BRES2017-0046I fd�
78-495 CALLE TAMPICO
T4ht 4 4v Qu!Kz,
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
Carrier: Policy Number:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's StateI
certify that in the performance of the work for which this permit is issued, l
BUILDING PERMIT
Application Number:
BRES2017-0046
Property Address:
78350 CRESTVIEW TERRACE
APN:
643192002
Application Description:
PERKINS / ELECTRICAL AND PLUMBING AT KITCHEN ONLY
Property Zoning:
3 of the Business and Professions Code) or that he or she is exempt therefrom and the
Application Valuation:
$1,000.00
Applicant:
JAMES PERKINS
78350 CRESTVIEW TERRACE
LA QUINTA, CA 92253
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:
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
JAMES PERKINS
78350 CRESTVIEW TERRACE
LA QUINTA, CA 9253
Contractor:
OWNER / BUILDER
Llc. No.:
Date: 4/5/2017
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one o__ 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. Mywor rs' compensation insurance carrier and policy number are:
I OWNER -BUILDER DECLARATION
Carrier: Policy Number:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's StateI
certify that in the performance of the work for which this permit is issued, l
License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
shall note ley any person in any manner so as to become subject to the workers'
city or county that requires a permit to construct, alter, improve, demolish, or repair
compensation laws of California, and agree that, if I should become subject to the
any structure, prior to its issuance, also requires the applicant for the permit to file a
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
signed statement that he or she is licensed pursuant to the provisions of the
comply with those provisions.
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
Date: LI �� Applicant:,' 1 \ l
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
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
as owner of the property, or my employees with wages as their sole
ONE HUNDRED THOUSAND DOLLARS ($100,OM). IN ADDITION TO THE COST OF
compensation, will do the work, and the structure is not intended or offered for sale.
COMPENSATION, DAMAGES AS PROVIDED FOP. IN SECTION 3706 OF THE LABOR CODE,
(Sec. 7044, Business and Professions Code: The Contractors' State License Law does not
INTEREST, AND ATTORNEY'S FEES.
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
APPLICANT ACKNOWLEDGEMENT
are not intended or offered for sale. If, however, the building or.improvement is sold
IMPORTANT: Application is hereby made to then Building Official for a permit subject to
within one year of completion, the owner -builder will have the burden of proving that
the conditions and restrictions set forth on this application.
he or sh d not build or improve for the purpose of sale.).
1. Each person upon whose behalf this application is made, each person at whose
as owner of the property, am exclusively contracting with licensed contractors
request and for whose benefit work is performed under or pursuant to any permit
to construct the project. (Sec. 7044, Business and Professions Code: The Contractors'
issued'as a result of this application , the owner, and the applicant, each agrees to, and
State License Law does not apply to an owner of property who builds or improves
shall defend, indemnify and hold harmless the -City of La Quinta, its officers, agents, and
thereon, and who contracts for the projects with a contractor(s) licensed pursuant to
employees for any act or omission related to the work being performed under or
t , o ctors' State License Law.).
following issuance of this permit.
�( I am exempt under Sec. . B.&P.C. for this reason
1 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
we k for 180 days will subject permit to cance.lation.
�te: Owner: r
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
Lender's
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
construction, and hereby authorize representAives of this city to enter upon the
above-mentioned property for inspection purposes.
&te: Signature (Applicantor Agent),
M
Date: 4/5/2017
Application Number: BRES2017-0046 Owner:
Property Address: 78350 CRESTVIEW TERRACE JAMES PERKINS-
APN: 643192002 78350 CRESTVIEW TERRACE
Application Description: PERKINS / ELECTRICAL AND PLUMBING AT KITCHEN ONLY LA QUINTA, CA 92253
Property Zoning:
Application Valuation: $1,000.00
Applicant: Contractor:
JAMES PERKINS "OWNER / BUILDER
78350 CRESTVIEW TERRACE
LA QUINTA, CA 92253
E Lic. No.:
---------------------------------------------------------------------------------------------
Detail: ELECTRICAL RECEPTACLES AND LIGHTING WITH GAS LINE TO ISLAND AT KITCHEN ONLY. THIS APPROVAL DOES NOT INCLUDE ALTERATIONS TO
BUILDING FRAMING OR ADDITIONAL SQUARE FOOTAGE. 2016 CALIFORNIA BUILDING CODES.
0
FINANCIAL INFORMATION
DESCRIPTION ACCOUNT CITY AMOUNT
BSAS 561473 FEE
101-0000-20306 0 $1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
DEVICES, FIRST 20
101-0000-42403
0
$25.33
DESCRIPTION
ACCOUNT
CITY
AMOUNT
DEVICES, FIRST 20 PC
101-0000-42600 '
0
$25.33
DESCRIPTION
ACCOUNT
CITY
AMOUNT
DEVICES/FIXTURES, ADDITIONAL
101-0000-42403
0
$12.65
DESCRIPTION
ACCOUNT
CITY
AMOUNT
DEVICES/FIXTURES, ADDITIONAL PC
101-0000-42600
0
$3.15
Total Paid for ELECTRICAL: $66.46
DESCRIPTION
ACCOUNT
CITY
AMOUNT
PERMIT ISSUANCE
101-0000-42404
0
$96.27
Total Paid for PERMIT ISSUANCE: $96.27
DESCRIPTION f
ACCOUNT
CITY
AMOUNT
GAS SYSTEM, 1-4 OUTLETS
101-0000-42401
0
$12.67
DESCRIPTION -
ACCOUNT
CITY
AMOUNT
GAS SYSTEM, 1-4 OUTLETS PC
101-0000-42600
0
$25.33
Total Paid for PLUMBING FEES: $38.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
SMI - RESIDENTIAL
101-0000-20308
0
$0.50
Total Paid for STRONG MOTION INSTRUMENTATION SMI: $0.50
DESCRIPTION
ACCOUNT
CITY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
• $5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
LA
C4
P.D. BOX 1504
LA QUINTA, CALIFORNIA 92247-1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT-
(760)777-7012
EPARTMENT-
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 building permit has been submitted in your name listin yourself as the builder of the property
improvements specified at 7 Jd C j (t IZ,,A l
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 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 cainot execute this notice
unless you, the property owner, obtain the prior approval of the permitting authority:
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
DIRECTIONS: Read and initial each statement below to signs you understand or verify this information.
/�C U1. I understand a frequent practice of unlicensed persons is,to have the property owner obta.:n 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 ty 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_!pjoperty
�1�_22__ I 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 permit filed in his or her name instead of my
own.
n� a 4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on
permits and contracts.
5A 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 corsidered an ".employer"
understate and federal law.
,M' °. understand if I am considered an "employer" under state and federal law, I must register wi-h the state and federal
government, withhold payroll taxes, provide workers' compensation disability insurance; and contri-�ute to unemployment
compensation for each "employee." I also understand my failure to abide by these laws may subject :ne to.serious financial
risk.
7. 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.
/1 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 injuries 'sustained by any subsequent owner(s) that result from any latent construction defects in the
wor inship or materials.
("'w 9. I understand I may obtain more information regarding my obligations as an "employer" from the Internal 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 (CSLB) at 1-
800-32 1 -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
party legally: and^ financially' ' responsible_ for proposed construction activity at the following address:
X11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all
applicable laws and requirement$ that govern Owner -Builders as.well as employers.
/jam-`Ibl2. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any 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, the Contractors' State License Board may be unable to assist you with any financial loss
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 firms injured while working
on your property, you maybe 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, this form must be completed and signed by the property owner and returned to
the agency responsible for issuing the permit. Note: A copy of the property owner's driver's licens , 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. r-�
Signature of property owner _tel " j Date: 11 —3-1-7
Note: The following Authorization Form is required to be completed by the property owner oprly 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 responsibiity, I hereby authorize
the following person(s),to act as rriy 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: % 9�7, 4-7-) /,-n_z�2.4--f Q A. 12•x, n n _AOri
Name of Authorized Agent: T1064 a"ol Tel No
-t_' 1 s
Address of Authorized Agent:
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 ether verification
acceptable to the agenc.94s required to be p the pe ued to verify the property o wpe r s signature.
Property Owner's Signature: Date:
�- /
Bin rr pity of 1A Qbin to
Building 82- Safety Division
Permit 7 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-701,2
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Building Permit Application and Tracking Sheet
>FP_rojectAddress: ? 0 64a'fST.0•1tOwnerls'1 i
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
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Tele hone:
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Address:
P,75 —1 escripiion:
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City, ST, Zip:
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Telephone:
State Lie. # :
City Lie.
Arch., Engr., Designer:
Address: .
City, ST, Zip:
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Telephone:
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s traction Type: Occupancy:
Con YP
State Lic.#
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Project type circle one • New Add'n Alter
Repair. r'Demo
i le:OL2onntact'Person:.7—.,5_q �. S'
Sq. Ft.:
# Stories:
# Units:
Telephone of,Contact,P_erson:
-stimated�Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
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Submittal
Req'd
Rcc'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Check Dep•sit
Truss Calcs.
Called Contact Person .
Plan Check Balance.
Title 24 Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2°" Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
14.0:A. Approval
Plans resubmitted
Grading
IN ROUSE:-
3". Review, ready for correction issue
Developer Impa:t Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees,
Total Permit Fc-:s
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CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DATE 3M%WBY
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All dimensions _size designations This is an original design and must
given are subject to verification on not be released or copied unless
.job site and adjustment to fit.job applicable fee has been paid or job
conditions. order placed.
RC -Perkins kitchen rev
Designed: 1/31/2017
Printed: 2/3/2017
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CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DATE 3M%WBY
pwwf 8069 ww N46664&
r—
All dimensions _size designations This is an original design and must
given are subject to verification on not be released or copied unless
.job site and adjustment to fit.job applicable fee has been paid or job
conditions. order placed.
RC -Perkins kitchen rev
Designed: 1/31/2017
Printed: 2/3/2017