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11-1303 (ELEC)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: .11-00001303 Property Address: 51045 AVENIDA HERRERA APN: 773-063-013-2 -000000- Application description: ELECTRICAL Property Zoning: COVE RESIDENTIAL Application valuation: 1600 Applicant: T419�'4 " BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Architect or Engineer: VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 12/07/11 Owner: MARTYN BELL 51045 AVENIDA HERRERA LA QUINTA, CA 92253 --------------------------IN Contractor: Owner t J ------------------------- ------------------------------------_------------------------------------------------------------ LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION 1 hereby affirm underpenalty 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: Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. _ I 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 I 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 sho Id 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 Cod hall 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 1 any ,pplicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars 1$500).: te: 12 �1 ' pplicant: () 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 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, 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.). (_) 1, 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 /ate: VL 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 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 build' g construction, and hereby authorize representatives of this county to enter upo he above-mentioned pro � rt f 'nspectio urpos s. EBte k_ 1 t \ ignature (Applicant or Agent): Application Number . . . . . 11-00001303 Permit . . . ELEC-MISCELLANEOUS Additional desc . Permit Fee 22.50 Plan Check Fee .. 5:63 Issue Date . . . . Valuation 0 Expiration Date 6/04/12 Qty Unit Charge -Per Extension BASE FEE 15.00 1.00 7.5000 EA ELEC PWR APP >1 TO <=10 7.50 ---------------------------------- Special Notes and ----------------------------------------- Comments REPLACE POOL MOTOR WITH 3 HP VARIFLOW. 2010 CODES. ---------------------------------------------------------------------------- Other Fees . . . . . . '. BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged Paid Credited Due ----------------- Permit Fee Total ---------- ---------- - 22.50 .00 ..00 22.50 Plan Check Total 5.63 .00 .00 5.63 Other Fee Total 1.00 .00 .00• 1.00 Grand Total 29.13 .00 00 29.13 r LQPERMIT ak. AW P.O. BOX 1504 LA QUiNTA, CALIFORNIA 92247-1504 BUILDING & SAPETY DEPARTMENT 78-495 CALLE TAMPICO (760) 777-7012 LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011 PROPERTY ON"ER' S PACKAGE Disclosures & Forms for Owner-Bullders AprplyIng for Construction Permits TWal MUCH TO f'Rt1UM QMR Dear Property Owner. " application for a buildingpermit has been submitted in your. mune hating as the btu o€ the property in*w0v�l;4 spmAfitd at l o u" S CA .:�22 S_ WC 80 pMvidmg you wft an Owner -Budder ACIra0Yt WVnemt-and bfmmatten Verificattmi form to make yQQ away of YM respowibilities and possible risk you racy in= by trrtviag thispesmit.iumdin your Dams as the of �� Oe+nec-Builder. we WW not Issas a buildding permit unti-yo.-lrave read, mitt" yaw mderstaadi� Rt n, signed, and returned this form to us at our.offidal address indicated. An agent of the owner cw3wt exectft this notice unless you, the property owner, obtain the prior approval of the permitting authority. 2WWS Ae QMM%1 � AWNERVICAMON ty.>t-�lt t DOWITONS Read an& brim e=k suuer mt ttefaw-t& sWufy you wrdw3tand or vertfy das uRfonnGUori- 1 ` J bi- I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Buildtz- building permit that erroneously implies that the property owner is providing his or her own labor and material Pessonafiy. I, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an untioeased pWM and his or her employees while working on my property. My hmneownces insurance may not pmvide save nP- for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my imtrILDce.coverage for injuries to wtoel= on MY py- \,%%,_2. I understand building permits are not required to be signed by property owners unless they are responsible for th construction and are not hiring a licensed Contractor to assume this responsibility. 3. I understand as an "Owner-Buddee' I am &t responsible party of record on the permit. I understand that I may prote myself from potential financial risk by hiring a licensed Contactor and baying the permit filed in iris or her name instead of o own. 4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers permits and contracts. �N s 5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total vi of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an emplo under state and federal law. 76. I understand if I am considered an "employer" under state and %deral laver, I must register with the state and fo government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to uaemploy compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious fiW risk \jL7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family resii structures cannot legally build them with the intent to offer them for sale, unless all work is performed by iii subcontractors and the number of structures does not exceed foot within any calendar year, or all of the work is pert under contract with a licensed general building Contractor. 8. 1 understand: as an Owner -Builder if I.sell the property for which*d& permit is issued, J may be held liable for any financial or perso* nlj' uries •vastalned.b an subsequent owner(s) _ that result from an latent construction defects in. the : y . y . �t r workmanship. or materials.... I understand I may obtain more inforination regarding my obligations as' an "employer" from the Ian > evenuo• . 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 (CSM at 1- 800-321-CSLB (27 52) or www.cslb.mgov for more information about licensed contractors. unaware 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: 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. l2. I agree to notify the issuer of this form immediately of any additions; deletions. of CUWVN W ,,ay 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, rho Contractors' State Lioease Board may be unable to assist you with any finaneW loss you may sustain as a result of a complaint Your only remedy against unlicensed Contractors may ba invivil court. It is also UUPM ant for you to understand that if am uwd l mensed Centra er of employee of that individual of fhm is i qumd while wwking on Your Ply, you may be Add H" for damages. If you obtain a permit as Oww-Budder sad wwb to him Conftactors, you will be reqpasMofor vedlfyiug or not those CorrtracUors arm properly lysed ad the SM"'Of their workers' con insurance coverage. Before a building permit can be issued, this form must be completed and dgneyd by the property Qwtku and returned to the agency y responsible for Isaft.tl w ¢serest. Notae A copy of tiW prverty oivntr•'s mveresomtsm, form x0ftdWW)M 0 other vaViicadon aecqd4k to &e Rgency is required to be presented when eke pFratit ishSWA to the owner's signature. . Signature of property owrner Date: Note: The following Authorization Form is required to be completed by the proper. ty owner only when deaignatin an agent of the property owner to apply for a construction permit for the Owner-Builder- 6—U.MRIZ,ATION OF AGENT TO ACT ON IP>EtOPERTY �'S BT �,F Excluding.the Notice to Property Owner, the txomtion of which I understand is my personal cespoasrbrl4,1 herby a vdm the following pecson(s: to act as my *gent(Q to apply for, sign, and file the documents necessafy to obtain an Owner-BuM 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 information and certify its accuracy. Note: A copy of the owner's driver's license, form notarization. or other ver(/ica" acceptable to the agency is required to be presented when the permit is issued to verify the property owners signature.. Property Owner's Signature: Date: Bin # of Q[(tt1 Q Building &r Safety. Division P.O. Box 1 SO4, 78-49S Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # %,� ✓ Project Address: Owner's Name: A. P. Number. Address:. `� S Rv�w�r,A Legal Description: City, ST, Zip: U- v? J\ r -N I -CN C,7L L S 3 Contractor:: • w r»<) ">`'>.s' Telephone: � Address: Project Description: City, ST, Zip:`PCJ)rC PaaL MTCo n— Telephone:, ,iHh� :12 til $Hk3iFSv State Lic. # : City Lic. #.. Arch., Engr., Designer. Address: City, ST, Zip: Telephone: Construction Type: (1-<S\ t-�c-,cOccupancy: Project type (circle one): New Add' Alter CRe2aiDDemo •.ins `. y..,�.:,:v::.>.,> State Lic. #: camt A".r xt?;k ,r. Name of Contact Person: Sq. Ft.: csiz� # Stories: \ # Units: \ Telephone # of Contact Person: Estimated Value of Project: 7VI��oC3o APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACMG PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cales. Reviewed, ready for corrections Plan Check Deposit Truss Cales. Called Contact Person Plan Check Balance. Title 24 Cales. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2'' Review, ready for correctionstissue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Pians picked up S. A. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- 7rd Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees