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14-0050 (ELEC)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 14-00000050 Property Address: 53725 AVENIDA VILLA APN: 774-133-026-12 -000000- Application description: ELECTRICAL Property Zoning: COVE RESIDENTIAL Application valuation: 100 Applicant: T4ht VOICE (760) 777-7012 1 ' —� FAX (760) 777-7011 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 Architect or Engineer: ----------------- LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT 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).: (/j�j('I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and •T/j 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 herown 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, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 4,. 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 /f"'t pursuant to the Contractors' State License Law.). . nl am exempt under Sec. , B.&P.C. for this reason Oat j rq— L' owner:) s� 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 fSec. 3097, Civ. C.). Lender's Name: Lender's Address: LQPERI%ItT Owner: MARVIN MARK/LAURA STONE P.O.B. 2258 BLUE JAY BLUE JAY, CA 92317 J Contractor: Owner Date: 1/17/14 U JAN i 7 2014 f _OFjL QUINTA I '1RIAfVrie... ------------------------------------------------ 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. 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: 'Carriers �� Policy Number --------- - - - - -- i/J'):}.certify that, in the performance of the work for which this permit is issued, I shall not employ any y/ 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, halllllffoorthwith comply with thh[oossse� provisions. Date:�Applica � 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 constru tion, and hereby authorize representatives /off his county to enter /ppon the above-mentioned /prrooperty f pectitdn purposes. lDate:—6ignature (Applicant or Agent LQPERMIT Application Number . . . . . 14-00000050 Permit . . . ELECTRICAL 2013 Additional desc . Permit Fee . . 23.83 Plan Check Fee .00 Issue Date Valuation . . . . 0 Expiration Date 7/16/14 Qty Unit Charge Per Extension 1.00 23.8300 LS ELEC FIXTURES, FIRST 20 23.83 Other Fees . . . . . . . PLAN CHECK, ELECTRICAL 23.83 PERMIT ISSUANCE M/P/E 90.57. Fee summary Charged Paid Credited Due Permit Fee Total 23:83 .00 .00 23.83 Plan Check Total .00 00 .00 : .-00 Other Fee Total. 114.40,. -.00 .00 114.40 Grand Total 138.23 .00 :00 138.23 LQPERMIT Bin # _ ., . City of La. Quinta k• ', 4% Building Bt Safety'Division '' , P.O. Box 1504, 78-495 Calle Tampico " ` Per 't # • • - La Quinta, CA 92253 - (760) 777-7012 Building Permit Application °. and Tracking Sheet Project Address: 3� �l �C Owner's Name: �IZ, A. P. Number: Add ess. ' 6 Legal Description: City, 3T, Zip. (J Contractor.ba telephone:•:c:}yz::<;>:::rr:'s:•,<:..><,;>a�;<.. Address: �'- ' `"" ` _ , Project Description: City, ST, Zip: Telephone: 1 ly State Lic. # : City Lic. #; Arch., Engr.; Designer: a ., ` • ti . _, Address: .. City., ST, Zip: a Telephone:::r•>;;:;::>;:;:::«x::> :;::;;<; <:::::::;:;:::: Construction Type; Occupancy: yP pan O y. State Lic. #: r... f.:;;; ;szs:;;✓;:::::>::a;:;;:::s<:<:<:<.<:<:> :a ---- Name of Contact Person: , ' Sq. Ft.: ' . # Stories: #Units: Telephone #,of Contact Person: n y :' Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE - tl Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item x Amount Structural Calcs. Reviewed, ready for corrections r 'Plan Check Deposit Truss Calcs. Called Contact Person x. Plan Check Balance Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2°" Review, ready for corrections/issue x Electrical Subcontactor List Called'ContactPerson ' Plumbing - Y Grant Deed Plans picked up _ S.M.I.. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- '"' Review, ready for correctionsrissue Developer Impact Fee. Planning Approval Called Contact Person,,: A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees F' Total Permit Fees el-" I " P.O. BOX 1504 LA QU(NTA,' CALIFORNIA 92247-1504 18-495 CALLE TAMPICO, LA QU.INTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT PROPERTY OWNEWS PACKAGE (760) 777-7012 FAX (760) 777-7011 Disclosures & Forms for 04'n'er-BuNers Apip Mg "1" - &r Consttuction Permits 4Y IWORTANT! NOTICROPER-TV OWNER Dear Property Owner. WW*9-W= has submitted in yo uL FIRM listing yourself as the builder of the,property An..application-for-ab _0 at �Is ffiw. :� .< d 1_1 I k� . . improvements specified - 1") r� -)Pf-,1 -:. We are providing you with an Owner -Budder Acknowledgamt-and InformationNerification Form to make you awamof your responsibilities and possible risk you may incur by having this permit issued in *your name as the - Ownef-Builder. We will not issue a building permit until you -have read, initialed your understandingof each'provtsion, signed, and returned this form to us at our official address indicated. Anagent of the owner cannot, execute this -notice unless YOU, the property owner, obtain the prior approval of the permitting authority. Read and iff&W each staietii&a below to signify you'i6idensta a 0 -ii verify this iriform.don.' 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. 1, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained byan 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 -Budder and am aware of the limits of my insurance -coverage for injuries to workers on MYY nrope rty I understand building permits are not required to be signed by property owner's unless they are responsible for the construction and. are notAkfing a Licensed Contractor to assume this responsibility.. moI understand as an "Owner -Builder" i am the responsible party of record on the permit- I understand that I may protect li from potential financial risk by'hiring a licensed Contractor and havin . g the permit filed in his or - fier name instead of my own. 0�4- 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. I 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 "employee' under state and federal law. I understand if I am considered an "employee' 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. 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 f6r 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. 6: 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 igjaries 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 "employee" from the 6,U raal 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 (MS B) at 1- 800-321-CSLB (2752) or www.c-slb.ca.gov for more information about licensed contractors. /14�- 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the Ply legal 4,n t—finanqi y!Trnsible f proposed construction activity at the following address: 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. 1/2. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the infcrrmatioh 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,. die Contractors' State License Board :may be unable to 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 wOddag on your property; you may be heldliable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible fore verifying w tedw or not those Contractors are properly licensed andd the status of .their workers' con4xnsation 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 ismdug,tdwpermiL Note. A copy of Me property owner's dtiver'sIkense, form or other verifuadon acceptable to agency is required to ' F&CAted when the permit is issued to, verify the property owner's signature. 7 Signature of property o 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 excwtion 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 ft: 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. Rote. '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: CITY OF LA BUILDING.& SAFETY DEPT. APPReVED DATE ���1 Lk -BY `kr-/ 3-