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BELC2018-000678-495 CALLE TAMPICO • . C� Q D LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT BUILDING PERMIT Permit Type/Subtype: Application Number: ELECTRICAL/ BELC2018-0006 n Property Address: �"�-- 78395 SINGING PALMS DR. D APN: 643181023 Application Description: SANTANA RESIDENCE/ PANEL UPGR -E JAN Property Zoning: Application Valuation: .OF(gpUIIVTA � ��' _!! JELOPMENTDEPART,Ir �' - -" Applicant: -----� CARLA SANTANA 2162 LEON AVE SAN DIEGO,CA 92154 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjurythat 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 y basis for the alleged exemption. Any violation of.Section 7031.5 by any applicant for a j 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 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 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.). (_) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. (Sec. 7.044, 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 Contractors' State License Law.). (_) I am exempt under Sec. . B.&P.C. for this reason 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 Add VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 1/16/2018 Owner: CARLA SANTANA 2162 LEON AVE SAN DIEGO, CA 92154 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 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: - Policy Number: I . _ 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 of the Labor Code, l shall forthwith comply with ase ovisions. t Date: �pplican 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 186 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 cit er upon the above-meion d property for inspection purposes. Date: / Signature_(Applicant or Agent . Date: 1/16/2018 Application Number:. BELC2018-0006 Owner: Property Address: 78395 SINGING PALMS DR CARLA SANTANA APN: 643181023 2162 LEON AVE Application Description: SANTANA RESIDENCE / PANEL UPGRADE SAN DIEGO, CA 92154 Property Zoning: Application Valuation: Applicant: Contractor: CARLA SANTANA OWNER / BUILDER 2162 LEON AVE SAN DIEGO, CA 92154 ----------------------------------------------------------------------------- Llc. No.: Detail: UPGRADE ELECTRICAL PANEL TO 200 AMP. PER 2016 CALIFORNIA BUILDING CODE ------------- FINANCIAL DESCRIPTION f •1. ACCOUNT QTY AMOUNT SERVICES 101-0000-42403 0 $26.01 DESCRIPTION ACCOUNT QTY AMOUNT SERVICES PC 101-0000-42600 0 $13.00 Total Paid for ELECTRICAL: $39.01 DESCRIPTION ACCOUNT QTY AMOUNT PERMIT ISSUANCE 101 0000-42404 0 $98.83 Total Paid for PERMIT ISSUANCE: $98.83 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 r Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00 TOTALS: I . RECEIVED 01/02/2018 01:09PM 7608348590 01/02/2018 10:42AM 7608348590 ALLPHASE DRYWALL & D ALLPHASE DRYWALL & D PAGE 02/02 Contractor Name: y , Address: s' `�� PERMIT # Conditioned Space Sl: City, St, Zip 1Ca 5 9Z2 n Telcphono: 1 �� Garage SF. Patio/Poreb SF Email: Co Allp Sufic ux.11. CDM -PLAN LOCATION: Project Address: "'�g�s ePal � � projeetDescription: Pool,Reuwdel,,gdd't, Elect, Flumb, lMec6 APN #: AppUcant Name: Address: ; City, ST, Tip•. L q Telephone: (D lti► - (�D Email �j► ,) . Valuation of Project 5 b �� Q i G Contractor Name: y , Address: s' `�� 'New Sl~D Construction: Conditioned Space Sl: City, St, Zip 1Ca 5 9Z2 n Telcphono: 1 �� Garage SF. Patio/Poreb SF Email: Co Allp Sufic ux.11. CDM Fire Sprinklos SF State Lic: 81302. City Bus Li c: ## Units: ArcWZng Name: Construction '] "C: Occupancy: Address: Gradlog: City, St, Z4p Construction Type: Occupancy: Telephope: Bedrooms: Stories: ## Units: Email: ' State Lir.: City Bus Lie: Property Owner's Name: �` Av �� 154t1 �Qnol New Coeaibercial /Tenant Improvements:. Address: Toral•Building SF Cityn ST, Zip Construction Type: Occupancy: Talepbone: tD l4 %t Email! Sir,i .78495 CALLE TAMPICO LA QUINTA, CA 92x53 760-7777000 ' 4 January 12, 2017 11 To :The City of La Q6inta 78-495 Calle Tampico La Quinta, CA 922531 Attn: Design & Development Department 1, Carla Santana property owner of, 78395 Singing Palms Drive, La Quinta 92253 authorize Mark Kerns to act on by behalf in reference to obtaining a building permit. Should you have any \ questions or concerns please do not hesitate to contact me at (619) 813-1685 or by email. Kinds Regards, Carla Santa s P.O. BOX 1504 LA QUINTA, CALIFORNIA 92247-1504 BUILDING & SAFETY DEPARTMENT 78-495 CAL,LE TAMPICO LA QUINTA, CALIFORNIA 9225.3 PROPERTY .OWNER'S PACKAGE (760) 777-7011 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 a been submitted in y ame lis Ing yo self as the b er of the property improvements specified at :3 64 We are providing you with Owner -Builder Ackno ledg . ent and Infon-nation e i cationForm to ma a you aware of your zesponsibilities 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. 1. 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 ani aware of the limits of my insurance coverage for injuries to workers on my property. ekI understand building permits are not required to be signed by property owners unless they are. responsible for the tion and are not hiring a licensed Contractor to assume this responsibility. 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. I understand Contractors are required bylaw to be licensed and bonded in California and to list their license numbers on penruts 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. . 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 Califomia Contractors' State License Law, an Owner -Builder who builds single-family residential al 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. JI understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any fliTancial orpersonal injuries workmanshipor materials. sustained. by any subsequent owner(s) that result from any latent construction defects in the A144. I 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 1 800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the arty legally, and financially responsible for proposed construction activity at the following address: n j I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all pplicable laws and requirements that govern Owner -Builders asmell as employers. 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 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 persons) 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 thatI 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 owner's signature. Property Owner's Signature: Date: