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BRES2017-003978-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Twit 44Q,mrw DESIGN & DEVELOPMENT DEPARTMENT BUILDING PERMIT Application Number: BRES2017-0039 Property Address: 45185 DESERT HILLS CT APN: 604280015 Application Description: WEISMAN / ADD BAR SINK TO HALLWAY Property Zoning: Application Valuation: $1,800.00 Applicant: ANDREW WEISMAN 45185 DESERT HILLS CT 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: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that 1 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 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 subiftts the applicant to a civil penalty of not more than five hundred dollars ($500).: t`�+ as owner of the property, or my employees with wages as their sole ompensation, 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 he or a did not build or improve for the purpose of sale.). II as owner of the property, am exclusively contracting with licensed contractors to n`sfruct the project. (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or imhereon, and who contracts for the projects with a contractor(s) license nt to the Con actors' State License Law.). am exempt under Sec. . B.&P.C. for th' VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 3/24/2017 Owner: .ANDREW WEISMAN 45185 DESERT HILLS CT LA QUINTA, CA 92253 Contractor: Llc. No. 0 N d4 4 M Q t— z w a~c'. a w F— o z F— w C3 0101 3 � w _ o U p z c.D Cn w 0 . 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: Carrier: N Policy Number: _ certify that in the performance of the work for which this i ed, I sha f employ any person in any manner so as to become s orkers' compensation laws of California, and agree that if I sho ject he workers' compensation provisions of Se ion 3700 Co e, I shall hwith 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 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 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-o'! d. CONSTRUCTION LENDING AGENCY 1 certify that I have read this application and state that the above infor ' n i orrect I hereby affirm under penalty of perjury that there is a construction lending agency for I agree to comply with all city and county ordinances �th�is ate la to building the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). construction, and hereby authorize representatives ofci upontheabove- mentioned fro�� for inspection purposes. Lender's Name: �`1 Ar � G' Lender's Address: Aa Application Number: BRES2017-0039 Property Address: 45185 DESERT HILLS CT APN: 604280015 Application Description: WEISMAN / ADD BAR SINK TO HALLWAY Property Zoning: Application Valuation: $1,800.00 Applicant: . ANDREW WEISMAN 45185 DESERT HILLS CT LA QUINTA, CA 92253 Owner: ANDREW WEISMAN 45185 DESERT HILLS CT LA QUINTA, CA 92253 Contractor: Llc. No.: Date: 3/24/2017 -------------------------------------------------------------------------------------------- Detail: BAR SINK ADDITION. THIS PERMIT DOES NOT INCLUDE POOL, SPA, BLOCK WALLS, ELECTRICAL WORK OR DRIVEWAY APPROACH. 2016 CALIFORNIA BUILDING CODES. FINANCIAL INFORMATION DESCRIPTION ACCOUNT QTY AMOUNT BSAS SB1473 FEE 101-0000-20306 0 $1.00 Total Paid for BUILDING STANDARDS ADMINISTRAT'ON BSA: $1.00 DESCRIPTION ACCOUNT QTY AMOUNT PERMIT ISSUANCE 101-0000-42404 0 $96.27 Total Paid for PERMIT ISSUANCE: $96.27 DESCRIPTION ACCOUNT QTY AMOUNT FIXTURE/TRAP 101-0000-42401 0 $12.67 DESCRIPTION ACCOUNT QTY AMOUNT FIXTURE/TRAP PC 101-0000-42600 0 $12.67 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: $50.68 DESCRIPTION ACCOUNT QTY AMOUNT SMI - RESIDENTIAL 101-0000-20308. 0 $0.50 Total Paid for STRONG MOTION INSTRUMENTATION SMI: $0.50 DESCRIPTION ACCOUNT QTY AMOUNT TECHNOLOGY ENHANCEMENT FEE 502-0000-43611 0 $5.00 Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00 i, "'`�,� Bin , Permit # .Project Address: CD -2 J i City of La Qui[ to Buifding 8t Safety Division 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-701,2 Building Permit Application and Tracking Sleet +4; j _s Qrner's Name: ° A. P. Number: Address: 5 — �' l-`! Legal Descr'iption: City, ST, Zip: , Q 4 ontra C ct r. r— 0 t Address: 1 r t t Tele hoot: P D 7 7 ....... ........... c o ,Project Description: :::::::: C Y, ST, Zip: Telephone: �L. 8 t State Lic. # : 7 t =City Lic. #.- Arch., Engr., Designer: Address: City, ST, Zip: Telephone: ... Construction ccuoanc Type: O Y• Y P State t to Lic. # - Project type circle one), New Add'n Alter Repair.air Demo 0 Nae of Contact Person:Donn�y s Sq. Ft.: #Stories: #Units: Telephone #of Contact Person: (7&0) 3�% — % q 5 Estimated Value of Project:Ly co ' APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rcc'd TRACKING FERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cates. Reviewed, ready for corrections Plan Chcck De[:osit Truss Cates. Called Contact Person Plan Check Balance • Tile 24 Calcs. Plans picked up Construction Flood plain plan Pians 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. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- 'rd Review, ready for corrections/issue Developer Imp:.ct Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees, n No 16 F Toa MA -3 446 COMM N OF LA QU1NTA ny OEVELOPMEN'r . � 45185 �Ese ar HiLLS C -b it 'B�s P;'O. Box 1504 LA QUINTA, CALIFORNIA 92247-1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & 'SAFETY DEPARTMENT (760)777-7012 FAX (760) 777-7011 PROPERTY OWNER'S PACKAGE 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 s ^ "tted in your na h ting yourself ss the LAkilder of the property improvements specified at am --[_k- �_ Zz 3 ,c erg r c. We are providing you with an 0wner-Builder Acknowledgment and Information Verification Form to Hake 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 understanc:ing of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner carrot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION A-Lq DIRECTIRead and initial each statement below to signs you understand or verify this information.. I 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 prov:•de 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. 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. /Ivk4. 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 frnancialaisk by hiring a licensed Contractor and having the permit filed in his or. her name instead of my own. /t / V"t-4 I understand:Contractors are required by law to be licensed and bonded in California and to list their license numbe permits and contracts.. is on understand if I employ or otherwise engage any persons, other than California licensed Contractcrs, 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. I understand if I am considered an `.`employer" under state and federal law, I must register with the state and fed government, withhold payroll taxes eral p yro ,provide workers' compensation disability insurance; and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject nu 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 thr work is performed under contract with a licensed general building Contractor: 4 (E.0 lit , pa 10(4 r ` 8. I understand as an Owner -Builder if I sell the property for which thiserr it is issued I•ma be held P y liable for any financial or personal injuries' sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. AA -VI understand I may obtain more information regarding my obligations as an."employer" from the Internal Revenue Service; the United States Srnall.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 1 880 0 3221-CSLB (2752) or www.cslb.ca.gov.for more information about licensed contractors. am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the party legally an financially sponsible for li o os@d construction ctivity the following,, address: V. I 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. jt`� i2. 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 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, this form' must be completed and signed by the property owner and returned to the .agency responsible for issuing the permi ;Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the agen'moi requir �o be presented when the permit is issued to verify the property owner's signature. ; Signature of property owner --- — Date: z -z. 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 owners signature. Property Owner's Signature: Date: �U��U� �� U�-��]F�A�TK�� XU�� ^ - �� - - SUB -CONTRACTOR _ � - —`- ` - _'_ ' . � JOB ADDRESSPERMIT. o ��VV0E BUILDER This form shall be posted on the.job with the Building Inspection Card at all times in a conspicuous place. Only persons � appearing on this list or 'their emp|oywes,a/aauthorized to work on this job. Any changes-tn'this list must be approved by the Building Division prior to commencement of work. Failure -to ournp|y will result in a stoppage of work and/or the voidance of bui|ding'errnit. For each applicable trade, all information requested below -must bocnnnpiotod by applicant. "On File" is notan acceptable nue. . .... ... Company Name Classification License Nurriber Exp. Date Carrier Name Policy Numb6r Exp 'Date License Number (e.g. A, 13, C-8) (xxxxxx) (xxlxx/xx) (e.g. State Fund, CalComp) (Format Varies) (xx/xx/x 02 C. CITY OF LA QUINTA BUILDING & SAFETY DEPT. APPROVED FOR CONSTRUCTION DATE U' 1 BY ( Y" dar S 1AK r CITY OF LA QUINTA BUILDING & SAFETY DEPT. APPROVE® FOR CONSTRUCTION DATE3 I -Ag BY z�i I GAY` Sl"lk, add;+-1yr> z W La Lu 14. CL CD O N w O ' � g au �. c c, 0 Q a Lu ca �