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BRES2019-012478-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Permit Type/Subtype: Application Number: Property Address: APN: Application Description: Property Zoning: Application Valuation: T4hf 4 64� QU&&i DESIGN & DEVELOPMENT DEPARTMENT BUILDING PERMIT BUILDING RESIDENTIAL/REMODEL BRES2019-0124 57670 BLACK DIAMOND 762380025 SIRES INVESTMENTS/ ELECTRICAL AND PLUMBING FOR FUTURE BBQ $200.00 Applicant: SRES INVESTMENTS LLC - JOHN SEOANE 57670 BLACK DIAMOND LA QUINTA, CA 92253 n Q 0 V OR 2 3 2019 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 permit 0.�,V J.t:.cts the applicant to a civil penalty of not more than five hundred dollars ($500).: I, ps 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 did not build or improve for the purpose of sale.). as owner of the property, am exclusively contracting with licensed contractors to ns 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 hereon, and who contracts for the projects with a contractors) f7kced pursuant the Contractors' State License Law.). I am exempt under Sec. B.&P,C�aF�his a I hereby affirm under penalty of p0rury that thenKs a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name: VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 4/23/2019 Owner: SIRES INVESTMENTS LLC 57670 BLACK DIAMOND 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 for which this permit is issued. My workers' compensation insurance carrier and policy number are: CarriPolicy Number:_ I certify that in the performance of the work for which this permit is issued, I s hrlr4l mpioy any person in any ma nner so as to become subject to the kers' compensation laws of Cafifornia, and agree that, if I shout come subje the workers' compensation provisions of Section 3700 of th bon Co e, I S for comply with! base provisions. WARNING: FAILURE TO SECURE WORKS ' COMPENSAT N COVERAGE WUNLAWFUL, AND SHALL SUBJECTANEMPLOYERTCfCRIMINAL PEN LTIESAND CIVIL FINES UPTO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COSTOF 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 a ny 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 inform on is I agree to comply with all city and county ordinances and state la rel +ng to construction, and hereby authorize representatives of this ci o to upon th mentioned gropefty for inspection purposes. 4t4 r �I 1 � Signature (Applicant or Lender's Address:_ - Date: 4/23/2019 Application Number: BRES2019-0124 Owner: Property Address: 57670 BLACK DIAMOND SRES INVESTMENTS LLC APN: 762380025 57670 BLACK DIAMOND Application Description: SRES INVESTMENTS / ELECTRICAL AND PLUMBING FOR FUTURE BBQ LA QUINTA, CA 92253 Property Zoning: Application Valuation: $200.00 Applicant: Contractor: SRES INVESTMENTS LLC - JOHN SEOANE OWNER BUILDER 57670 BLACK DIAMOND LA QUINTA, CA 92253 Llc. No.: 3 i 4 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Detail: ADD GAS STUB OUT AND 4 OUTLETS FOR FUTURE BBQ. THIS PERMIT DOES NOT INCLUDE ANY OTHER WORK. PER 2016 CALIFORNIA ELECTRICAL CODE AND 2016 CALIFORNIA PLUMBING CODE. DESCRIPTION ACCOUNT I QTY I AMOUNT BSAS SB1473 FEE 101-0000-20306 j 0 j $1.00 Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 DESCRIPTION ACCOUNT QTY AMOUNT DEVICES, FIRST 20 101-0000-42403 0 $26.68 DESCRIPTION ACCOUNT QTY AMOUNT DEVICES, FIRST 20 PC 101-0000-42600 0 $26.68 Total Paid for ELECTRICAL: $53.36 DESCRIPTION ACCOUNT QTY AMOUNT PERMIT ISSUANCE 101-0000-42404 0 $101.40 Total Paid for PERMIT ISSUANCE: $101.40 DESCRIPTION ACCOUNT QTY AMOUNT GAS SYSTEM, 1-4 OUTLETS 101-0000-42401 0 $13.34 DESCRIPTION ACCOUNT QTY AMOUNT GAS SYSTEM, 1-4 OUTLETS PC 101-0000-42600 0 $26.68 Total Paid for PLUMBING FEES: $40.02 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 l Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00 Architect/Engineer Name: Construction Occupancy: Address: Grading: City, St, Zip Telephone: Email: State Lic: City `Bus Lic: J .� property Oirvner's Name:, Address:567 City, ST, Zip Telephone: Email: Bedrooms: I Stories: # Units: r✓ New Commercial / Tenant Improvements: Total Building SF ZZ Y Construction Type: Occupancy: 78495 CALLE TAMPICO LA QUINTA, CA 92253 760-777-7000 OFFICE USE ONLY I# i Submittal I Required I Received I Pian Sets Structural Calcs Truss Calcs Title 24 Calcs Soils Report Grading Plan (PM10) Landscape Plan Subcontractor List Grant Deed HOA Approval School Fees Burrtec Debris Plan Planning approval Public Works approval Fire approval City Business License -A Db 5-T u ¢ o2. fuTUi2p- C36Q — RDD VLEC'ieIcAc(, For, RI-rulk2 U60, - PCr 9.016 Cai.)fooul-k E Le C,T 21C kip ,DES ri r Q V LO Titf 4 4 a" P.O. Box 1504 LA QUINTA, CALIFORNIA 92247-1504 78-495 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 IMPORTANT! NOTICE TO PROPERTY OWNER Dear Property Owner: An application for a building permit has been ubrni ted in Xour name I#ting yourself s th uilder of the property improvements specified at _ (,z , We are providing you with an Owner -Builder Acknowledgment and informatio Verification Fo 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 DIR TIONS: Read and initial each statement below to signs you understand or verb this information. } .4 1 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 Iny property. 4aI'l understand building permits are not required to be signed by property owners unless they are responsible for the Jy ction and are not hiring a licensed Contractor to assume this responsibility. I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my 4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on its and contracts. 5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" der state and federal law. 6. 1 understand if I am considered an "employer" under state and federal law, I must register with the state and federal ernmeut, 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 Zr . -"]. 1 understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential �1" ct"I es 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. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any nancia or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the w rkxnanship or materials. - ;.�I� understand l may obtain more information regarding my obligations as an "employer" from the Internal Revenue the United States Small Business Administration, the California Departmen# of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact about licensed contractors. the California Contractors' State License Board (CSLB} at 1- 0-321-CSLB (2752) or www.cslb.ca.gov for more information erstand _1.0. I am aware of and consenthe t to an Owner -Builder building permit applied pp i on r n my name at an�endfollowingat ad�ess: arty legally and fin nc y respon ibie +for spas s � as the legally and financially responsible for this proposed construction activity, I will abide by all 1..1 agree that, party pli ble laws and requirements that govern Owner -Builders as well as employers_ deletions, or s to any of the f l agree to notify the issuer of this form immediately of h additions, signed to protecttheepublic, If you contract information iwith �e provided on this farm Licensed contractors are regulate Y be unable to assist you with any financial loss someone who does not have a license, the Contractors' State License Board may be in civil court. It is also you may sustain as a result of a complaint, Your only remedy against unlicensed Contractors may individual or firm is injured while working important for you to understand that if an unlicensed Contractoror employee0 as owner -Builder der and wish to hire Contra tars, on your property, You naay be held liable for damages. If you permit g whether or not those Contractors are properly licensed and the status of their workers' you will be responsible for verifyin compensation insurance coverage. permit can be issued, this form eco leted and signed by the property owner and returned to Before a building p lie ra clay owcr'ti driver's License, form notarization, or the agency responsible for issuing the t. N er Gopy reser�r 1 Jr" ttthe permit is issued to verify the property other verification acceptable to the Agency 's r red to p owner's signature. � Date: Signature of property owner is required to be completed by the property owner only when designating Note: The following Authorization Form an agent of the property owner to apply for a construction permit for the Owner_Builder. y AUT i19RIZATION OF AGENT TO AU I v1,4 rAeisr F A%X P '' -' � I hereby authorize Excluding the Notice to Property Owner, the execution of which I understand is m personal re onsibility, Y 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. — — (or Description of Work): Scope of Construction Project Project Location or Address: Tel No -- Name of Authorized Agent: Address of Authorized Agent: I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above otarizati verifica f the information and certify its accuracy- Note: A owner's driver's crit is issued to veorverify the prope�ty owneh'srsig to Leon acceptable to the agency is required to be presented when the Date: Property Owner's Signature: