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14-0115 (RER)1.0. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application description: Property Zoning: Application valuation: Applicant: 14-00000115 49790 COACHELLA DR 646-240-0057 - - REMODEL - RESIDENTIAL LOW DENSITY RESIDENTIAL 5000 c&ht 4 4 Q" Architect or Engineer u�y BUILDING & SAFETY DEPARTMENT BUILDING PERMIT -------------------------------------------------- LICENSED CONk ECLARATION I hereby affirm under penalty of perjury that I am licen ed r ns of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Profe i and my License is in full force and effect. License Class: se 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 Iicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: 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 or she did not build or /�. , improve for the purpose of sale.). 01/1 `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.). am exempt under Sec. , B.&P.C. for this reason Date:% -11 —1 !1 Owner: CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction le ding agency for the performs of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name: Lender's Address: LQPERMIT Owner: _ JOHN COWDEN 49--790 COACHELLA D LA QUINTA, CA 92253 1 J ( 1 r Contractor: Owner VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 3/28/14 CIS QUINTA ----------------------------------------------— 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: Carri r 2013 Policy Number - - - - - - - - - - - - - - - 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 i2 3700 of the LOQLCode, I shall forthwi -comply with th apro Bions. Date; Applicant." WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE I NLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO E 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 Director of Building and Safety 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 authoriz repre entatives of this cou/gntt toen/ter upon the above-mentioned per—opperty"� for inspection pu oses. Dat, Signature Signature (Applicant or Agent): LQPERMIT ation Number . . . . 14-00000115 Permit . . . REMODEL 2013 Additional desc . . Permit Fee . . . . 48.62 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 9/24/14' Qty Unit Charge Per Extension 1.00 48.6200 ---------------------------------------------------------------------------- LS MISC REMODEL, 1ST 100 SF 48.62 Permit . . . PLUMBING 2013 Additional desc . Permit Fee . . . . 47.68 Plan Check Fee .00 Issue Date Valuation . . . . 0 Expiration Date 9/24/14 Qty Unit Charge Per Extension 3.00 11.9200 EA PLBG FIXTURE/TRAP 35.76 1.00 11.9200 ---------------------------------------------------------------------------- EA PLBG WATER'INST/ALT/REP• 11.92 Permit . . . MECHANICAL 2013 Additional desc . Permit Fee . . . . 95.34 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 0 Expiration Date 9/24/14 Qty Unit Charge Per Extension 1.00 35.7500 EA MECH FURNACE 35.75 1.00 11.9200 EA MECH APPL REP/ALT 11.92 1.00 35.7500 EA MECH CONDENSER/COMP 35.75 1.00 11.9200 ---------------------------------------------------------------------------- EA MECH VENT FAN 11.92 Permit . . . ELECTRICAL 2013 Additional desc . . Permit Fee . . . . 23.83 Plan Check Fee .00 Issue Date . . . . Valuation 0 Expiration Date . . 9/24/14 Qty Unit Charge Per Extension 1.00 23.8300 LS ELEC FIXTURES, FIRST 20 23.83 --------------------------------------7------------------------------------- Special Notes and Comments REMODEL - CONVERT 54 SQ. FT. OF DEN TO. NEW BATHROOM AND RELOCATE HAVC UNIT TO ATTIC. Application Number . . . . . 14-00000115 ---------------------------------------------------------------------------- Special Notes and Comments February 19, 2014 1:29:21 PM JJOHNSON. ---------------=-------------------------------------------------------- ---- Other Fees . . . . . . BLDG STDS ADMIN (SB1473) 1.00 PLAN CHECK, ELECTRICAL 23.83 PLAN CHECK, REMODEL 132.99 PLAN CHECK, MECHANICAL 57.20 PLAN CHECK,�PLUMBING 47.68 STRONG MOTION (SMI) - RES .50 Fee summary Charged Permit Fee Total 215.47 Plan Check Total .00 Other Fee Total 263.20 Grand Total 478.67 LQPERMIT Paid Credited Due .00 .00 215.47 .00 .00 .00 .00 .00 263.20 .00 .00 478.67 Bin # -7 6 City of La Quinta, -Building 8r Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # Project Address: Owner's Name: A. P. Number: -64b 240 Address: A -r-) - 790 Legal Description: row. I-on 17 5- T2,41Z 90 ­5 City, ST, Zip: Utbhl- (QJk &—EKA- j� Contractor: 7151p, Telephone: Address: Project Description: City, ST, Zip: Telephone: State Lic. City Lic. ZMM;Z9P-, Designcr:,Pz>� eztc+�Mv: Address: —7-7-67-7-fvl%.AJIZ:s%aO6 City., ST, Zip: 6N C)ZV I Telephone: _*i State Lic. #: . ....... .... . .......... Construction Type: Occupancy: Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person: 1?25 Sq. Ft.: # Stories: #Units: Telephone #,of Contact Person: 760346 W�� I Estimated Value of Proje,4 5 000 12- APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Reqld Rcc1d TRACKINGPERMIT FEES Plan Sets Plan Check submitted Item Amount Structural CaIcs. Reviewed, ready for corrections Plan Check Deposit Truss Cales. Called Contact Person Plan Check Balance. Title 24 CaIcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2" Review, ready for corre Electrical Subcontactor List Called Contact Person Plumbing Y Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading 1.'IN HOUSE:- 3rd Review, ready for corrections/issue Developer Impact Fee A Planning Approval Called Contact Person V) Pub. Wks. Appr Date of permit issue School Fees W AALOW W 1_7 I Total Permit Fees fl RECEIVED FEB 0 4 2014 CITY OF LA QUINTA COMMUNITY DEVELOPMENT 4 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 IWORTAN—V NOTICE TO FROR Tib OWNER Dear Property Owner. An. application for a building permit has been submits in your list� yourself the bpil N of the property improvements specified at 4q"q y r 0ay) Pr 10, i � u I r7 t'A , I Z V 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 -Budder. We will not issue a building permit until you have read, Wfiafed your understand of eac4'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. OV 'S AC -M WLEDGMINT AND VE 'KATION 6F.HWOPWAIWN DIRECHONS. 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 -Builder'' _VUding permit that erroneously implies that the owner is providing his or her own labor and material personally. I, as Party P � 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 co traction and are not hiring a licensed Contractor to assume this responsibility. r 3. I understand as an "Owner -Builder" I am the responsible party of record on the permit I understand that I may protect if from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. 'g�_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. qL 5.1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value o my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. qe 6. I understand if I am considered an "employer" under state and federal law, I must register with the state and federal rnment, 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 1 7,;. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential ctures 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. d 8. 1 understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable, for any ancial or personal. 4uuies sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. - 9. I understand I may obtain more information regarding my obligations as an "employee' from the Internal TLC Venue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand 1 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: 10. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the Arty legally and financially responsible . for proposed construction activity at the following address: I 1. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all a plicable laws and requirements that govern Owner -Builders as well as employers. 12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I �hive 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,. fire Contractors' State License Board may be unable toMth a—my, 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 unik4nscd Contractor or employee of that individual or firm is injured while working on your property; you may be heldliable 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 tkc property owner's diver's 1?cerese; farm rmts*aiidsN 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 � t/ 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 ,^ Scope of Construction Project (or Description of Work): YI KVJ . b of � Y ` 1,/ O o m Z� Project Location or Address: 4q- -110 C O q � h & l l / Dy,. J,& q j41 111 1X ?' Name of Authorized Agent: MKITOM I u O I/� 1� Zl 174✓I Tel No . 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 requir to be presented when the permit is issued to verify the prope owner's signature. (-u Property Owner's Signa Date:, j f�} 7?Q CITY OF LA QUINTA UB -CONTRACTOR_ LIST , JOB ADDRESS l ! J� - PERMIT NUMBER 4-'' l OWNER((�G Folf. _ _ , BUILDER This form shall be posted 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 permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response. Trade::::>:Classificati .n...... ... ra ::...::........ .......... r.............:.::.::.......... ,... .....:..:...:..`:,':«.:;.:: Stat�Contractors.. ic.erase....:............................ 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