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10-0131 (PLBG)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 -o Application Number: ( 10 00000_13-1 Property Address: 79760 DESERT WILLOW ST APN: 649-470-047-78 -28601 Application description: PLUMBING Property Zoning: MEDIUM DENSITY RES Application valuation: 5000 Applicant- Architect or Engineer: ,� M BUILDING & SAFETY DEPARTMENT BUILDING PERMIT 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 c struct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the p it to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State Li nse Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or th he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by a pplicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars �a:nd ( I eon, wand 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 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 I am exempt under Sec. , B.&P.C. fo�,Ahi? reason CONSTRUCTION -MN DING AGENCY 1 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 Owner: LIU STEVEN 2240 CITATION LA QUINTA, CA (626)378-1075 Contractor: Owner COURT 92253 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 2/22/10 WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 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: 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 t e workers' compensation laws of California, and agree that, if I should b ubrect to a work rrs' compensation provisions of Section 3700 of the Labor Cod I. orthwith mply wi those provisions. f 0lican Appt: 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. 1 certify that I have read this application and state that the abov�rf or is co ct. I ogre to comply with all city and county ordinances and state laws relating to buildin constru o an reby authori representatives of this cou y toe ter upon the above-mentioned proper for ins pur ses. 'Date:- ^gnature (Applicant -or -Agent): --I z:6 Application Number . . . . 10-00000131 Permit . . . PLUMBING Additional desc . . Permit Fee . . . . 25.50 Plan Check Fee 6.38 Issue Date . . . . Valuation 0 Expiration Date . . 8/21/10 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 7.5000 EA PLB VACUUM BRKR FIRST 5 7.50 1.00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS 3.00 -=------------------------------------------------------------------=------- Special Notes and Comments CONNECT THE GAS PIPE FROM THE HOUSE TO BACKYARD FOR FUTURE BBQ TOTAL OF 41 FEET. PER APPROVEDPLANS & BY K.K. ---------------------------------------------------------------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged Paid Credited Due ------------------------------------- Permit Fee Total 25.50 -------------------- .00 .00 25.50 Plan Check Total 6.38 .00 .00 6.38 Other Fee Total 1.00 .00 .00 1.00 Grand Total 32.88 .00 .00 32.88 LQPERMIT l� P.O. BOX 1504 LA QUINTA, CALIFORNIA 92247-1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENTrD (760) 777-7012 PROPERTY OWNER'S PACKAGE FAX (760) 777-7011 Disclosures & Forms for Owner -Builders Applying for Construction Permits LMMIANT! NOTICE TO PROPERTYO�TIER Dear Property Owner. An. application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your nacre as the Owner -Builder. We will not issue a building. permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. Read and initial each statement below to signify you understand or verift this information. I. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder" b ding 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 by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those Munes. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers o my prqXrty. 2. I understand building permits are not required to be signed by property owners unless they are responsible for the truction and are not hiring a licensed Contractor to assume this responsibility. 3. I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect 4f from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my 4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on its and contracts. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employee' state and federal law. 1 understand if I am considered an "employer" under state and federal law, I must register with the state and federal vent, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment sation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residentia es cannot .legally build them with the intent to offer them for sale, unless all work is performed by licenser ractors and the number of structures does not exceed four within any calendar year, or all of the work is performe, ontract with a licensed general building Contractor. ....-. .--. M I understand as an Owner -Builder if I sell the property.for which this permit is issued, I may be held liable for any J or personal. ir&tnes sustained. by any subsequent owner(s) that result from any latent construction defects in the unship or materials. 9. I understand I may obtain more information regarding my obligations as an "employer" from the internal Revenue ice, the United States Small Business Administration, the California Department of Benefit Payments, and the California icon of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CS -LB) at I- 321=CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. 0. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the 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 cable laws and requirements that govern Owner -Builders as well as employers. kma I agree to notify the issuer of this. form immediately of any additioffi, deletions, or changes to any of the information I havided on this form. Licensed contractors are regulaied by laws designed to protect the public. If you contract with som who does not have a license,. the Contractors' State License Board may be unable to assist you with any financial loss you 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, ties form must be completed and signed by the propertyowner and returned to the agency responsible for issuing; the.perm L Note:py of the property owner's QRiver'sAcensei form notal*at 14 or other verification acceptable to the a .en is to be preserrtted when the permit is issued to verify the property owner's signature. Signature of property owner Date: Z LZ 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 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 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: A N City of Req'd Rec'd TRACIaNG PERMIT FEES DM, . Plan Sets P.O.Box 1504,, Structural Cafes. La •(760)'777-7012 Reviewed, ready for corrections Plan Check Deposit Building Permit Application and Tracking Sheet Called Contact Person Plan Check Balauu . imi • Title 24 Calcs. i .., 1 1. � H.O.A. Approval Plans resubmitted Grading IN HOUSE: ''` Review, ready for corrections/sssue Dovcoper. Impact Fee ' 111 n Planning Approval 1 Pub. Wks. Appr S2 r`y��`•.;�<��t(pfyw«:..�t'L� �v:•n}J7� 1 1 1 1 • •111 •: 1 �. 99 �A In-�:L.3• i> .v.f%;i:1.\ .'Lv ` `A'Yr. �� 1 1 � � .1 . r _ 1 •1 11 .1 _ 1 _ii t.1 •�• 1L.Jaa1:11 a. • i A N Submittal Req'd Rec'd TRACIaNG PERMIT FEES Plan Sets Pian Check submitted Itw Amount Structural Cafes. Reviewed, ready for corrections Plan Check Deposit Truss Cala. Called Contact Person Plan Check Balauu . Title 24 Calcs. Plans picked up Coustructiou Flood plain plan Plaas resubmitted Mechaokal Grading plan 2'' Review, ready foi correctioaslissue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.L H.O.A. Approval Plans resubmitted Grading IN HOUSE: ''` Review, ready for corrections/sssue Dovcoper. Impact Fee Planning Approval Called Contact Person A.LP.P. Pub. Wks. Appr Date of permit issue School Fee Total Permit Fees