnamially reWo*nsible for this proposed construction activity, I will abide by all
applicable laws and requirements that govern Owver-Iluilders as well as employers.
12. t agree to notify the issuer of this form immediately of any additians, ddefims, as ch409e0 to AMY Of the iebae&ti09 I
have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If YW ctotttract with
someone who does not have a liewso� tiro Contractors' State License Board way be tenable to assW you with arty I3nauaid loss
You may sustain as a remilt of a eomptaint. Your only remedy against unlicensed Contractors malt do 1ftV%Vd WWW It is also
UvVorftnt for you taumkrstanddaifarFunhacesod C:euttaenir OF OUVMYW of the i divi&d of fkM is igjtuad
on Your PAY, you way be ddd H" ft da mSes. If you obtain a ptxmit as Ow= Builder and wixb to h ,
sm Ccauam
you wdl be � &r vein or not those Ceubectora are Iieensed and the sWtA of tb* v alms'
oierrr iasuasnoe oovara�e,.
Before a bald U" permit cm be issued, this farm must be completed and signed by the property owner and returned to
the agency rtispondble for Upft Oo bE. None: A copy. of Me pmpaW w.aw's d &WF'aa r f4m "W*RdM or
other ver #Uadon qpnq is requh-end to be prweaw inhere &V pmt is WwA to tic pmt
owner's signature. /I
Signature of property
Date _-V �Zc)?_
Note: The following Authorization Form is 'required to be completed by the property owner early wltan designator
an agent of the property owner to apply for a construction permit for the Owner -Builder.
AU R17.,t�'T QN OF AOEIVT TO AO'T ON PROPERTY OVN- 'S BEHAL
Excluding.the Notioe to Property Owner, the oxamfiou of which I understand is my priori. vespcnad-Wity, I bn*Y atrthori
the following P ro to act as my t+gstago to apply for, sign, amd file rho documeata nee=ar'y tea obuiin an Oww-Budde
Permit for MY ProjecL
Scope of Coost<uction 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 our the
information and certify its accuracy. Note: A copy ofthe owner's driver's license, form notarization, or other ver*,atios
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 # .. ..
.. - , .. .
cit,Of : %a Qu1h.M..
Bulldhig & Safety Division .:. .: .
P.O. Bog. 1504,78-495 Calle Tampico - -
La.Qulnta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Mel
Permit # :
ai.' X38
Project Address: -. I I A V e i/ 1 L.L /4
Owner's Name:.
p GAP,
A P. Nuinber.
Address: . V LL/
l� AVE N;Z-
Legal Description:
City, ST, zm: ,: r p C Z 3Contractor.EoCA
ac �
Telephone• �(, a % •% !Address:
Pmjea Description:
City'ST,Zrp:PC
�E 'T Ftp' Oy-FDPfTf•2
Telephone: gCl F— A k- 6 2
State Lia #: City Lia #:
Arch, EW., Designer.
Address:
City, ST, Zip:
AHP. C.� C;1rC-, 1tS
Telephone:
State Lia #:
Construalon Type:. Oocupaacy:
Pm'ea
1 typec (isle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. FL: # Stories: # Units:
Telephone # of Contact Person: Estimated Valine of Project P P 4ZO'� YSO — SOO
APPLICANT: DO NOT WRITE BELOW THIS UNE
# Submittal Req'd Beed TRAC9(OTIG PERMIT FEES
Plan Sets
Pian Check submitted. Item Amount
Structural Coles
Reviewed, ready for corrections Plate Cbcck Deposit. .
Truss Cato.
Called Contact Polon Pias Check Balance
Tide T4 Cales.
Plans picked up Co3strnetion ,
Flood plain plan
Plans resubail ted.. MecharitW i .
Girding plan
Z'! Revitw, ready for correc6onsliissue Electrical
Subcontactor List
Called Contact Person Plambiug
Grant Deed
Pians plelced up . S.M&
H.O.A. Approval
Plans resubmitted
IN HOUSE.-
''• Review; ready for correctiondissue t Fee
Planning Approva
Called contact Person
Pub. Wks. Appr
Date of permit issue
Eftmmdt
School Fees
s