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13-0001 (BLCK)TA P.O. BOX 1504 VOICE (760) 777-7012 78495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT - - Date: 1/02/13 Application Number: 13-00000001 Owner: Property Address: ' �--- -52110 AVENIDA MONTEZUMA MEEKS DAVID APN: 773-201-024-20 -000000- 52110 AVENIDA MONTEZUMA Application description: WALL/FENCE LA QUINTA, CA 92253 �: Property Zoning: COVE RESIDENTIAL ----------------------------k-- ILII Application valuation: 953 I D II 1 7�10 IJContractor:Applicant: Architect or Engineer: Owner qy OLA QUINTA -------------------- --- PIP ---------------------—----------—--------------------------—---------—--------------------------- LICENSED CONTRACTOR'S DECLARATION - WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations: Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect._ I have and will maintain a certificate of consent to self -insure for workers'�compensation, as provided Licepse Class: License No.: for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 'Date: Contractor: _ 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 OWNER -BUILDER DECLARATION insurance carrier and policy number are: 1 I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier Policy Number following reason (Sec. 7031 .5, Business and Professions Code: Any city or'county that requires a permit to I certify that, in the performance of the work for which this permit is issued, I shall not employany construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner so as to become subject to the workers' compensation laws of California, permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I should become subject to the workers' compensation provisions of Section . License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3700 of the La or Code, I shall forthwith comply with those provisions. that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by �1 y plicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: te� a ^-' licant: / 6 ( 1 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 WARNING: FAIL E TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND and who does the work himself or herself through his or her own employees, provided that the DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. ' 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.). APPLICANT ACKNOWLEDGEMENT (_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building -and Safety for a permit subject to the 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application. property who builds or improves thereon, and who contracts for the projects with a contractors) licensed 1. Each person upon whose behalf this application is made, each person at whose request and for pursuant to the Contractors' State License Law.). whose benefit work is performed under or pursuant to any permit issued as a result of this application, (_) I am exempt under Sec. , B.&P. for this reason 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 ' --p / performed under or following issuance of this permit. /date: �^ Z "' Cl 0 er: / 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 CONSTRUCTION LENDING AGENCY permit to cancellation. I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify that I have read this application and state that the above information is correct. I agree to comply with all work for which this permit is issued (Sec. 3097, Civ. C.). city and county ordinances and Wte laws relating to building construction, and hereby authorize representatives Of !P9 county to enter upon above-mentioned property for i ection purposes. Lender's Name: �J� `q �� at /JJ X.ture (Applicant or AgenU:� �1� Lender's Address: LQPERMIT - Application Number .. 13-000000.01 Permit WALL/FENCE PERMIT Additional desc . Permit Fee. . . 25.00 Plan Check Fee .00 Issue'Date . . . . Valuation 953 Expiration Date 7/01/13 Qty Unit Charge Per Extension BASE FEE 15.00 5.00 2.0000 HND BLDG 501-2,000 10.00 --------------------------------------- ---------------------------------------- Special Notes and Comments 36 L.F. 51 GARDEN WALL CITY STANDARD'& (2) 2' COLUMNS (ORCO SYSTEM) TO REPLACE - ORIGINAL WALL. WALL FOOTING -NOT TO EXTEND INTO RIGHT OF WAY. 2010 CODES. ----------------------------------------------------------------- Other Fees BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged Paid Credited Due -- ---------- ---------- Permit Fee Total 25.00 .00 ---------- .00 25.00 Plan Check Total -.00 .00 .00 -.00 Other Fee Total 1.00 .00 .00 1.00 Grand Total 26.00 .00 .00 26.00 LQPERMIT ,. _ S- .. i i 01= -L) IN BUILLING&SAFETYDEPT.APFI- . HF! D / F R C NS RUC iO ` DUEal t �,v w ay N v w* 3 6 — jil l/e / _ rF P.O. Box 1504 LA QUINTA, CALIFORNIA 92247-1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 1 BUILDING & SAFETY DEPARTMENT PROPERTY OWNER'S PACKAGE (760) 777-7012 FAX (760) 777-7011 Disclosures & Forms for Owner -Builders Applying for Construction Permits L1krr MUNT1 NOTICE To MQpEgTy O)MR Dear PvVerty Owner. An. application for a building permit has been submitted in your nage listing yourself as the builder of the .psopeity improvements specified at We am Provrding you with an Owner -Builder Acknowledgment -and Information Verification Form to make you awtaaje.of your Mponsrbilities and possible risk you may incur by having thispe mit_issned m your nam as the Owner -Builder. we will net issue a badldiag.permit until you tiave read, initialed your. agde:staasding of eadt'previadon, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execvte this:notice unless you, the Property owner, obtain the prior approval of the permitting authority - you CIiONS: Read and iiritial each stateirreratbe i+ t� signify you ww&mtarrd or very dais irtformaatiorr. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personaft.1, 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 eery property. ' 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. 3. I understand as an "Owner-Buildee' 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. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on pemuts and contracts. 5.1 understand if 1 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" L-6. unstate and federal law. 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. I 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. 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 financial or personal, b4uries sussed 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 lntersal 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.esib.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 ply legally and financially responsible for proposed construction activity at the following address: 1 LI agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable liws 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 in5arma61 I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with somoone who does not have a lir ease, the Contractors' State License Board may be unable to assist you with any &MWM loss you may sustain as a result of a complaint Your only remedy against unlicensed Contractors may be tn�civd court. It is also important for you to understand that if an uwlicensed Contractor or employee of that individual er fam is injured while wotting on your property, you may be held H*k for damages. If you obtain a permit as Owner -Builder and wilb to hue Conufttors, you will be reaponsiblo for ve&*ying vw ndw or not those Contractors are pt4erty Neeosed and The status of tonin woticers' oompensation ire coverage. Before a building permit can be issued, this form must be completed and signed by the property owner and retained to the agency responsible for isnuf.&e,pw=iL Nota: A copy of tke property owner's :'a fam 'g or other verrrcadon acceptable so the agency is required to be presented when dao psroat is issreeg to verify t&e property owner's signature. Signature of property own; 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 ageat(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 Authorized 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 of the owner's driver's license, form notarization, or other verification acceptable to the agency is required to be presmited when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: Bfn. # City. Of La Qutnta ' BulfCing a Safety Division P.O. Box 1504,78-495 Calle Tampico 1.a.Quinta, CA 92253 - (760) 777-7012 Building Penmit- Beaton and Tracking Sheet ' Permit # ` 13 \ Project Address: ' '-5_221() 44ACI /)A ^ &4,- zb Owner's Name:o&,S A P, Number. Address: .Z/1 b rt>"i �y�2Ulrl� . Legal Description:3<�-04 q Hare �iJlNL7// City, ST, Zip:,•A _ Contractor. Telephone: Address: Project Description: .City, ST, Zip: Telephone: State Lic. # : City Lia #; Arch, Engr., Designer. Address: , City., ST, Zip: Telephone: State Lic. #: Name of Contact Person: Construction Type:. Occupancy: . project type (circle one): New Add'n Alter Repair Demo Sq. FL: # Stories: #Unit; Telephone # of Contact Person: Estimatod Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE t q Submittal Req'd Reed TRACENG - PERMfr FEES Plan Sets Pian Check submitted Item . Amount Structural Cates. Reviewed, ready for corrections Plan Check Deposit. . Trus Cales. Called Contact Pcrson Pian Check Balance Tithe Zd Cales. Plans picked eP Canstractlan Flood plain plan Plans resubmitted • . Mechanical Grading plan Z'! Review, ready for rnrrectioasfissue ©ectrical Subcoatactor List Called Contact Person Plumbing Groat Deed Plans picked up S M.L H.O.A.Approval Plans resubmitted Gradlag- IN HOUSE:- s'" Review; ready for correctioni/issuc Developer Impact Fee Planning Approval Calk Contact Person A.LP.P. Pub. Wks. Aper Date of permit.issue School Fees } Total Permit Fees