BRES2019-002778-495 CALLE TAMPICO Ct 0 D 4uS1U�+4J
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Permit Type/Subtype: BUILDING RESIDENTIAL/REMODEL
Application Number: BRES2019-0027
Property Address: 78144 HACIENDA LA QUINTA
APN: 646280009
Application Description: ALLEN / STRUCTURAL RETROFIT AT GARAGE
Property Zoning:
Application Valuation:
Applicant: U
DARYL FRAZIER
59 PAYSON CIR FEB 0 8 2019
LA QUINTA, CA 92211
CITY OF LA QUINTA
DESIGN & 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 alleged exemption. Any violation of Section 7031.5 by any applicant for a
4n1,
suh)ects the applicant to a civil penalty of not more than five hundred dollars
as owner of the property, or my employees. with wages as their sole
sation,will da 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
with' one year of completion, the owner -builder will have the burden of proving that
she did not build or improve for the purpose of sale.).
1, as owner of the property, am exclusively contracting with licensed contractors
nstruct 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
there n, and who contracts for the projects with a contractor(s) licensed pursuant to
ntractors' State License Law.).
I am exempt under Sec. B.&P.C. for this reason.
I hereby affirm under penalty of per4jppthaCthere is a.9dfijymetron lending agency for
the performance of the work for which this permit is is ued (Sec. 3097, Civ. C.).
Lender's
Lender's Address:
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 2/8/2019
Owner:
GENIE ALLEN
78144 HACIENDA LA QUINTA
LA QUINTA, 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.
I have and will maintain workers' compensation insurance, as required by
Section 3700 of the.Labor Code, For the performance of the work forwhich this permit
is issued. rkers' eampensatinn insurance carrier and policy number are. -
Ca ' Polic umber: _
thatsn the.performance of the work for which this permit is issued, I
sha of mploy any person in arty 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 La E.0)e, I shall forthwith
comply with those provlsioq _-
- 0— V [ Applicant:
WARNING: FAILURE TO SECURE W0_RKERS'P6WENSATI E E IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CR INAL P IF$ CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS (SI00, . I TION 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
YYDdLI`Drr 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.
Dat r _ ( Signature (Applicant or Agent):
Date: 2/8/2019
Application Number:
Property Address:
APN:
Application Description
Property Zoning:
Application Valuation:
Applicant:
DARYL FRAZIER
59 PAYSON CIR
LA QUINTA, CA 92211
BRES2019-0027
78144 HACIENDA LA QUINTA
646280009
ALLEN / STRUCTURAL RETROFIT AT GARAGE
Owner:
GENIE ALLEN
78144 HACIENDA LA QUINTA
LA QUINTA, CA 92253
Contractor:
OWNER BUILDER
Llc. No.:
Detail: STRUCTURAL RETROFIT OF GARAGE ONLY [ENGINEERED] OCCUPANCY SEPARATION TO BE RECONSTRUCTED IF NECESSARY TO CURRENT CODE
STANDARDS. THIS APPROVAL DOES NOT INCLUDE ALTERATION TO MECHANICAL, ELECTRICAL OR PLUMBING INSTALLATIONS. 2016 CALIFORNIA BUILDING
CODES.
DESCRIPTION I ACCOUNT I QTY I AMOUNT
PLAN CHECK DEPOSIT - ADDITION/REMODEL 1101-0000-42600 1 $125.00
Total Paid for PLAN CHECK DEPOSIT - ADDITION/REMODEL: $125.00
DESCRIPTION
ACCOUNT
QTY
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
QaiaraPERMIT
#
PLAN LOCATION:
Project Address: D
J _ , , 7
Z-q Pno'e t Ue iptiart: Pool, Remodel, Add't, Elect, Plumb, Mech
APN #:
Applicant Name:"Q
Al
Address:
f
City, ST, Zip: '
Telephone: ,
'
Email:
Valuation of Projeet S' 9 `t
Contract9—t&
New SFD Construction:
Address:
Conditioned Space SF
City, St, Z
Garage SF
Teleph°ne'
Patio/Porch SF
Email:
T, i (—� I 1
I Fire Sprinklers SF
State Lic: City Bus Lie:
Arch/Eng Name: C Construction Type: (1� yP : Occupancy:
Address: C�
��r 1
Grading:
City, St, Zi
a
Telephone: '7
Bedrooms: Stories: E#Units:
Email:
State Lic: City Bus Lic:
operty Owner's Nam
New Commercial /Tenant Improvements:
[Address-
Total Building SF
y, ST, Zip
Construction Type: Occupancy:
Telephone:
Email:
78495 CALLE TAMPICO
LA QU I NTA, CA 92253
760-777-7000
/ CITY OF LA QUINTA SUB -CONTRACTOR_ LIST �J
JOB ADDRESS ` LCjOPE igN NUMBER r312t5Zo(`�-OOZ70WNER L ����!E ��C►.� „BUILDER `j —(--
This form :shall be posted on the job- with the Building I Section Card at allt mes in a conspLe-ugus 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
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Trade ! Classification
Contractor
State Contractor's License
Workers Compensation Insurance
City Business License
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 IC-5}r
1 • Cl 1� 1'Yl t'
d/ (
L(�
l47 T�y /
lT�/��
n �Z t (�
h 1111'7
bl_��V�
JI ��1
STRUGT. STEEL (C,`511:
MASONRY (C=29:)
`
PLUMBING (C-36)
LATH, PLASTER (C-35)
.DRYWALL (C-9)
HVAC (C-201
ELECTRICAL (C-1 { )
ROOFING (C-39..)
SHEET METAL (C-43)
FLO0RING (C-15)
GLAZING (.C-17)
INSULATION (C-2)
SEWAGE DISP. (C-42)
PAINTING (C-33)
CERAMIC TILE (C-54)
CABINET$ (C-6)
FENCING (C-13)
(C-27)
LANDSCAPING
C=53)
T44f 4 4 a"
P.O. Box 1504
LA QUINTA, CALIFORNIA 92247-1504
7$-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
PROPERTY OWNER'S PACKAGE
(760)777-7012
FAX (760) 777-7011
Disclosures & Forms for Owner -Builders Applying for Construction Permits
lAff WT9NP NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application for a building permit has been submitted your. n me listing yourself as the builder of the property
improvements specified at i� ,-j6 I �+ { t
We are providin
g g you with ati 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 verb this information.
C �� 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 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.
( _--3. 1 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.
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.
/6 X N 5. 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.
4':!) P 6. 1 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.
� 7. 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 the work is performed
under contract with a licensed general building Contractor.
AW- 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
financial or personal injuries sustained by any subsequent owner(s) that result from any WCnt construction defects in the
workmanship or materials.
. I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue
10 Service, the United States Small -Business Adnunistration, 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 I.
800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors.
zoo[CIO. I 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:
1S ---1 L I agree that, as the party legally acid financially responsible for this proposed construction activity, I will abide by all
applicable laws and requirements that govern Owner -Builders as well as employers.
CX"XVQ-12. I agree to notify the issuer of thus 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 field 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 o dr " �" � � I 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.�� i�,q�,!
Scope of Construction Project or Description of Work): f I v eAs
Project Location or Address: 79/
Name of Authorized Agent:
Address of Authorized Ager
65�_
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 thepermitis issued to verify the property owner's sighature.
Property Owner's Signature: Date: