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BRES2019-0337ced�t Oil 78-49$ CALLE TAMPICO Df'l! LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT BUILDING PERMIT Permit Type/Subtype: BUILDING RESIDENTIAL/REMODEL Application Number: BRES2019-0337 Property Address: 80688 SPANISH BAY APN: 775310018 Application Description: WOLCOTT / OFFICE CONVERSION TO BEDROOM Property Zoning: Application Valuation: $5,000.00 Applicant: MIGUELTAFOYA D 80688 SPANISH BAY LA QUINTA, CA 92253 ®CT 3 n 2019 D'D VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Owner: CYNTHIA WOLCOTT 80688 SPANISH BAY LA QUINTA, CA 92253 Contractor: OWNER BUILDER CITY OF LA QU 1NTA Llc. No.: DESIGN & DEVEi�OPAEN i DEPARTMENT LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I 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 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 su ects the applicant to a civil penalty of not more than five hundred dollars ($500).: Lt,J* 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 9sthe 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 tractors' State License Law.). (^ am exempt under Sec. , B.&P.C. for this reason Date: d f !7 Owner: CONSTRU 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 Na Lender's Address: Date: 10/30/2019 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: Carrie : _ Polity Number: _ i certify that in the performance of the work far 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, I shall forthwith comply with hose provisions. z U 1 Date: + Applicant: WARNING: FAILURE TO SECURE WOR RS' 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 ,equest 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 Jefend, 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 `ollowing issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is not :ommenced within 180 days from date of issuance of such permit, or cessation of work 'or 180 days will subject permit to cancellation. certify that I have read this application and state that the above information is correct. agree to comply with all city and county ordinances and state laws relating to building :onstruction, and hereby authorize representatives of this city to enter upon the above- nentioned property for inspection purposes. �, a )ate: Signature (Applicant or Agent): Date: 10/30/2019 Application Number: Property Address: APN: Application Description Property Zoning: Application Valuation: Applicant: MIGUEL TAFOYA 80688 SPANISH BAY LA QUINTA, CA 92253 BRES2019-0337 80688 SPANISH BAY 775310018 WOLCOTT / OFFICE CONVERSION TO BEDROOM $5,000.00 Owner: CYNTHIA WOLCOTT 80688 SPANISH BAY LA QUINTA, CA 92253 Contractor: OWNER BUILDER Llc. No. Detail: REMODEL- OFFICE CONVERSION TO BEDROOM. THIS PERMIT DOES NOT INCLUDE ANY INCREASES TO THE CONDITIONED/LIVING SQUARE FOOTAGE. 2016 CALIFORNIA BUILDING CODES FINANCIAL DESCRIPTION INFORMATION ACCOUNT CITY AMOUNT DEVICES, FIRST 20 101-0000-42403 0 $26.83 DESCRIPTION ACCOUNT CITY AMOUNT DEVICES, FIRST 20 PC 101-0000-42600 0 $26.83 Total Paid for ELECTRICAL 2019: $53.66 DESCRIPTION ACCOUNT CITY AMOUNT PLAN CHECK DEPOSIT - ADDITION/REMODEL 101-0000-42600 1 $125.00 Total Paid for PLAN CHECK DEPOSIT - ADDITION/REMODEL: $125.00 DESCRIPTION ACCOUNT CITY AMOUNT RECORDS MANAGEMENT FEE - MAJOR 101-0000-42416 0 $21.00 Total Paid for RECORDS MANAGEMENT FEE - MAJOR: $21.00 DESCRIPTION ACCOUNT CITY AMOUNT REMODEL, EA ADDITIONAL 500SF 101-0000-42400 0 $24.15 DESCRIPTION ACCOUNT CITY AMOUNT REMODEL, EA ADDITIONAL 500SF PC 101-0000-42600 0 $19.32 DESCRIPTION ACCOUNT CITY AMOUNT REMODEL, FIRST 100SF 101-0000-42400 0 $54.74 DESCRIPTION ACCOUNT CITY AMOUNT REMODEL, FIRST 100SF PC 101-0000-42600 0 $149.73 Total Paid for REMODEL 2019: $247.94 DESCRIPTION ACCOUNT CITY AMOUNT TECHNOLOGY ENHANCEMENT FEE 502-0000-43611 0 $5.00 Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00 DESCRIPTION ACCOUNT CITY AMOUNT ALTERATIONS/ADDITIONS - RESIDENTIAL 101-0000-42400 0 $81.00 Total Paid for ZONING CLEARANCE - PLANNING PLAN CHECK: $81.00 c4aaiara —c;F,\ffi ./rFf IW, [-RI — PERMIT # x,,ee.5-;C0Vf PLAN LOCATION: Project Address: go(�O& <+ Project Description: Pool, Remodel, Add't, Elect, Plumb, Mech APN#: �� �" J IQ Tb ts- Applicant Name: �. Address; City, ST, Zip. '['ele hone: p ��) ��� -vS3 Email; © ri. yry�,� ) s @, 1- Valulu ation of Project 5 Contractor Name:. v New SFD Construction: Address: Conditioned Space SF City, St, Zip Garage SF Telephone: Patio/Porch SF Email: Fire Sprinklers SF State Lie: City Bus Lie: ame: IY�CZl/ �-��— Construction Type: Occupancy: Address: Grading: City, St, Zip Telephone: Bedrooms: Stories: F#Units: Email: State Lic: City Bus Lie: Property Owner's Name: G ll�Y�t New Commercial/Tenant Improvements: Address: Total Building SF City, ST, Zip Construction Type: Occupancy: Telephone. --, Email: 78495 CALLE TAMPICO LA QUINTA, CA 92253 760-777-7000 i P.O. Box 1504 LA QUINTA, CALIFORNIA 92247-1504 78-495 CALLS 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 submitted in your name listing yourself as the builder of the property improvements specified at 80680 Spanish Bay, La Quinta 92253 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 D�IIREECTIONS: Read and initial each statement below to signify you understand or verify this information. )d 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. 'ti' 3. 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 her name instead of my ow�n� 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. )VitS. 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 ate and federal law. 6. I Iuidersiand 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. x� 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 latcnt construction defects in the wor nship or materials. _: 9. 1 understand 1 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 I - 80sn 1-CSLH (2752) or www.cslb.ca.gov for ore information about licensed contractors. %f 1G. 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: t 11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicab laws and requirements that govern Owner -Builders as well as employers. x _ 12. I agree to notify the issuer of this form inunediately of any additions, deletions, or changcs 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 thoso 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. 2 Signature of property o4er"CLJA % _ _ — Date. October 30, 2019 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 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: Tel No _.. Address of Authorized Agent: Zach Mogan of Vacay Stay 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 r qe •ed to be presented lien the permit is issued to verify the property owner's signature_ Property Owner's5igna re: Date: OCtOber30, 2019