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BWFE2015-0064LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that) 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.::CONV:140528101254135646 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) orthat 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 s owner of the property, or my employeesmith 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.):' ?06s owner of the property, arri 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 contractors) licensed' ursuant to the Contractors' State. License Law.). P-IoNm exempt under Sec. . e:&P.C. for this reason D Own Oita Y 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: WORKER'S COMPENSATION DECLARATION I hereby affirm under penaltyof perjury -'one of the following declarations: 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 Secti6n3700'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: Carr' r:_ Policy'Number: :►�I �:: Lce rtify that in the performance of the work for which this permit is issued, I sha117-66e mploy any person in any manner so as to become subject to the workers' cohnpensation. laws of California, and agree that, if I should become subject to the- workers he workerscompensation provisions of Section 3700 9OLLIageLoor Code, I,shall forthwith comply with those• provisions. 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; ANDATTORNEY'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 si bjecf permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree fo comply with all city and county ordinances and state laws relating to building construction; and hereby, authorize representatives of this city t enter upon the above mentioned propertyfor inspection purposes. Day? Signature (Applicant or Agent): 0 . I 78-495 CALLE TAMPICO Q.�i • D VOICE (760) 777-7125 LA QUINTA, CALIFORNIA 922` FAX (760) 777-7011 COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153 ! i BUILDING PERMIT Date: 4/1/2015 Application Number: BWFE2015-0064 Owner: Property Address: 53565 AVENIDA OBREGON PORFIRIO MENDOZA APN: 774114013 AVENIDA OBREGON Application Description: MENDOZA 100''OF V AND 6' BLOCK WALL AT SOUTH PROPERTY LINE LA QUINTA, CA 92253 Property Zoning: ��—" Application Valuation: $2,800.00 Applicant: I' Contractor: � ti PORFIRIO MENDOZA PORFIRIO MENDOZA w� CyLy AVENIDA OBREGON AVENIDA OBREGON ® sQ LA QUINTA, CA 92253 LA QUINTA, CA 92253 - c C) g (760)238-0960 a Llc. No.::CONV:140528101254 I LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that) 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.::CONV:140528101254135646 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) orthat 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 s owner of the property, or my employeesmith 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.):' ?06s owner of the property, arri 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 contractors) licensed' ursuant to the Contractors' State. License Law.). P-IoNm exempt under Sec. . e:&P.C. for this reason D Own Oita Y 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: WORKER'S COMPENSATION DECLARATION I hereby affirm under penaltyof perjury -'one of the following declarations: 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 Secti6n3700'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: Carr' r:_ Policy'Number: :►�I �:: Lce rtify that in the performance of the work for which this permit is issued, I sha117-66e mploy any person in any manner so as to become subject to the workers' cohnpensation. laws of California, and agree that, if I should become subject to the- workers he workerscompensation provisions of Section 3700 9OLLIageLoor Code, I,shall forthwith comply with those• provisions. 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; ANDATTORNEY'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 si bjecf permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree fo comply with all city and county ordinances and state laws relating to building construction; and hereby, authorize representatives of this city t enter upon the above mentioned propertyfor inspection purposes. Day? Signature (Applicant or Agent): 0 . 78-495 CALLE TAMPICO LA QUINT:A, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT (760) 777-7012 I AX (760) 777-7011 ROPERT Y _ O . �'.�",:1 `EEX IJ _ PACKAGE Msclosure.s & Forlrls for OWner.-Bnllders Applying for Construction Permits C14 P{�RT�41YZ7 NO'�')�CE TQ �ROPE>Et'>L Y OWNER Dear Property Owner An application -for a building :permit ,has, been submitted Jn .your name .listing yourself . as the guilder of .the property improvements specified at..G S kreN-10 ' _..n�2 tDoJ.... LJ� ( .1 i�•G12 2S3 We are providing *you with awO:wner-Buil ec Acknowledgment;and tnforiaation Verification Form to,.malce you aware of your responsibilities,and possible risk you.miy.incur by'having this.pem it:isv&ed-in y.oar:name ads the � , Owner -Builder.- Wemin not iss".a.bg#ding,permit qutil:you,l ave.read, initialed your. uadera Mding of.eack'previcion, signed, and retur ned 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. r1fM'i�tl'1":.d.1V7)+V�12:T6,'�G�`A_'If.i(:1T�I/.•1�-Y;11Ir`i613'Fl1i'�>il"6Y4iiN:. . 1 1 .tindemtartd a fr l�qE,M - cqucnt practice' of unlicensed persons, -is -to. have, the prof erty owner. obtain an "Owner-i3uildct" building 1*6111it That erroneously implies that the property owner is providing'Im or ltcr.awn labor aiid. matcnal:l ersonalijr L� asi an Owner-i3uilder, may be: lrc(d liable and subject to serious financial risk for any tniuiies:sustained by an tutlic. * od pans. 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•coveragc for injuries to -workers on my prim' F,�r•t 2_ 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. pF;,AA3. I understand as an "owner-Buildet" I am ttie responsible party of.recoird on the permit I understand that I may pirotect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his of her name instead of my p F A/14. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. r, C,ry 5.1 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. p•w46. I understand if I am considered an "employet"`undec state and .federal law, I must register with the state and federal compensation for each "employee." I also understand thy' 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.. R i tiodersland as an Owner -Builder if I sell the property for which this permit is issued, I may be he'd liable, for any ' financial or. personal, .owes austamcd by any subsequent owners) that result from any latent construction defects in the W0&1ianshi15 tir niatcrials. . I understand I may obtain more information regarding my obligations as an "emliioycs" {roro tlue lrutcrz►al Itcvenuc m Service, the United States Small Business Administration, tltoCaliforitia Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand ]may. contact. the California Contractors' .Stale License Board (QS03) .at 1- 800-321'-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. P. E,-4. 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: 1"11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that governOwner-Btdtdcrs as well as employers. PLC -J \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 liecasc, the Contractors' State License Boardmay be unable to assist you with any Fina Oki loss you may sustain as a result of a complaint Your only remedy against unlicensed Contractors may be in'civil coot_ It is also important for you tounderstand that if an uAlictused Contractor or employoe'of that individual or firm is injured wbile wwod dng on your property; you may be (held. liti Ale for darns . if you obftuui *A.— t pis ()wner-BUiJder :and Wish to hire Contractors, you will be responsible for Ve fying %toffiar:or4io( .diose Goniiactors arc properly licensed and .tlre sates of their wotkeW compensation iasuntnoe ooverago. 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 issaitag:tthc.perssu#. Now A copy of dkepreperf owner's diiver'sli arrsrt farm aur as Of other verification aeceptaMe to the agency is required to be presented when the permit is issrecii to'Per* the PrOP" owner's signature. Signature of property ownerI t 10 C i Date: D 'D 1 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.AGENTTO ACT ON I'IEZOPERTX OWNFR'S..BEHAI,F Excluding the Notice to Property Owner, the exemuon of which I understandds my personal responsibility, I hereby authorize the following persons) 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 (kuthorized Agent: 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 oj[he owner's driver's license, form nbtarization, or other verification,_ _ acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: _ 16 H CK 'OF "'E - w Wo 1� Qin # Qty ,of La Quinta Building 8T.Safety Division P.O. Box 1504, 78-495Calle Tampico La Quints, CA 92253 -.(760 )777-7012. Building Permit Application and Tracking Sheet Permit # Project Address: V tN I Owner's Name: D rt IV 2/S A. P. Number: Address: —S v eo Arj,c—koA.) Legal Description: City, ST,. Zip:. nr ; 2ZS3 Contractor: T - eleP e. hn• o 2 b Address: Project Description: City, ST, Zip: } cT A Telephone: P one: State Lic. # : . City Lie. #: Arch., Engr., Designer: / t Address: City., ST, Zip: Telephone: Co•n truction Type: Occu an cY State Lic. #: ProJect hPa circle one):: New Add'n Alter r ReP air Demo Name of Contact Person: Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: o^� Estimated Value of Project: o APPLICANT: DO NOT WRITE BELOW THIS LINE k Submittal Req'd Rec'd •'TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs.I.Called Contact Person Plan Check Balance Title 24 Cales. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2qd 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:- 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 ' f V'.r-2asr,=.,.ta;..:,,r: in,,,.(,r,..., ;.•+lan°' i?",�, ',"d'.'. �tr.',',�aa:.. °'..,r aw? .+�,.. r trz,.�,:�: MOUNT)'•�.. } �DESCRIR-T,IONC ACCOUNT:. ^QT;Y A.•PAIp�, a�PAIDpATE�' 0.6 : BSASSB1473fEE .. 101000020306 0 $3'x00 $0.00; ���MINN'1"tl. a*' %1.' ssNF`it PAIDBY METHOD. +I,'RECEIP�T�?#CLTDkBY ,,,'.3"i �a�s�i "r '..t�•.t ..x .r-,x . • �:.., k._rJ i a. ., .» . � ..,.... .-a. zx^.m ..n-0+ v�. s'....•. .., e,+ s e:.: ,�,.. 3�' R;r ."rww r�c3s4'`x�`•_ . 2.. Total Paid qo NILDING STANDARDS,,,_ ISTRATION}BSAcr4= " x$1.00 $0.00 :. acr Ar, - ` � f tih:NR7G.kC'%.:iP ,ry -_i UATENA PADyQ �. WALL/FENCE .FIRST 100 LF -101-0"404 $0:00 ,. ,.. nt(,°�+:•Zd:.''. �n �::r p. ....., I�{�'4P''' r C=..'.'.'EC 6ib' C INK"" is? =€'PAIDBY�"Ov�;z�4 METHOD�'7���RKEPT �HECK# , .RSessbF 4�?'�"Ws�aty� <y..• .�`.+&� �' �� ' �UESCRIPrTION. �`.;„��txa``r"3}�r�',��i�`,�=:�;es,�;�'. �, ,... ss t '-:,`+lwrf � �.�. , -. ';�.�� ehV�`' ? ` ?QTp t ". AMOUNT `.af ;, �/,g RAID �� PAIp�DATE ..a?SL�'cv�.:.tw..tsa�ffi� ani 4 i:'I��'Sk:.%?rna-'Sire WALL/FENCE ='FIRST 1001F PC r 1U1 0000=42600. ; < 0` * $60 91 $0.00 'j��h ��.k �'�c�,. R �:h*S�'�• ��5�"f��;" '�:Tf iSt. 6§,' .n :� °i� '^`+TOW."", n'� PAID.BYR�r I� ",rr,.fi". �.fiikN.%^"�Ir.'� METHODx� �rrFRECEIP�T#b OteT#fWrS�.:c+ �°r CHECK #r .F 0CLTU BY :. . ,., wxaI .,s. sE:-';t:, :acrd a,5^�.. c...tna. i M. �' •i > ..mi'�' a cY zu zM aM.�t Total Paid for FENCE OR FREESTANDING WALL 3 '� $108 77 $0 00 .. '.. .'. :.:.: ,.:�...-_.. ':.. _:..-... .. .. -.._�. .. ....:ae_-Kis .�h�:-FtC .A..L'ft1a P..s•.t+u?_s. w•�Fl:'.l.�, :ti. �.t.h:...�. �..1.!M�.... .1.., .+,4 k._?r la.. .,...—. i aY S. DOM, 40 i� Description: MENDOZA 100' OF 5' AND 6'. -BLOCK WALL AT SOUTH PROPERTY LINE Type: WALL/FENCE Subtype: Status: UNDER REVIEW Applied: 4/1/2015 SKH Approved: Parcel.No: 774114013 Site Address: 53565 AVENIDA OBREGON LA QUINTA,CA 92253 Subdivision: SANTA CARMELITA AT VALE LA_ QUINTA Block: 189 Lot: 3 Issued: UNIT 19 Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $2,800.00 Occupancy Type:, Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 Details: 10OLF OF 5'/6' GARDEN WALL AT SOUTH PROPERTY LINE [CITY SPECIFICATIONS] PRECISION CONCRETE BLOCK SHALL BE COVERED WITH STUCCO, PAINT, OR TEXTURED COATING WHERE VISIBLE FROM OUTSIDE THE PROPERTY. 2013 CALIFORNIA BUILDING CODES. i• •2. � � - "(` �+{.' 1 1 {�, i:- �.,+ �'4 �YSry ; Y it {,� 4 � --. i. _ ,ii£ 'Ft a ♦ • , �• i'bw•�{"����a i-. _ t ���r�`_ _jc;.- i ...��3Y` Z .- s- .: q t .... a .eg G- dl.: eT r ra- .i '+ •."` x - .tea+ "a � ' NAME.TYPE-` rNAME 'i ADDRESSl ' CITY ='STATE ZIP ;. PHONE FAX ,: EMAIL APPLICANT PORFIRIO MENDOZA AVENIDA OBREGON LA QUINTA CA 92253 (760)238-0960 CONTRACTOR PORFIRIO MENDOZA AVENIDA OBREGON LA QUINTA CA 92253 (760)238-0960 OWNER PORFIRIO MENDOZA AVENIDA OBREGON LA QUINTA CA_ " 92253 (760)238-0960, DESCRIPTION ACCOUNT QTY AMOUNT PAID �. PAID DATE RECEIPT'# {HECK #` METHOD PAID BY CLTD , BSAS 561473 FEE 101-0000-20306 0 $1.00 $0.00 Total Paid forBUILDING STANDARDS ADMINISTRATION $1.00 $0.00 BSA: Printed: Wednesday, April 01, 2015.1:35:20 PM 1 of 2 SYSTEMS opo D. • M • M res.. OF +.-_.�-,e ��".w,«<•.,"�. ;x T -r �"��:. Hs�.�.. �". � s ,.tet . � �'� DESCRIPTION ,ACCOUNT :'QTY:'. =,AMOUNT ' PAID PAID DATE RECEIPT # CHECK .# METHOD PAID BY B WALL/FENCE - FIRST 101-0000-42404 0 $47.86 $0.00 100 LF WALL/FENCE - FIRST. 101-0000-426000 $60.91 $0.00 100 LF PC Total Paid forFENCE OR FREESTANDING WALL, $108.77 $0.00 _ r. ��.� Y"i 7 �~ y; � i. •a:µs; • q 1 • s �,�'� - 1 1 1 Y �'§ of � r- �.-x 'r .,..r ... 3 a ::,. -•,. .34..„Y4 Printed: Wednesday, April 01, 2015 1:35:20 PM 2 of 2 SYSTEMS