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10-0308 (BLCK)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Td4t 4 4ZQ," BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Application Number:1-0-00.0.00.30.8 Property Address: 51970a ENIDA OBREGON APN: 773 -164 -011 -11 -000000 - Application description: WALL/FENCE . Property Zoning: COVE RESIDENTIAL. Application valuation: 3350 Applicant: Architect Or Engine r. r LICENSED CONTRACTOR'S DECLARATION hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with. Section 7000) ofDivision 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, de molish,.or repair'any,structure; prior to its•issuance, also requires the applicanYfor the permit to file a signed statement that he or she islicensed 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 iheiefrom and the basis for thealleged exemption. Any violation of Section 7031.5 by - any aplicant for permit'subjects the applicant to a -civil penalty of not more than five hundred dollars ($500).: . 1'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 hiinself or herself through his or her own employees, provided that the improvements are.not.intended or, offered forsale; 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.). - (_ 1 1, as owner of the property, am exclusively contractingwith 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 theprojects with a contractor(s) licensed pursuant to the Contractors' State L' ns Law.). / 1 _ 1 I am exempt under Sec. . P.C. or this r�son / I hereby affirm under penalty of perjury that there is a construction ceding 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: GUTIERREZ CARLOTA 51970AVENIDA OBREGON LA QUINTA, CA 92253 (760)574-4939 _._..Contractor:.. Owner VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 4/13/10 D)Q I o� 3 2090 Cti `i OF LA QUINTA e FNC. C 01 zE"P 1. 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-ihe Labor Code, for the performance of the workfor -which this permit is issued. My workers' compensation insurance carrie,rand policy number are; - Carrier - - - - - - - - - - - - - =- - - - - - -' --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 subje5,to the workers' compensation laws of California, and agree that, if• o Id become subject t the workers' compensation provisions of Section 3700�of,the La r CoVe, I shall ,forth it mply. with those" provisions. - D` ate:• Applica ' WARNING: FAILURE TO SECURE WORKERS' COMPENSATI COVERAGE, IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED. THOU SAND DOLLARS 1$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 corre I agree to comply with all city and county ordinances and state laws relating to bui ng onstr and h y authorize representatives of this cougty to enter upon the above-mentioned propifirtyf9f in ion pyrp LQPERMIT - Application Number . . . . . 10-00000308 Permit . .. WALL/FENCE.PERMIT Additional desc . . Permit Fee 63.00 Plan Check Fee _ .00 Issue.Date Valuation 3350 Expiration Date 10/10/10 Qty Unit Charge Per Extension. BASE FEE 45.00 2.00'. 9.0000 THOU BLDG 2;001-25,000 18,00 Special Notes and rGomments 13;4 -:LN FT X 6 FT Ht BLOCK WALL PER CITY ..APPROVED" PLANS ': - -- ----- - - ""-- - - •- -------------------------------------------------------------------- Other Fees BLDG STDS ADMIN (SB1473) - 1.00 F66,Asummary Charged. Paid Credited' Due.' Permit Fee .Total. 63.0,0 .00 .00 6;3.00 Plarf "Check _totals 00 00 - 00 .00 - 00.:Other Other Fee Total 1:00- .00 .00: 1.00 Grand Total: 64.00- :00 .00 64.00 LQPERMIT - 0 .40 Fe Y\ c. f- 21� P.O. BOX 15.04 LA QUINTA' CALIFORNIA 9224771504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT (760) 777-7012 XROPERLCTNOWNER'S PACKAGE FAX (760) 777-7011 Disclosures & ForMs for Owner -Builders Applying for Construction Permits IMPORTANT! NOVICE TO PROPERTY OWNER :.Dear Property Owner: .An. --application fora .building permit has been �ubtnitted in your name ;listing. yourself as the builder of the .property improvements specified at. SI.T7,6 'Au b (,--in 6 n We are .providing you: with anOwner-$uilderAcknowledgpient and. nformation Verification Form to make you aware of your responsibilities and possible riskyouu ma y;,incur b:having,this permit issuedt id 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. f)fRECTIONS: Read `and iniiial each. statement below 1.6-sign.i_fyyou understand or verify"this information. C!9I . I understand a frequent practice of unlicensed persons is to have. the property owner obtain an "Owner -Builder" b. � mg 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 in I am willfully acting 8 an Owner -Builder and ani aware of the limits of my insurance coverage for injuries to workers on. my property. *2. I understand building permits are not. required to be signed by.property owners unless they are responsible for the ction and are not hiring a licensed.Contractor-to assume this responsibility. I understand as an Owner Builder" I arn'the responsible party`of record on the permit. I understand that Lmay protect myself froth potential financial risk by hiring a licensed Contractor and.havng,the permit filed in his or her name instead of my o I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. 5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value o 'construction is at least five hundred dollars ($500), including :labor and materials, I may be considered an `.`employer" er state and federal law. 6. [understand if I am considered an `.employer" under state and federal law, A must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment KI ation for each "employee." I also 'understand' my failure to abide by these laws may subject me to serious firiancial understand under California Contractors' StateLicense 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. u V qZ8. I understand as an Owner =Builder if I.sell the property for which this permit is issued, I may be held liable for any financral or personal. injuries susCained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. I understand I may obtain more information regarding my obligations as an "employee, from the Internal Revenue Se e, 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 (CS- LR) at I- 80000-32 -CSLB (2752) or www.csib.ca.gov for more information about licensed contractors. 6 il0. I am aware of and consent to an. Owner -Budder 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: agree that, as the party legally and financially responsible foe this proposed construction activity,.I will abide by all 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 he rovided 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 issaitug, the ermit. Note: A' copy of tlrrproperty owner's diriver's.license; form notarit a�bn; or other verification acceptable to: a agency � quire to be p ented when the permit is issued to verify the property owner's si,-nature. Signature of property Date: VAP`3-iv Note: Phe 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 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 tAuthorized Agent: Address of Authorized Agent: Tel No I declare under penalty of perjurythat 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 propertyowner's signature.. Property Owner's Signature: Date: Bin #., City of Ia Qurn to Building &r Safety Division P.O. Box 1504; X78-495 Calle Tampico La. Qulnta, CA :92253 = (760) 777-7012 Building. Permit Application and Tracking Sheet Permit # Pro'e ms c'� t'TAddress:Q ( ( Owners Name: A.- P..Number: Ai ddress: Legal Description: �Gity; ST—ZiP : Contrcto �ar - ,v,-�P2 -; ' flephone: ;;<y�i�:}>�;:y;:i�• �,v:. .�h. 'I'e �/� Address: �% Lly Cjl Proms ectDescription: - City, ST, Zip: Z l Telephone �� . . . . . . . . . . . .. • �':s��.�.`•x'>:y:<�:":�'"r?�<5'`>:r: State Lic. # : Ci Lic. #I- ,Arch., Arch.,Engr., Designer: Address: City.,. ST, Zip: Telephone: •:.r;• �;..ti;<.:is;;,<y:> :;�� " State Lic. #: Name of Contact Person: Construction Type: Occupancy: Project'type (ciccle.one):. New Add'n Alter Repair Demo Sq; Ft.: #Stories: # Units: Telephone # of Contact Person: BstimatedtValue ofProject:. APPLICANT ;ADO NOT WRITE:BELOW THIS LINE t! Submittal Aeq'd Recd*. TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cates. Reviewed, ready for corrections Plan Check Deposit Truss Cates. Called Contact Person Plan Check Balance, Title 24 Cates. Plans picked: up Construction Flood plain plan Plans resubmitted Mechanical Grading plan I V.Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- ''d 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