10-0486 (BLCK)P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153.
BUILDING PERMIT
Date: 6/07/10
Application Number: 10-00000486 Owner: 1f &A
PropertyAddress: 54659 AVENIDA MONTEZUMA MARKWARDT THOMAS J 1�
APN: 774-264-003-3 -000000- 54659 AVENIDA MONTEZ
Application description: WALL/FENCE LA QUINTA, CA 92253' �?
Property Zoning: COVE' RESIDENTIAL
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Application valuation: 900
CITY Cr
Contractor: t_- J' :1 :�..._7 -°tom
Applicant: Architect or Engineer: Owner — –
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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 - 1 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-irisure for workers' compensation, as provided
License 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 forwhichthis permit is issued. My workers' compensation
OWNER -BUILDER DECLARATION insurance carrier and policy number are:
1 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 toI artily that, in the performance of the work for which this permit is issued, I shall not employ any
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 Labor 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 (/
Jnr applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: ate: . ' "/�TOSEZRE
:
1 V ) 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 WARNING: FAIL ORKERS' 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.).
(_ 1 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 thereon, 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
ate: _ % �ner:
CONSTRUCTION LENDING AGENCY
1 hereby affirm under penalty of perjury t Zhere 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
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 c my ordinances and state laws relating to building construction, and hereby authorize representatives
of thi ounty to enter upon the abo -mentioned pro pe for inspection purposes.
ate: ' % Wil/ Sig re (Applicant or Agent):
Application Number . . . . . 10-00000486
Permit . .
. WALL/FENCE PERMIT
Additional desc .
Permit Fee . . .
. 23.00 Plan Check Fee
.00
Issue Date . . .
. Valuation
900
Expiration Date
12/04/10
Qty Unit Charge Per
Extension
BASE FEE
15.00
4.00 2.0000 HND BLDG 501-2,000
8.00
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Special Notes and
Comments
36 L.F. 6' GARDEN
WALL .@ SIDE P/L, CITY
STANDARD. 2007 CODES.
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Other Fees .
. . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary
Charged Paid Credited
Due
Permit Fee Total
23.00 .00 .00
23.00
Plan Check Total
.00 .00 00
.00
Other Fee Total
1.00 .00 .00
1.00
Grand Total
24.00 .00 .00
24.00
LQPERMIT
I
SITE REQUIREMEMTS
ItMf?IOR LOQ'
SIDEYARD. 5 FEET RF.ARYARD: 10 FEET
. M]T11MUIv1 EACH SIDE,hi]Ti1IvILJM
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FRONT'YARD:
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PROPER'T'Y
LINES
B
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W?
CURBLINE
June 7, 2010
To City of La Quinta:
I, as owner of the property at 54-661 Avenida Montezuma, La Quinta, CA, hereby acknowledge and give
my consent to a block wall being built on the north side of our shared property line with and by our
neighbor Thomas Markwardt.
Sincere[ ,
Rex Slezak
. 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) 777-70I1
Disclosures & Forms for Owner=Builders Applying for Construction Permits
WPORTANT! NOTICE TO PROPERTY OWNER
Dear Property Owner.
An. application for a building permit has been submitted .in your name listing yourself as the builder of the property
improvements specified at
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 -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.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION.
-DIR 'CTIONS: Read and initial each statement below 6 signify you understand or verify this information.
I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder"
building permit that erroneousl implies that
Y imp the property owner is providing his or her own labor and material personally. 1, as
an Owner -Builder, may beheld 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.
r/� 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.
TAXI understand as an "Owner -Builder" 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
permits and contracts.
I15. I 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.
. 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.
LYN. 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. I understand as an Owner -Builder ifl:sell the property for which this permit is issued, I may be held liable for any
rf nancial or personal. injuries susutined. by any subsequent owner(s) th6t result fromany latent construction defects in the
workmanship or materials.
ZIN. I understand I may obtain more information regarding my obligations as an "employer" from the Inter -Bat 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 (CS -LB) at 1-
800-321-CSLB (2752) or www.csib.ca.gov for more information about Iicensed contractors.
TALNO. 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:
I. 1 agree that, as the party, legally and financially responsible for this proposed construction.activity,.i will abide by all
pplicabie laws and requirements that govern Owner -Builders as well as employers.
MM12. I agree to notify the issuer of this form immediately of any additions; detetions, 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 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 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 issuiing. the permit Nate: A.copy of the propertyowner's driver's.tki!mei foim 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
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 AG—ENT-T-0 ACT ON_RROPF.RTY__QWNER'S BEHALF
Excluding. the Notice to ro wner, dheexecv no of which I understand. is my personal resp nsi x ty, l 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): 66,ck. IA -&l I
Project Location or Address: 5q&561 A V4'AI JA I V 10V1k,Zg" U Q I rrk 64 q% -a-93
Name of Authorized Agent: J 255e. Tel No 960- 09'1 -Ml
Address of Authorized Agent: 54"o AV mV,d, 4 or(e*m , (tel Qui)' A. CIA 3
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 presented when the permit is issued to verify the pro rty ner's signature..
Property Owner's Signature: Date: ZrO
Bin #
City of La Quinta
BAUng &r Safety Division
P.O. Box 1504, 78-49S Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Pem* # p,�
U
Protect Address: 5 5� i DYIi �7 t lJ�
'Owner'.s Name: TTom Mw k wak-cL+
A. P. Number.
Address: 54&55 Atw4A
Legal Description:
Contractor: 077b hbUI
City, ST, Zip: L,. Gh gaa53
Telephone: (�a-7 rj I- V39
Project Description: 9 I be vl L I I
i� 3 (0 L
" `.� �'
Address: 5 ` &5q jd� 1 r�Urr�7�Gt
City, ST, Zip: 1-4- l y ( 11 c13 a 53
Telephone: +' 0-911-.3931
State Lic. # :
City Lie. C
Arch., Engr., Designer: n )
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:
#Units:
Telephone # of Contact Person:
Estimated Value of Project 'F3,01)0
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKIIVG
PERMTf FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cala.
Reviewed, ready for corrections
Plan Check Deposit
'Fuss Cala.
Called Contact Person
Plan Check Balance
Title 24 Cala.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for correctionossue
Electrical
Subcontaetor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S M L
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
3" 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