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09-0423 (BLCK)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 T4'!t 4 4 " BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Application Number: 09-00000423 Property Address: 54124 OAK TREE APN: 775-081-017- - - Application description: WALL/FENCE Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 144 Ap I� .. Architect or Engineer: 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 Professionals 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 five hundred dollars (5500).: (_) I, 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.). (_) I, 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 theieon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). (_ 1 I am exempt under Sec. , B.&P.C. for this reason Date: 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: LQPERMIT Owner: BAILLE RACHEL & GRA 54124 OAK TREE LA QUINTA, CA 92253 (760)314-9018 Contractor: Owner VOICE (760) 777-7012 FAX (760) 777-7011 :TIONS (760) 777-7153 Date: 5/06/09 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: Carrier - - - - - - - - - - - - - - - - - - - - - -- Policy Number I 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 rr 3700 of the Labor Code, I s ith comply with those provisions. Date:v )-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 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 und%r 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 cou ry t enter upon the above-mentioned property ;��iurpose D' ate:: " o;Sig`nature (A ,car)t.o Agent): Application Number . . . . . 09-00000423 Permit . . . WALL/FENCE PERMIT Additional desc . . Permit Fee 15.00 Plan Check Fee . Issue Date . . . . Valuation . . . . Expiration Date . . 11/02/09 .00 144 Qty Unit Charge Per Extension BASE FEE 15.00 ---------------------------------------------------------------------------- Special Notes and Comments 6 IN FT X 218"GARDEN WALL & 3110 IN FT X 218"GARDEN WALL CITY STANDARDS AND APPROVED PLANS. ---------------------------------------------------------------------------- Other Fees . . . . . ... . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged Paid Credited Due ------------------------------------- Permit Fee Total 15.00 .00 -------------------- .00 15.00 Plan Check Total .00 .00 .00 .00 Other Fee Total 1.00 .00 .00 1.00 Grand Total 16.00 .00 .00 16.00 LQPE"11T P.O.,�B-ox 1504 LA QUINTA" CALIFORNIA 9224.7-1504 BUILDING & SAFETY DEPARTMENT 78-495 CA(LE'TAMPICO (7 60) 777-70121. LA QUINTA, CALIFORNIA 92.253 FAX (760) 777-7011 PROPERYY;0W-NER S PACKAGE E. Diselosuribs&Fi'D**r'*m"'s'for Owner -Builders Applying .f--orConst-ru'ctig.,n-Pe,rmits MWORTANT! ' NOTICE -ATO : PROPERTY OWNER ..Dear Property Owner*. An. application. fora building petmit has been submitted in yo"u'r, name listing ,yourself :as the builder Of the .property -improvements specified -it W, e.areproviding,you with an: Ow led' n ton nerrB'UilderAckridW - and-Itif wmake you aware of your gifiefit orinati&b:►V,6rificA Form responsibilities -and possible risk you mai -indurbyta�iiigthi"sd-` -y th y permit:issue in purnameas, e Owner -Builder.. Wewill notrissttea-b.itild-mg'.p.ermittiiitit,'.yo.'u-::kave :read; initiiited.yoitr . understanding of,each. provision, signed, and returned:tho,is form to us at our official - address indicated. An agent oUthe owner cannot execute. this notice unless you, the property wner,obtain the prior approval of the permitting authofity. DI RECTIONS:R-ead'drid,*-iiiitirl,each. statement 6ito �you iuiniid&, understand 1. 1 understand a frequent -obtain an "Owner -Builder" practice of unlicensed persons i�­ to, have property owner building permit.'tiiaferroriebul�� implies that the propeity-own . er is providing his,or- he'?Iown� labor and s iiiaterial persdiially. 1, as an Owner -Builder, may be held liable and gubject 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. 0. 1 understand building permits, are not required 'to, be signed by property owners unless they are responsible for the construction and are.not , hiring alicensed: Contractor to.assume this responsibility. , 3. I understand as an "Owner on the permit. -Buildee, -am the responsible part of record. I understand that Lmay protect .;;.. : pons myself from potential financial risk* byhiring a licensed Contractor and having the permit filed in his' or her name instead of my own. Ai. I understand Contractors are required by law to belicensed and bonded in California and to list their license numbers on permits and contracts. 5. 1 understand if I employ or otherwise engage any liersons,,other. than California' licensed Contractors, and the total value .of my construction is at least five hundred dollars -($500), including labor and "materials, .1 may be considered an "employee' under state and federal law. 06- 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: contribute to unemployment I also undersLr penation. disability insurance;; and compensation for each "employee." my fiilure to abide'by these laws may subject me to serious financial risk. 07. 1 understand under Califo''a Contractors' State LicenseLaw, an Owner -Builder. who builds single-family residential structures cannot legally build them With the intent to -o f(ef . 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. �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 latent construction defects in the workmanship or materials. M � or9. I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue Service, the United States Sniall 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. A/0- I am aware of and consent to anwner-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: 1.L I agree that, as the party legally and financially responsible for this proposed construction activity, .l will abide by all applicable laws and requirements that govern Owner-Builders'as well as employers. /hav/�V� 12. I agree to notify the issuer of this form immediately of any additions; deletions, or changes to any of the information I eprovided 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 tialile for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors, you wdl.be responsible for verifying whether, or -not those Contractors are properly licensed, and the status of their wormers' 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 dri-ver'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. -Z i �/� Date: G f Note: The following Authorization Form is required to be completed by the proper. ty 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 agents) 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: Address of Authorized Agent: Tel No 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 Co be presented when'the permit is issued to verify the property owner's signature.. Property Owner's Signature: Date: 'Bin # City of Lal Quanta Building 8r Safety Division P.O. Box 1504, 78-495 Ca1Ie Tampico La Qdinta, CA 92253 - (760) 777-70:12 Building: Permit Application and -Tracking Sheet Permit # riSjec At 'dress: s fE ,.d4f• I I- F �. A 14 26 cr f ,. _Owners Name: �/( �vN.r /l -/,1..014 `r L_ (2 41 t_t_ t C A. P. Number: Address:t t S 'SL•F.: 2 � 0�4 Legal Description: i �C►_ty, ST,'Zip° .. L,/,JQac ,j C 2Z S3 jg6n—tractor: S C a may . :Te'lephone: 7� c� 31 t �. �i l fs. all Address: P`roject-Description: L s t , „q I-�— .7-.p City, ST, Zip: Telephone: <.;;;';•,.•:z„>::>•:::zs»>;:>;;:.::; :;_:>:. "�i:•i>i• J'ijik<ii;4iiJii::•ii:i tC:> State Lic. # : City.Lic. #; t`. 3 .:: i� t-1-, 144 Arch., Engr., Designer: Address: City., ST, Zip: Telephone: :: ;»;;:<f:>:::F.;;;:::•:>:>::>,;r.:>z:: f;.:•> .:.>::%%r ” Construction o Type: Occupancy: State Lic. #: . Project a circle one New Add'n Alter Repair Demo Name of Contact Person: . Sq. Ft.: #Stories'. # Units: Telephone # of Contact Person: Estimated Value of Project: APPLICANT: DO .NOT WRITE. BELOW THIS LINE # Submittal Req'd Reed TRACKING PERMIT FEES Plau Sets Plan -Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2n4 Review, ready for correctionsfissue Electrical . Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up. S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- '"' Review,.ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P;P. Pub. Wks. Appr Date of permit issue . School Fees Total Permit Fees