BRES2018-033078-495 CALLE TAMPICO T41,1t 4 4o
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Permit Type/Subtype:
BUILDING RESIDENTIAL/REMODEL
Application Number:
BRES2018-0330
Property Address:
77841 CALLE SONORA
APN:
773272023
Application Description:
PALMER-SLIDING DOOR INTALLATION
Property Zoning:
Application Valuation:
Applicant:
PALMER LUANNE M & GERALD B
77841 CALLE SONORA
LA QUITA, CA 92253
f'CT 11 2018
cay0FLA0UINTA
COMMUNITY DEVELOPMEN [TOEPARTMENT
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 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
r } 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
XI,
he did not build or improve for the purpose of sale.).
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 Contractors' State License Law.).
() I am exempt under Sec. B.&P.C. for this reason
Date: Q
J s 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
Lender's
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/12/2018
Owner:
PALMER LUANNE M & GERALD B
77841 CALLE SONORA
LA QUITA, CA 92253
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.
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:
CartI Policy 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 of the Labor Co , shall forthwith
comply with those provisions.
Date: /0 he 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
above -mentioned property for inspection purposes.
:)ate: I I2- ' Signature (Applicant or Agent)'
Date: 10/12/2018
Application Number:
BRES2018-0330
Property Address:
77841 CALLE SONORA
APN:
773272023
Application Description:
PALMER -SLIDING DOOR INTALLATION
Property Zoning:
Application Valuation:
Applicant:
PALMER LUANNE M & GERALD B
77841 CALLE SONORA
LA QUITA, CA 92253
Owner:
PALMER LUANNE M & GERALD B
77841 CALLE SONORA
LA QUITA, CA 92253
Contractor:
OWNER BUILDER
Llc. No.�
Detail: REPLACE EXISTING (6) FOOT WIDE WINDOW AND (3) FOOT WIDE DOOR WITH A (12)FOOT (4) PANEL SLIDING DOOR.
FINANCIAL INFORMATION
DESCRIPTION ACCOUNT
CITY
AMOUNT
DEVICES, FIRST 20
101-0000-42403
0
$26.01
DESCRIPTION
ACCOUNT
CITY
AMOUNT
DEVICES, FIRST 20 PC
101-0000-42600
0
$26.01
Total Paid for ELECTRICAL: $52.02
DESCRIPTION
ACCOUNT
CITY
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
DESCRIPTION
ACCOUNT
CITY
AMOUNT
DOOR/WINDOW, NEW/ALT, FIRST 1
101-0000-42400
0
$104.03
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DOOR/WINDOW, NEW/ALT, FIRST 1 PC
101-0000-42600
0
$118.59
Total Paid for WINDOW/SLIDING GLASS DOOR/FENESTRATION: $222.62
•$280.14
CITY OF LA QUINTA SUB -CONTRACTOR, LIST
OWNER_
JOB ADDRESS_ _ - _. PERMIT NUMBER - - - - . _. � . .,_--__ -BUILDER
Card at all times in a conicuousla pce. Only persons appearing on this list or their employees
s �
are authorized to work
This formDeCti011
on this job. Any changes to this list must be approved by the Building Division prior to commencernent of work_ Failure to comply will result in a stoppage of
work and/or the voidance
of building permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response.
., ... -:. � , ' u
.. - •• .:..: .:.:.: ... ...:::..:.:.... 1CC�-'%ULiI�}CIi53Lip1l.iIF�
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. :.:..�'- .. .. ;.. SL.7,tC.-C1]r1[�aG[oT:5:L10Er1$C-=:;-'.... ..... .
Trade l.�l 1SSifICailpil- :::: :: ' . :::' . •{.oll.lr�lG nr - :.
r?� �i ess License.
Company Name Classification License Number Exp. Date Carrier Name Policy Number Exp. Date
(xxlxxlxx)
License Ivumuer Exp. Date
(xxxx) (xxlxxlxx)
(e.g. A, B, C-8) (xxxxxx) (xxlxxlxx) (e.g. State Fund, CalComp) (Format Varies)
EAHTt• WORK (Gi 1.2Y-, .
c6r4CRIRTE ( -8) . �;v
I
FRAfV iNG (C-a) ... /� /' '' [. , i' f �•Il
T -
'STRUCT- STEEL (C' 51)
MASONRY (C-7.0)
P'LUMB'ING IC-316)=.
LE17"N,•PLl15TE� (C,'35) ---
FIVAC (C720) _ -----
lrLECTRICAi (C-1'0)::.•...
rr r of ivc (c= G
GLAZING (C-'17}. ,r
INSULATION [C.-2)..: ..::
51rWACYE DISP. (C-42) T
erz.RAM1C
CABINETS (C-Cil --
FENCING (C-13) _— --
LA._. DSPAPING.(C 211.
GE:b1 gjrbr DFSER7 -
—
IrojectAddress: e�q//E Sn4r�
iPN#: 77-3 -Z72-'®Z3
applicant Name: aey- c fa Vrm p4-
lddress: Y f 34 3 5- a /, . f� i VW (� r[
City, ST, Zip: -T me c k I a eh 92-
Sq
Telephone:
Imai l
J l��e.a►�� 95-f
Contractor Name: (Dw WGQ- -�>V t
Address:
City, St, Zip
Telephone:
Email:
State Lie: City Bus Lie:
Arch/Eng Name:
Address:
City, St, Zip
Telephone:
Email:
State Lie:
City Bus Lie:
Property Owner's Name: 96 ra U 7
Address: ' J 3 t V-k
City, ST, Zip 7-e/p�ecda C4
Telephone: arGJ ,■l , !A-3
Email: .J PAL Mt�- ic 9 n-t [� �
PERMIT # "�"`"� l$ 033 C)
PLAN LOCATION:
Project Description: Pool, Remodel, Add't, Elect, Plumb, Mech
((1 rr• e �3 �r/� w+`�e dd�r tur�a �7% c ����
67 �D01oBi-/,ter C� /7yyj_C{�C'-�` GIT
eGr-�-r�� �rj.��1> �rY�U��r�s�a ►v der•%a.��
�N' Al r �
66uC i /`lam 4 Jl x-12 r%Gy
Valuation of Project $- ZT &%
New SFD Construction:
Conditioned Space SF
Garage SF
Patio/Porch SF
Fire Sprinklers SF
Construction Type:
Grading:
Bedrooms: I Stories:
Occupancy:
# Units:
� / kke,I,- I New Commercial / Tenant Improvements:
Total Building SF
�s Construction Type: Occupancy:
78495 CALLE TAMPICO
LA QUINTA, CA 92253
760-777-7000
TWyl 4 4Q"
BUILDING & SAFETY DEPARTMENT
78-495 CALLE TAMPICO (760) 777-7012
LA QUINTA, CALIFORNIA 92253 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 en ub ed in your 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 signs you understand or verify this information.
OP
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 am aware of the limits of my insurance coverage for injuries to workers
on my property,
)I' 2. I understand building permits are not required to be signed by property owners unless the are responsible
construction and are not hiring a licensed Contractor to assume this responsibility. y P for the
Af>
3. I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may rotect
myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my
j own.
,1W 4. I understand Contractors are required bylaw to be licensed and bonded in California and to list their license n
peamits and cantxacts. umbers on
5.. I understand if I employ or otherwise engage any persons, other than California lice
tal value
Of my construction is at least five hundred dollars ($500), including labor and materials, I licensed
be considered an"eomployer"
under state and federal law.
_�W6. I understand if I am considered an "employer" under state and federal law, I must register with the
government, withhold payroll taxes g state and federal
p 3� ,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
y residential
structures cannot legally build them with the intent to offer them for sale, unless all work lis performed ds lby !icensed
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.
ra
8. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held Iiable for any
fnancil or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the
workmanship or materials.
9. 1 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.c.slb.ca.gov for more information about licensed contractors.
AEl 0. 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I 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 ty, abide by all
applicable laws and requirements that govern Owner -Builders as. well as employers.
12. 1 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 t e agency is r urr to be presented when the permit is issued to verify the property
owner's signature. /W- I-) ,g I--)
Date: 20 jy
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 permitfor the Owner -Builder.
AUTHORICZATIQN Or' 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 owner's signature.
Property Owner's Signature: Date:
CadCe, SOF.O ra
77841 Calln Sonora �X/ j, dL0-1 J'
k1jlj
I
BUILDING DIVISION
REVIEWED FOR
CODE
COMPLIANCE
itesto ISOM 0330
l?g4 I CALM S0001e,Fi
/JT
10% zatl - 033 0 C, lvtY
7'7=4I tAu.E '49N04L4
61XNGrLA QUJ
SDIVISION
REViE11VFD FOR
.,�. CODE
I
i
ij
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3ftEPS2,618 - 0310 may:,
n'144l c*u.F SoNo" CITY
11 r
JELD-WEN Windows & Doors
2760 PROGRESS STREET
VISTA
CA
92081-8449
Sold To:039337
THE HOME DEPOT (CORPORATE USE ONLY)
ATLANTA, GA 30348-5524 USA
Packing List(PLANT) g
Order SW 1119528
Truck 90879 Load 465.812
Delivery Type SITE Load Dt 09/11/18
PO 30518240
ID EDI
Ship Via: Company Trk
Shipp To: Distribution Center
AMERICAN RELOCATION (CDS-LA)
13565 LARWIN CIRCLE
SANTE FE SPRINGS, CA 90670
562-229-3693
PALMER
Line Item/Description/Cult SKU Order Pa1Qty Qt Due UM TallyQ.t
-�. KH7621- VSDPR4N14I80-_..-------------------------------..__1.00
00-EA _----1.00
Premium Vinyl Sliding Patio Door , Nail Fin (1 1/41' setback),
4 Panel, US National-AAMA PG20, DP+20 -20, White Ext White
Int , OXXO - Passive/Active, Narrow S ile, Fits Roug Opening
141 X 80 , (Actual Frame Size 140 1/2 -in X 79 1/2 -in } (1/4
Vent) Vent width = 36 , Glass Breakage Warranty (RS Glass
Package) EStar South Central , Law-E 366 Clear Tempered ,
Argon 0 - 3500 feet , Select Screen with Fiberglass Mesh,
White Ext Hardware, White Int Hardware, , Clear 0 ening
58.4w, 76.4h, 31sf, Crate for Ship ing [NFRC - UPfact:0.28
SHGC:.22 VT:.51 CR:54 ER:17 CPD #: EL-A-697-11406-000011
IvL.d-L wel nL k 1DS ) : L 10 Toual rieces :
Carrier: Mine Trucking Log Delivery Terms:
TrailerNumber: 1W&lR
TY OF LA QUIN A
BUILDING DIVISION
REVIEWED FOR
CODE
COMPLIANCE
co
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//�� /// CITY OF LA QUINTA SLlB-CONTRCTO T _
JOB ADDRESS_.77041 `ialte 9�ar� PERMIT NUMBER �jfZES26lS���WNER � �A� • L��1� � „BUILDER
--
This form shall be roosted on the job with the 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 hermit. For each aDDlicable trade, all information renuested below must be cbmnfeted by annlicant_ "On File" is not an acceptable response.
Trade. / Classification
Contractor
State Contractor's L.iae..nse .
Workers Compensation. Insurance
City $usiness.Lieerase
Company Name
Classification
(e.g. A, B, C-8)
License Number
(xxxxxx)
Exp. Date
(xx/xx/xx)
Carrier Name
(e.g. State Fund, CalComp)
Policy Number
(Format Varies)
Exp. Date
(xx/xx/xx)
License Number
(xxxx)
''Exp. Date
(xx/xx/xx)
EARTHWORK (C-12):
CONCRETE (C-8)
FRAMING (C-5)
�whe, J 4, PiV
STRUCT. STEEL (G: 511
MASONRY (C-29.)
-
PLUMBING (C-36)
LATH, PLASTER (0-.3.5):
DRYWALL (C=9)
0 u, i-
HVAC (C-20)
ELECTRICAL (G-10)
R, OOFIIVG (C-39)
SHEET M1=TAL.(C43)
FLOORING (C-1:5.)
GLAZING (C-17)
INSULATION (C..2)
SEWAGE DISP. (C-42)
PAINTING (C-33)
CERAMIC TILE (C-54)
CABINETS (C.-6):
FENCING (C 13)
LANDSCAPING:(.C-27)
POOL- (C-53)