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
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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.