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BPLB2018-002178-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Permit Type/Subtype: Application Number: Property Address:. APN: Application Description: Property Zoning: Application Valuation: Applicant: ROBERT LINCOLN. 53405 AVE MADERO LA QUINTA, CA 92253 PLUMBING/ BPLB2018-0021 c ' 0 &t�p 4 4 umro DESIGN & DEVELOPMENT DEPARTMENT BUILDING PERMIT 51845 EISENHOWER DR 773174017 LINCOLN / SEWER CONNECT AND ABANDON SEPTIC $4,000.00 FEB 14 2018 CITY OF LA QUINTA COMMUNITY DEVELOPMENT DEPARTMENT LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 {commencing with Section 70001 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. 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 i F exemption. Any violation of Section 7031.5 by any applicant for a permit s the applicant to a civil penalty of not more than five hundred dollars ($500).: as owner of the property, or my employees with wages as their sole compensation, 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 town 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 o/r h�e did not build or improve for the purpose of sale.). dam'- 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 C ntractors' State License Law.). ,&–Ij am exempt under Sec. B.&P.C. for this reason Date: /`r%1 / Owner: 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 Date: 2/9/2018 Owner: ROBERT LINCOLN Contractor: OWNER BUILDER Llc. No.: 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 Df 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:_ Policy Number: _ I certify that in the performance of the work for which this permit is issued, I shalrnot employ 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 with those provisions. Date: �ki?��Applicant: 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. 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 representatives of this city to enter upon the above- mentioned property for inspection purposes. / Date: 10/e! . Signature (Applicant or Age e Date: 2/9/2018 Application Number: BPLB2018=0021 Owner: Property Address: 51845 EISENHOWER DR ROBERT LINCOLN APN: 773174017 Property Zoning: Application Valuation:- $4,000.00 Applicant: Contractor: ROBERT LINCOLN OWNER BUILDER 53405 AVE MADERO LA QUINTA, CA 92253 Llc. No.: Detail: ABANDON SEPTIC TANK AND FILL WITH SLURRY OR SAND, HOOK UP TO CITY SEWER. PER 2016 CALIFORNIA PLUMBING CODE. 1 0 I n FINAKi im IKIMOMATInKI 4 DESCRIPTION e ACCOUNT QTY AMOUNT BSAS SB1473 FEE 101-0000-20306 0 $1.00 Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 DESCRIPTION ACCOUNT QTY AMOUNT PERMIT ISSUANCE 101-0000-42404 0 $98.83 r Total Paid for PERMIT•ISSUANCE: $98.83 DESCRIPTION ACCOUNT QTY AMOUNT BUILDINGSEWER 101-0000-42401 -0 $26.01 DESCRIPTION ACCOUNT QTY AMOUNT BUILDING SEWER PC 101-0000-42600 0 $18.20 Total Paid for PLUMBING FEES: $44.21 DESCRIPTION ACCOUNT QTY AMOUNT RECORDS MANAGEMENT FEE 101-0000-42416 0 $10,00' Total Paid for RECORDS MANAGEMENT FEE: $10.00 DESCRIPTION ACCOUNT QTY AMOUNT TECHNOLOGY ENHANCEMENT FEE 502-0000-43611 0 $5.00 Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00 •0 1 Contractor Name: , JA Address: PERMIT #' 149' • ........__._ . <� ks��fi . faP r.� roc �:rrr- ..�....'........._; '. ' Telephone: 5 Zlk 09 f2 PLAN LOCATION: 5r_2`ecfAddrets ;P.roject_Deicriation: Pool, emodel,'Add'.t; Elecf; Plumb; M.ech APN #: S State Lie: City Bus Lie: pplicant Name: ; ,Address_ �.C��S~�T Z � Y,_._.., _.E 2 mel ��G^�� � a/ • � � � �� –Ema�I• ' / 4 aluation of Project co l/ P Contractor Name: , New SFD Construction: Address: Conditioned Space SF City, St, Zip Garage SF Telephone: 5 Zlk 09 f2 Patio/Porch SF Email: %a /D Fire Sprinklers SF State Lie: City Bus Lie: . Arch/Eng Name: Construction Type:, Occupancy - Address: Grading: City, St, Zip Construction Type: Occupancy: Telephone: Bedrooms: Stories: #Units: Email: ' State Lie: City Bus Lie: t I'iroper y-Gw-ner=sA_a.m.e, New Commercial /Tenant Improvements: :Address: Total Building _ SF Crit S�T; Zi Construction Type: Occupancy: e1e74" h—o Zak- , 78495 CALLE TAMPICO LA QU.INTA, CA 92253 , 760-777-7000 COACHELLA VALLEY WATER DISTRICT' - P.O. BOX 1058, COACHEL.LA, CALIFORNIA 92236 (760) 39872651. INVOICE Date: 10/13/2017 SUBJECT: SANTA CARMELITA, 51845 EISENHOWER DR., LA QUINTA, LID 682520 "SCC ONLY" ROBERT AND WENDY LINCOLN Project: 17-8388 51-845 EISENHOWER DR. Project Date: 10/13/2017 Amount Due: $4,851•.00 LA QUINTA,`CA 92253 GEO: 06-06-01-4 Planner: SARA LOPEZ TO INSURE PROPER CREDIT, PLEASE RETURN THIS PORTION WITH REMITTANCE AND INCLUDE THE PROJECT ON YOUR CHECK SUBJECT: SANTA CARMELITA, 51845 EISENHOWER DR., LA QUINTA, LID 682520 "SCC ONLY" COACHELLA VALLEY WATER DISTRICT P.O. BOX 1058, COACHELLA,.CALIFORNIA 92236 (760) 398-2651 Pagel P.O. Box 1504 LA QUINTA, CALIFORNIA 92247-1504 78-495 CALLE TAMPICO. LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT - PROPERTY OWNERS 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 submiitted inour 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 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 DIRECTIONS:'Read and initial each statement below to signify you understand or, verify this information. ty 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 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. a:�`' 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. A/-3. 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 f led in his or her name instead of my own. Yv 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. �. 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. I 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 to unemployment 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 re s ctures cannot legally build thewith 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. knancia I understand asan Owner -Builder if I sell the property for'which this permit is issued, I may beheld liable for any l or personal injuries' sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. , understand I -may obtain more information regarding my' obligations as an. "employer" from the Internal Revenue ervice,.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- 8007321-CSLB (2752) or www.cslb.ca.gov.for more information about licensed.contractors. �10. 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I.am the 1PanY. 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 applicable laws and requirements that govern Owner -Builders as.well as employers. . hP2. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the InformationI verovided on this form Licensed contractors are re ated b laws.desi ed to protect. the ublic. If you 1'� Y >� p p y 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. Itis also important for you to understand that if an unlicensed Contractor or employee of that individual or firm. i'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 permit. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable 4thency-is requir to be presented when the permit is issued to verify the property owner's signature. Signature of property owner Date: g 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 ACTON 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:.4 copy of the -owner's driver's license, form notarization, or other verification acceptable to the agency is required to bepresented when thepermit is issued to'verify theproperty owner's signature. Property Owner's Signature: Date: CITY OF LA QUINTA SUB -CONTRACTOR LIST JOB ADDRESS _ PERMIT NUMBERS 13, o1� ( OWNER - _ - -BUILDER l"leis form shall be posted on thc' iob withthe Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employees are authorized to work on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance of building permit. For each applicable trade, all information requested below must be completed by applicant.. "On File" is not an acceptable response. :..:. • = Cit Business License ..:. •Trade : Classr(rcatrott Ci7i7trctar, ;:. '::' :;.` State Contractor s License Workers Conipen atiort.InsuranCc Y. Company Name Classification License Number Exp. Date Carrier Name Policy Number Exp. Date License Number Exp. Date (e.g. A, B, C-8) (xxxxxx) (xx/xx/xx) (e.g. State Fund, CalComp) (Format Varies) (xxlxx/xx) (xxxx) (xx/xx/xx) EARTHWORK •1b12j.'.. y CONCRETE FRAMING (C-5) 'STRUCT:;STEEL MASONRY (C-29). PLUMbiNG (C-36)•; 103 w a3 a I_ATH,.PLASTER (C :-++:35) DRYWALL (C9),., :><. I-IVAC (C-20)--:: L•LEGTRICAL (C=10) .. ROOFING (C-39) ::: ....;. ShI1 ET META (C=43) FLO'OR)NG (C-15) GLAZING.(C-17) : :INSULATION fC�2). . SEWAG.G DISI?. (C-42) PAINTING (C-33) CERAMIC T1LE;:(C-50 CABINETS (C -G) FENCING (C.-13) .t.ANUSCAP.ING. (C-2.7) . .