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BPLB2017-0146M ao. VOICE (760) 777-7125 78-495 CALLE TAMPICO ++ Ct 4ht D !a . LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011 DESIGN & DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 11/7/2017 Permit Type/Subtype: PLUMBING/ Owner: Application Number: BPLB2017-0146 WILLIAM MALIK Property Address: 51100 CALLE .QUITO 118 S CALLE, ALTA APN: 770144010 ORANGE, CA 92869 Application Description: MALIK / NEW GAS SERVICE FOR ENTIRE HOME Property Zoning: Application Valuation: $3,000.00 Applicant: Contractor: WILLIAM MALIK ® OWNER BUILDER 118 S CALLE ALTA ORANGE, CA 92869 NOV ® 7 2017 CITY OF LA QUINTA DESIGN AND DEVELOPMENT DEPARTMENT Llc. No.: LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjurythat J 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 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 polity number are: C rrier: Polity Number: � I certify that in the performance of the work for which this permit is issued, I shall 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 Section 3700 f the Labor Code, 1 shall forthwith 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: > Ap Y/ 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 ($100,000). 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 FOR 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 the 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 did not build or improve for the purpose of sale.). 1. Each person upon whose behalf this applicarion is made, each person at whose -to- , 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 ,4th _ ntractors' State License Law.), �am following issuance of this permit. exempt under Sec. & C this g� 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 Lt 7ALt r"f for 180 days will subject permit to cancellation. CONSTRUCTION LENDING AGENCY 'I hereby affirm under penalty of perjurythat 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 represen atives this cienter upon theo above-mentioned property for' i p Date: 11/7/2017 Application.Number: ` Owner: Property Address: :7BPLB2017.0146 51100 CALLE QUITO WILLIAM MALIK' APN: 770144010 118 S CALLS ALTA Application Description: MALIK / NEW GAS SERVICE FOR ENTIRE HOME ORANGE, CA 92969 Property Zoning: Application Valuation: $3,000.00 Applicant: Contractor: WILLIAM MALIK OWNER BUILDER 118 S CALLE ALTA ORANGE, CA 92869 ' --------------------------------------- ---------------------------- Llc. No.: -------------------------- Detail: NEW GAS SERVICE. GAS RE-PIPE ENTIREHOUSE: DRYER, WH, COOK TOP, AFU, FIREPLACE, AND FUTURE BBQ. PEF. 2016 CALIFORNIA PLUMBING CODE. FINANCIAL •• • .-'DESCRIPTION ACCOUNT QTYAMOUNT ACCOUNT BSAS S61�473 FEE • 101-0000-20306 0 $1.00 AMOUNT TECHNOLOGY ENHANCEMENT FEE Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 0 $5.00 DESCRIPTION ACCOUNT QTY AMOUNT PERMIT ISSUANCE 101-0000-42404 0 $98.83 Total Paid for PERMIT ISSUANCE: $98.83 DESCRIPTION ACCOUNT QTY AMOUNT GAS SYSTEM, 5+ OUTLETS 101-0000-42401 0 $39.01 DESCRIPTION ACCOUNT QTY' AMOUNT GAS SYSTEM, 5+ OUTLETS PC 101-0000-42600 0 $26.01 Total Paid for PLUMBING FEES: $65.02 DESCRIPTION ACCOUNT QTY_ . AMOUNT RECORDS MANAGEMENT FEE 101-0000-42416 0 $10.00 Total Paid foi RECORDS MANAGEMENT FEE: $10.00 DESCRIPTION ACCOUNT QTY AMOUNT TECHNOLOGY ENHANCEMENT FEE 502-0000-43611 0 $5.00 Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00, I''°, New SFD Construction: PERMIT #' Conditioned Space SF City, St, Zip PLAN LOCATION Y Patio/Porch SF Projeet Ad.r1- ss- /1 Prod ject Descrijit'i-on:4�Pool; Remodel Add-t;�Elect; Plumb ech APN #: - State Lic: City Bus Lic: C, ! fV F_ L ek �� ►� �r_A-liptrcant��W I L -L / 4Nt %' I 14'L 7— -64u //V7-0 &Ax -7't ,6E !Addr-e s� s_f+ City,�ST;.Zi g ` - EEiin�ai+l Q/i �io �Q ��/� � as��alua'tion-df Project -$- Cont•r� a� cto 'Name;_ 1�L� New SFD Construction: Address: Conditioned Space SF City, St, Zip Garage SF, , Telephone: Patio/Porch SF Email: Fire Sprinklers SF State Lic: •� City Bus Lica' Arch/Eng Name: _ Construction Type: Occupancy:, Address: Giading: City, St, Zip Construction Type: Occupancy. •y Telephone: Bedrooms: Stories:' # Units: Email: State Lic: City Bus Lic: t Property Own:er�s�Name��YI 4Add�'mess +-TEl.ephon New Commercial/ Tenant Improvements: y � s. C - L ez— Total Building - SF City, ST-zi Construction Type: Occupancy. ` l• -,)2 —62- 6Z 2 T. E 78495 CALLE TAMPICO LA QUINTA, CA 92253 ` 760-777-7000 . J c R F-L W, OK e 1 90 F/p 3B 4 2 lig C-ITY OF LA QLKTA t i BUILDING & SAFETY DEPT. APPROVED c FOR .CONST CTION V DATE �� I • � adz � � - . �S�'�►VAN coP� 5iinn CALL9 t2u' I ro P.O. BOX 1504 LA QUINTA, CALIFORNIA 92247-1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 W BUILDING &- SAFETY DEPARTMENT PROPERTY OWNER'S PACKAGE (760) 777-7012 FAX (760) 777-7011 Disclosures & Forms for Owner -Builders Applying forConstrucB:ion Permits IMPORTANT! NOTICE TO PROPERTY OWNER Dear Property Owner: An application for a building t has bM ed your name listing yourself as the 'wilder of the property improvements specified at We are providing you with an Owner -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 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. 01. 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. 1, 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. u rte`. 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. Nom. 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 fier 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 permits and contracts. L461M. 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 cori:idered an "employer", under state and federal law. kJ47f4 I understand if I am considered an "employer'.' under state and federal law, I must register witE the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribite to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. �-M 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 tLe work is performed under contract with a licensed general building Contractor. .` v jA8. 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 . workmanship or materials. W ;t. 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- 800-321-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 thatI am the party legally. and financially responsible , for proposed construction activity at the following - address: agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all. applicable laws andrequirements that govern Owner -Builders as.well as employers. 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 bylaws designed to protect the public. If you contract with someone who. does not have a license, the Contractors' State License Board maybe 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 permit. Note: A copy of the property 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 owner's signature. / / Signature of property owner Date: < (.— 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 pernnt is issued to verify the property owner's signature. Property Owner's Signature: Date: CITY OF LA QUINTA SUB -CONTRACTOR. LIST JOB ADDRESS `the __ PERMIT NUMBER _ OWNER f „BUILDE(� -in acc. Only—persons appearing on this list or their employees are authorized to work This form shall be posted on the iob wiih Building Inst�ection Card at all times a consnictlous. �)4 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 permit. For each applicable trade; all information requested below must be completed by-opplicant.. "On File" is not an .acce.ptable response .building ..... ... .:.. .. , . .. .,.. ., _ ...• _. ::............... • .:. ....... .:.: .... t o. .... ....... .,,.:..>:. -:... �.... . _ � ..:.,.. State Contractor rkers C iii �cn a ion )ns...a •�. '13' LicGnYe ... -r C Ips snc�auon Tr c Ontrac r C Q ... 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) 1yF�F:ThiWOFtK(C 12) — MINNG (C'S) x ' "STRUCT STEEL (C ri1.} lVIl15ONRy (C 29) PLUMBING IC. 36} oU%N-F- I L .. °,HUAC fC 20) %�LEGTRICl1L.(.C;=7,'a)��»�• , >SF))wFT:IV(ETlIL (G 43)r` — — 'FLOORING (C 16) ., ' GLAZING (C 17) _ t Il11SU�ATlOt1( (C 2) ' ;SL1NlaG� D1SP (C �2j >irEl 'AIVII,G?TI.LE:.(C; - ---- Project ID 00000209423. 'xhibit A, SOUTHERN CALIFORNIA GAS CO. :E CALCULATION (ESTIMATES) **** PAYMENT RECEIPT ***+** 11/3/2017 4:05:14 PM TP2EMM y730751017 0089 5144 INDIO as Only Trench ISMS PROJECT 209423 10142.036 $3.752.93 ILLIAM MALIK $ 0.00 = $ 3076.17 18 SOUTH CALLE ALTA Allowance Applied NNE CA 92869- 'OTAL $� 00 $3,752.93 :ASHIERS CK $3.752.93 $ 3076.17 :HANGE $0.00 X 2 % _ $676.76 'YPE OFFICE SAVE TIME. DO MORE ONLINE_ $0.00 iO TO MYACCOUNT_SOCALGAS_COM TO VIEW. PRINT, & PAY. YOUR BILLS ONLINE. $ 3752.93 THANK YOU applicant provided trench will be treated per ts, if any, will be based on the agreed upon price per foot times the actual footage of the trench used. Form 3905-D, Effective 09/05 Line Extension Contract #: 00000209423-1 Detach and return this portion with your payment., Date Mailed 10/17/2017 THIS BILL IS NOW DUE AND PAYABLE ,� WILLIAM MALIK G. 118 SOUTH CALLE ALTA ORANGE, CA 92869 NBMS Project ID 00000209423-1 PLEASE PAY THIS AMOUNT 9200020942301000000037529300000 92 000209423 0 Line Extension Contract Project 209423 The Gas .Company A ,Sempra Energy utility' Applicant: ' Malik**William*" Fax: 0 Contact: William Malik Tel: 7146026228 From: JORGE CAZARES Fax: 7607739243 Address: 75095 MAYFAIR DR Email Address: JCAZARES@SEMPRAUTILITIES.COM City/ST/Zip: PALM DESERT CA `32211 5102 Tel 9093357634 Date: 10113/2017 The project planning and cost estimating for Project# 209423 has been completed and included with this letter. Under the Line Extension Rules, you have agreed to have SoCalGas perform the following gas facility installation: service.and.meter. Applicant provided gas only trench that SCG will back fill. SoCalGas estimated construction costs, (prior to applicable allowance, site area fees & taxes) are broke -.-i down as follows: Main 0 Stub - 0 Service 2681.55 MSA 409.62 Please execute vour Line Extension contract and return by email or fax to the followin Email: NBProcess-Inland@semprautilities.com Fax: 1-866448-3821 • If payment is due, please remit payment with Exhibit A Stub to: Southern California Gas Company Sundry Billing ML Z11 D P.O. Box 2007 Monterey Park, CA 91754-0957 Construction cannot begin until your signed Line Extension Contract documents and payment have been received and recorded by SoCalGas.. If you have any questions regarding this matter, please reply via'email or fax to the above' listed. Thank you, Southern California Gas Company New Business Process Team SCG Cover Sheet