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BRES2017-0057.4 Q�i aw -78-495 CALLE TAMPICO f D LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT BUILDING PERMIT Application Number: BRES2017-0057 Property Address: 77782 HERITAGE DR APN: 658425062 Application Description: PANC INVESTMENT LLC / ADD MAN DOOR TO GARAGE Property Zoning: Application Valuation: $300.00 Applicant: JOHN & PATRICIA REYNEN 78740 RUNAWAY BAY DR BERMUDA DUNES, CA 92203 LICENSED CONTRACTOR'S DECLARATION [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. 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 subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: I, as owner of the property, or my employees with wages as their sole ensation, 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 she did not build or improve for the purpose of sale.). ff 1, as owner of the property, am exclusively contracting with licensed contractors to C. n ruct 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 Cntractors' State License Law.). I am exempt under Sec. B. C. fort this reason Date:— ` I fOwner.- CONSTRU L NCY I hereby affirm under penalty of perjury that there is a onstruction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name: Lender's VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 3/31/2017 Owner: JOHN & PATRICIA REYNEN 78740 RUNAWAY BAY DR BERMUDA DUNES, CA 922 r` LIE 15 CI o C:= Contractor: C3 w` '� S OWNER BUILDER �' M 1 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 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:— Polity Number: _ t l certify that in the performance of the work for which this permit is issued, I shat not 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 Sectio of th;LCode, l shall forthwith comply with those rovisions. Date: 0 Applicant:— WARNING: FAILURE TO SECURE WORK RS' OMPENSAERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TOI INAL 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 t r upon the above- mentione prop e ty for inspection purposes. Date: Signature (Applicant or Agent): Application Number: BRES2017-0057 Owner: Property Address: 77782 HERITAGE DR JOHN & PATRICIA REYNEN APN: 658425062 78740 RUNAWAY BAY DR Application Description: PANC INVESTMENT LLC /ADD MAN DOOR TO GARAGE BERMUDA DUNES,.CA 92203 Property Zoning: Application Valuation: $300.00 Applicant: JOHN & PATRICIA REYNEN 78740 RUNAWAY BAY DR BERMUDA DUNES, CA 92203 Contractor: OWNER BUILDER Date: 3/31/2017 Llc. No.: -------------------------------------------------------------------------------------------- Detail: INSTALL 32" X 80" MANDOOR FROM GARGAE TO INNER COURTYARD HEADER IS PRE-EXISITING. PER PLANSPER 2016 CRC. IF ELECTRICAL SWITCH AND LIGHTING IS NOT EXISITNG NEW SWITCH AND LIGHT WILL BE INSTALLED. 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 Credit Card Fee 101-0000-43505 0 $4.02 Total Paid for Credit Card Fee: $4.02 DESCRIPTION ACCOUNT QTY AMOUNT SMI - RESIDENTIAL 101-0000-20308 0 $0.50 Total Paid for STRONG MOTION INSTRUMENTAT`ON SMI: $0.50 DESCRIPTION ACCOUNT QTY AMOUNT TECHNOLOGY ENHANCEMENT FEE 502-0000-43611 0 $5.00 Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00 DESCRIPTION ACCOUNT QTY AMOUNT DOOR/WINDOW, NEW/ALT, FIRST 1 101-0000-42400 0 $101.33 DESCRIPTION ACCOUNT QTY AMOUNT DOOR/WINDOW, NEW/ALT, FIRST 1 PC 101-0000-42600 0 $115.52 Total Paid for WINDOW/SLIDING GLASS DOOR/FENESTRATION: $216.85 `Lit y QUM& P.D. BOX 1504 LA QUINTA, CALIFORNIA 92247-1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT - (760)777 -70 12 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 subngi�ed in your name listing yourself as the ?uilder of the property improvements specified a�'��� We are rovidin — p g you with anOwner-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 caa- not 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 informatian. 71. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder" wilding permit that erroneously implies that the property owner is providing his or her own labor and imterial 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. (2: 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. tyseSPI understand as an"Owner-Builder" I am the responsible party of record on the permit. I understand that I may protect lf from potential financial risk by hiring a licensed Contractor and having the permitfiled in his or -her name instead of my 4r 1 understand Contractors are required by law to be licensed and bonded in California and to list their lice and contracts. nse numbers on p T'ts (- _5-�--1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value o 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 federal ve . ent, 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 Bri risk. e to .serious financial 42L 7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential s cret tures cannot legally build them with the intent to offer them for sale, unless all work is -)erformed by licensed b ractors 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. C 8: I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any ncial or personal injuries 'sustained by any subsequent owner(s) that result from any latent construction defects in the orkmanship or materials. f-'I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue c ,the United States Small -Business Administration, the California Department of Benefit Payments, and the California ion of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1- 800-321-CSLB (2752) or www.cslb-ca.gov.for more information about licensed contractors. 10. I am aware of and consent to an Owner -Builder building permit applied for in my name,and understand that I am the .legally: and financially responsible for proposedw construe'on activity at the r following address: I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all .e laws and requirements that govern Owner -Builders as.well as employers. l\ 12. I agree to. notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I rym e provided on this forLicensed contractors are regulated by laws designed to protect the public. If you contract with omeone 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 buildingpermit 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 to the agency is req r to b. esented when the permit is issued to verify the property owner's signature. f/ Sig�ture of property owner Date: 1 7// 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 Properly 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 verb the property owners signature. Property Owner's Signature: Date Bim # Permit ,# Project Address: %-7- J City of La Quin to Building 8t Safety Division . . 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-701,2 Building Permit Application and Tracking Sheet tri �'� • � Owner's Name: f -•A- A. P. Nwnber. j ,4X &.2 Address: �"1o A-4.zv 12 942 Z4 ✓ Legal. Description: /J % / City, ST, Contractor: or: rsTelephone: Address: L� >y Project Description: City, ST, Zi Qn . `{ Telephone: !O State Lic. # : City Lic. Arch., Engr., Designer: Address: City, ST, Zip: . Telephone: .................................................... Con tructi n Type: O ecu an cY: State to Lic. # ProJect type (circle 1e one : New Add'n f.lt er Repair.ai r Demo 0 Name of Contact Person: JJ Lor Sq. Ft.: � #Stories: � #Units: r Telephone # of Contact Person: �' Estimated Value of Project: 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 Depcsit Truss Calcs. Called Contact Person Plan Check Bala -ice. Til!e 24 Cales. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan god Review, ready for corrections/issue Electrical . Subcontactbr List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. II.O.A. Approval Plans resubmitted Grading IN ROUSE:- ''d Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks- Appr Date orpermit issue School Fees, I Total Permit Fees