BRES2020-004478-495 CALLE TAMPICO
C O D sli ` ;CI1
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Permit Type/Subtype: BUILDING RESIDENTIAL/REMODEL
Application Number: BRES2020-0044
Property Address: 78620 AVENIDA TUJUNGA
APN: 770091012
Application Description: MILLER / ALTERATION TO GARAGE DOOR OPENING
Property Zoning:
Application Valuation: $5,000.00
Applicant: FD
CHRIS RALLS MAR 1, 7 2020
78620 AVENIDA TUJUNGA
LA QUINTA, CA 92253
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 subjects the applicant to a civil penalty of not more than live hundred dollars
A-s 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
Xe 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: �� Owner: Z�► 3
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 Address:
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/17/2020
Owner:
JOSEPHINE M. MILLER
78620 AVENIDA TUJUNGA
LA QUINTA, CA 92253
Contractor:
OWNER BUILDER -JOSEPHINE M. MILLER
78620 AVENIDA TUJUNGA
LA QUINTA, CA 92253
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:
Car ri Policy Number:
ertify 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, I shall forthwith
comply with those provisions.
Date: / / 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 the
above -mentioned property for inspection purposes.
Dater / Signature (Applicant or Agentf
Date: 3/17/2020
Application Number:
Property Address:
APN:
Application Description:
Property Zoning:
Application Valuation:
Applicant:
CHRIS RALLS
78620 AVENIDA TUJUNGA
LA QUINTA, CA 92253
BRES2020-0044
78620 AVENIDA TUJUNGA
770091012
MILLER / ALTERATION TO GARAGE DOOR OPENING
$5,000.00
Owner:
JOSEPHINE M. MILLER
78620 AVENIDA TUJUNGA
LA QUINTA, CA 92253
Contractor:
OWNER BUILDER-JOSEPHINE M. MILLER
78620 AVENIDA TUJUNGA
LA QUINTA, CA 92253
Llc. No.:
Detail: REMODEL -ALTERATION TO THE HEIGHT ONLY OF EXISITING GARAGE OPEN ING.[CONVENTIONAL] THIS PERMIT DOES NOT INCLUDE ALTERATIONS TO
LOAD -BEARING OR LATERAL -RESISTING COMPONENTS NOR ALTERATIONS TO OTHER AREAS OF THE HOUSE. 2019 CALIFORNIA BUILDING CODES.
DESCRIPTION ACCOUNT CITY AMOUNT
HOURLY CHARGE - CITY BUILDING STAFF 101-0000-42600 0.5 $80.50
Total Paid for BLDG CITY STAFF - PER HOUR: $80.50
DESCRIPTION
ACCOUNT
CITY
AMOUNT
BSAS SB1473 FEE
101-0000-20306
0
$1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
PARTITION
101-0000-42400
0
$80.50
DESCRIPTION
ACCOUNT
CITY
AMOUNT
PARTITION PC
101-0000-42600
0
$148.12
Total Paid for PARTITION 2019: $228.62
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
SMI - RESIDENTIAL
101-0000-20308
0
$0.65
Total Paid for STRONG MOTION INSTRUMENTATION SMI: $0.65
DESCRIPTION
ACCOUNT
CITY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
1 $5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
4 Qa&rev
- - GEM affix DESERT --
PERMIT # 'Be e-3z 0 z 6— ac)
PLAN LOCATION:
Project Address:
?g' 6 Ald?Ns 7o— Un el
Project Description: Pool(,, Remodel, Add't, Elect, Plumb, Mech
APN #:
't
G i 2 Its 7LD
If0 e- t r
Applicant Name:
rJ0
Address: -74f_AA&_V
r' �� / a
City, ST, Zip:
C
Telephone:
Email:
Valuation of Project $ J, oo, o0
Contractor Name: ow.4NE�L 701
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:
Arch/Eng Name:
Construction Type: Occupancy:
Address:
Grading:
City, St, Zip
Telephone:
Bedrooms: Stories:
# Units:
Email:
State Lie: City Bus Lie:
Property Owner's Name: S a C � �nCMiller
New Commercial / Tenant Improvements:
Address:
Total Building SF
City, ST, Zip Q qi
Construction Type: Occupancy:
Telephone:
Email:
495 CALLE TAMPICO
LA QUINTA, CA 92253
760-777-7000
t(v Qa 4 ( t(V
CALIFORNIA
Disclosures & Forms for Owner -Builders Applying for Construction Permits
MAr7PTdA1T1 AlnTlrg Tn POrIPPOTV r%UUKIC17
Dear Property Owner:
An application for a building permit has been submitted i5 your name listing yourself as the builder of the property
improvements specified at _q r
We are providing you with an Owner -Builder Acknowl(edgmeAt 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.
QM_ �R'S ACKNOWLEDGMENT AND VERIFICA TION 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-
Ider' 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.
�f �1'\2. 1 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. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license
numbers on permits and contracts.
�;L5. 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.
M.
6. 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.
'\7. 1 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.
58. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for
any fi ancial or personal injuries sustained by any subsequent owner(s) that result from any latent construction
defects in the workmanship or materials.
Page 3 of 4
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.cslb.ca.gov for more information about licensed
contractors.
k j1,�10. 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand
thWil am the party legally and financially responsible for proposed construction activity at the following address:
,!AL11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will
ab& 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 the agency is required to be presented when
the permit is issued to verify the property owner's sigrnatune
1 AASignature of Property Owner: Date 3Qa��
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.
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:fS 4,,2 Q A V u ni L LA
Name of Authorized Agent: (��v 'N S CJ Phone:
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 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.
Signature of Property Owner: C ] Date. ' 3 6
Page 4 of 4
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CITY O F LA QU I NTA
BUILDING DIVISION
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^^'' _ CITY OF LA Q.UINTA SUB -CONTRACTOR. LIST
JOB ADDRESS 7'o6 U S�` PERMIT NUMBER LRk$ A;,g7d�-Lq OWNER 7iti . �L' ,��o� BUILDER _
hi sh 1 b posted o i t ildin Inspeo-0-an Card_at a�mt's in conspic�otis�iacQ. 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 permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response.
Trade / Classification
Contractor
State Contractor's License
Workers Compensation Ins4rance
Cit Business License
Company Name
Classification
(e.g. A, B, C-8)
License Number
(xxxxxx)
Exp. Date
(xx/).x/xx)
Carrier Name
(e.g. State Fund, CalComp)
Policy Number
(Format Varies)
Exp. Date
(xxlxx/xx)
License Number
(xxxx)
Exp. Date
(xx/xx/xx)
EARTHWORK (C=12)
CONCRETE (C-8)
FRAMING (C-5)��
STRUCT. STEEL (C-51:)
MASONRY _(C=29)
PLUMBING (C-36)
LATH, PLASTER (C-35)
DRYWALL (C-9)
HVAC iC-20)
ELECTRICAL (C-10)
ROOFING (C-39)
SHEET METAL (C-43)
FLOORING (C-15)
GLAZING (C-17)
INSULATION (.C=2)
.SEWAGE DISP. (C-421
PAINTING (C-33)
CERAMIC TILE (C-5.4.)
CABINETS (C-6)
FENCING (C-13)
LANDSCAPING (C-27)
POOL (C-53)
GC'rNI r20f GVE