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BRES2016-029478-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application Description Property Zoning: Application Valuation: Applicant: RAY ROOK 49410 BRIAN CT LA QUINTA, CA 922,53 c&�p - 4 4 Qumz DESIGN & DEVELOPMENT DEPARTMENT BUILDING PERMIT BRES2016-0294 46485 CAMEO PALMS DR 643181010 DANIELS / CHANGE COVERED AREA INTO LIVING AREA $20,000.00 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 Professions 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. 70315, 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 Ll�00).: as owner of the property, or my employees with wages as their sole c mpensation, 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 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 ON Contractors' State License Law.). L0*11Wbarn exempt under Sec. . B.&P.C. for this reason TIK L., -'Kate': Own A. 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: VOICE (760) 777-7125 FAX (760).777-7011 INSPECTIONS (760) 777-7153 Owner: ROBERT DANIELS Contractor: OWNER / BUILDER Llc. No.: ate: 9/14/2017 WORKER'S COMPENSATION DECLARATION I 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: Carri Policy Number: _ ertify that in the performance of :he work for which this permit is issued, I shall of ploy 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 the Labor Code, I shall forthwith comply wit thos provisions. L' ~ j Ddte. 1 Applicant WARNING: FAILURE TO SECURE WORKERS' COMPENSATIO 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 FOF IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT: Application is hereby made to the Building Official 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 perforn=d 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 appliotion becomes null and void if work is not commenced within 180 days from date of 5suance of such permit, or cessation of work for 180 days will subject permit to cancellation. . I certify that I have read.this application and st ate 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 city to enter upon the above -menti ned property for inspection purps Date: t Signature (Applicant or Ag M z u, 0 0 M z d LU d+ Ig a ® W �oL__L1 iso Cn U Z gO WORKER'S COMPENSATION DECLARATION I 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: Carri Policy Number: _ ertify that in the performance of :he work for which this permit is issued, I shall of ploy 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 the Labor Code, I shall forthwith comply wit thos provisions. L' ~ j Ddte. 1 Applicant WARNING: FAILURE TO SECURE WORKERS' COMPENSATIO 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 FOF IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT: Application is hereby made to the Building Official 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 perforn=d 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 appliotion becomes null and void if work is not commenced within 180 days from date of 5suance of such permit, or cessation of work for 180 days will subject permit to cancellation. . I certify that I have read.this application and st ate 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 city to enter upon the above -menti ned property for inspection purps Date: t Signature (Applicant or Ag - Date: 9/14/2017 Application Number: BRES2016-0294 Owner: Property Address: 46485 CAMEO PALMS DR ROBERT DANIELS APN: 643181010 Property Zoning: Application Valuation: $20,000.00 Applicant: Contractor: RAY ROOK OWNER / BUILDER 49410 BRIAN CT LA QUINTA, CA 92253 --------------- ---------------------------------------- Llc. No.: --------------------- Detail: ADDITION OF NEW BATHROOM 52 SQ. FT. A/C. PER 2013 CRC & CPC CODES. . ----------------- FINANCIAL INFORMATION DESCRIPTION ACCOUNT QTY AMOUNT ADDITION, FIRST 100 SF 101-0000-42400 0 $127.68 DESCRIPTION ACCOUNT QTY AMOUNT ADDITION, FIRST 100 SF PC 101-0000-42600 0 $179.36 Total Paid for ADD TION: $307.04 DESCRIPTION ACCOUNT QTY AMOUNT PLAN CHECK/PERMIT EXTENSION PROCESSING 101-0000-42600 1 $101.84 Total Paid for ADMINISTRATIVE: $101.84 DESCRIPTION ACCOUNT QTY AMOUNT BSAS SB1473 FEE 101-0000-20306 0 $1.00 Total Paid for BUILDING STANDARDS ADMINISTRATIOM BSA: $1.00 DESCRIPTION ACCOUNT QTY AMOUNT RESIDENTIAL, FIRST 1,000SF 101-0000142403 0 $152.00 DESCRIPTION ACCOUNT QTY AMOUNT RESIDENTIAL, FIRST 1,000SF, PC 101-0000-42600 0 $50.16 Total Paid for ELECTRICAL - NEW CONSTRUCTION: $202.16 DESCRIPTION ACCOUNT QTY AMOUNT APPLIANCE REPAIR/ALTERATION 101-0000-42402 0 $12.67 DESCRIPTION ACCOUNT QTY AMOUNT APPLIANCE REPAIR/ALTERATION PC 101-0000-42600 0 $5.07 DESCRIPTION ACCOUNT QTY AMOUNT VENT FAN 101-0000-42402 0 $12.67 DESCRIPTION ACCOUNT QTY AMOUNT VENT FAN PC 101-0000-42600 0 $5.07 Total Paid for MECHANICAL: $35.48 DESCRIPTION ACCOUNT QTY AMOUNT FIXTURE/TRAP 101-0000-42401 0 $38.01 DESCRIPTION ACCOUNT QTY AMOUNT FIXTURE/TRAP PC 101-0000-42600 0 $38.01 DESCRIPTION ACCOUNT QTY AMOUNT WATER SYSTEM INST/ALT/REP 101-0000-42401 0 $12.67 DESCRIPTION ACCOUNT QTY AMOUNT WATER SYSTEM INST/ALT/REP PC 101-0000-42600 0 $12.67 Total Paid for PLUMBING FEES: $101.36 DESCRIPTION ACCOUNT QTY AMOUNT SMI - RESIDENTIAL 101-0000-20308 0 $2.60 Total Paid for STRONG MOTION INSTRUMENTATION 5M1: $2.60 DESCRIPTION ACCOUNT QTY AMOUNT TECHNOLOGY ENHANCEMENT FEE 502-0000-43611 0 $5.00 Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00 Iain # Permitil Project Address: Qty of b Quinta Guifdino, &r Safety Division 78-495 Caffe Tampico La Quinfa, CA 92253 - (760) 777-701,2 Building Permit Application and Tracking Sheet G� Owner's Name: i A. P. Number: Address: 5Cx1>� e. Legal Description: City, ST, Zip: Contractor: Telephone: Address: Project Description: City, ST, Zip: �. Telephone: P o . rn State Lic. # : City Lic. Arch., Engr., Designer: Address: Zo 3If, I A t,4 c7l City, ST, Zip: T ele h on 7 b`b Con tru? cti n Type: e• O c cu an eY= Sto e t Lic- # G g Project type (circle one : New Ad'n Alter Repair r Demo 0 Name of Contact Person: Sq. Ft.: Stories: # Units: Telephone # of Contact Person:Estimated Value of Project:i d APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rcc'd TRACKING . PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called'Contact Person Plan Check Balance. Tit!e 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2" Review, ready for corrections/issue Electrical Subcontacfor List Called ContactPcrson Plumbing Grant Deed Plans picked up V S.M.I. II.O.A. Approval flans resubmitted Grading IN ROUSE:- '`�. 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 Tees, l - Total Permit Tces Date: 10/17/2016 No.: 16-00370-1 Owner: Daniels Address: 46485 Cameo Palms City: La Quinta Type: Residential Addition < 500 sq ft Lot # Street No. 46485 Comments: CERTIFICATE OF COMPLIANCE c JN�iec sy°o Desert Sands Unified School District 2Q� 47950 Dune Palms Road y BanNck0 MiR�GE La Qunita, CA 92253 r 1NOMp WELLS, �O CN �nE � *V LANT(760)771-8515 �o n�oro r° Email: Jurisdiction: La Quinta Tract #: Street Name Cameo Palms Sq. Feet APN Permit No. 52 643-181-010 At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions under 500 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking eating, or sanitation) or replacemef- mobile homes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason: Residential Addition 500 Sq Feet or Less Exempt This certifies that school facility fess imposed pursuant to Education Code Section 17620 and Government Code 65995 Et Seq. in the amount of $0.00 X 52 S.F. or $0.00 have been paid for the property listed above and that building permits and/or Certificates of Occupancy for this square footage in the proposed project may now be issued. Fees Paid By: Exempt - Ray Rooker Check No.: Bank Name/Recipient of Certificate Telephone: Funding: Exempt By Dr. Gary Rutherford Superintendent y Fee Collected/ Exempted by: Shar n McGil ey Amou,ntlDue: $u.00 riginal Payment(cec'd: z '$0:,00 New Payment Pac'd:w�yO.00 Over/Unz:er:. $0.00 NOTICE: Pursuant to Government Code Section 66020(d)(1), this will serve to notify you that the 90 -day approval period in which you may protest the fees Ior other payment identified above will begin to run from the date on which the building or installation permit for this project is issued, or from the date on which those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier. Notice to Building Department: THIS DOCUMENT VALID ONLY IF IMPRINTED WITH EMBOSSED SEAL. T-Vf 4 4 a" P.O. BOX 1504 LA QUINTA, CALIFORNIA 92247-1504 78-495 CALLS TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT PROPERTY OWNER'S PACKAGE (760) 777-7012 FAX (760) 777-7011 Disclosures & Forms for Owner -Builders Applying for Construction Permits IMPORTANT! NOTICE TO PROPERTY OWNER Dear Property Owner: An application for a buildm* peitnit ha b n submitte ' your name listing your as e b�der of the property improvements specified at APWe are providing youwith an weer -Builder cknowledgment and Information I 'cation Form t a you aware of your responsibilities and possible risk you may incur by having this permit issued in your name 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. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION DIRE CTIONS.- Read and initial each statement below to signer you understand or verify this information. �I USI 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. I, 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 injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. 42) 1)understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. I understand as an "Owner -Builder" I am the responsible party of record on, the permit. I understand that I may protect Myself from potential financial risk by hiring a licensed Contractor and having the prmit filed in his or her name instead of my own. . I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on per mits and contracts. 5. 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 "employer" under state and federal law. 6. 1 understand if I am considered an "employer" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute tounemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to.serious financial risk. I 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 for 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.