BWFE2014-114753590 Avenida Madero
BWFE2014-1147
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 9,(253
Application Number:
Property Address:
APN:
Application Description:
Property Zoning:
Application Valuation:
Applicant:
ERMA RENDON
OWNER BUILDER
LA QUINTA, 92253
BW FE2014-1147
53590 AVENIDA MADERO
774103004
BLOCK WALL CITY SZ
)ND)
Tit4t4laQ"
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
DEC 15 2014
CITY OF LA QUINTA
COMMUNITY DEVELOPMENT DEPARTMENT
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 Professions Code,
and my License is in full force and effect.•
License Class: License No.::CONV:140528101253000753
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 N
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
($500).:
(_) 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
/thereon, and who contracts for the projects with a contractors) licensed pursuant to
the Contractors' State License Law.).
( I am exempt under Sec. B.&P.C. for this reason
—*C Date:
Owner:
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
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 12/15/2014
Owner:
ERMA RENDON
53590 AVEN IDA MADERO
LA QUINTA, CV 92253
Contractor:
ERMA RENDON
OWNER BUILDER
LA QUINTA, 92253
Llc. No.::CONV:140528101253000753
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 3700 of the Labor Code, I shall forthwith
comply with those provisions.
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 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 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 city to enter upon the above-
mentioned property for inspection purposes.
Signature (Applicant or Agent):
d
•
P.O. BOX 1504
4
LA QUINTA, CALIFORNIA 92247-1504
78-495 CALLE TAMPICO
LA QUINTA,'CALIFORNIA 92253
PROPERTY O'
U
BUILDING & SAFETY DEPARTMENT'
(760)777-7012
FAX (760) 777-7011
' S TACKAGE
Disclosures & Forms for Owner -Builders Applying for Construction Permits .. .,
IMPORTANT! NOTICE TO PROPERTY OWNER
yf
� ? R
Dear Property Owner: f.
An application for a buildmi permit hasreen submitted in y ur nnaarrfe 1' ring yo se a the builder of the�property�
improvements specified at v { G(, L (—;�`
We are providing you with an Owner Acknowledgment and Information Verification Form to make yyoAu 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
DIRECTIONS: Read and initial each statement below to signify you understand or verify this information.
/1. I understand a frequent. practice of unlicensed persons is to' have the propertyi owner. obtain an "Owner -Builder"
building pemut,that.erroneously�imp`lies that the property owner is providing his oiher own labor and material personally. I, as
an Owner-Builde, `may be Fi�el'd lialilee 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 m}� property.
72. 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.
AI 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
o
1�
4. I understand Contractors are required b law to be licensed and n
q Y bonded m Caltforma and to list their license numbers on
permits and contracts.
V 5. 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.
Y 6. I understand if I am considered an "employer" under state and federal.law, I must register with,the state and federal
g eminent, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment
c mpensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial
r' k. .
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. I understand as an (iwner_RnilriPr if i ePll the .,r/V1PTh, Pnr uihirh rhic ,1Prm4 is icenPA r may hP hPli) 1,ah1P Fns anv
financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the
workmanship or materials.
Y9. I understand I may obtain more information regarding my obligations as an "employer" from the Internal 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.cslb.ca.gov for more information about licensed contractors.
'"'010. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the
pa legally and finanflTally respo ible for proposed construction a tivity at the following address:
a5 %0 Avtn, . M& r (oe. r
11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all
T applicable laws and requirements that govern Owner -Builders as well as employers.
O/V2,. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I
V 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 Lf'cense:Bbgrd jrtay be unable to -assist you with any financial loss
you`may sustain as a res I Wof a -complaint. You 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 issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or
other verification acceptable to the agency is required t be presented when the permit is issued to verify the property
owner's signature. A x.
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 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 ;t
the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner -Builder R
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 penaltyof perjury 1that 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 property owner's signature.
Property Owner's Signature: Date: t
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FINANCIAL .• 1•
DESCRIPTION i' 'ACCOIINT ,w. f
AMOUNT PAID, DATE
isn" 4 ,fii ;QTY
E" v „t ,PAID
et
BSAS SB1413 FEE
101-0000-20306 0
`$1.00 $0.00
r S 0 1D BY• `q, '. }
S METHOD xr. $ P: RECEIPT;# w ` ' x
CHECI(#CLTDBY-
.
* -
Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $1.00 $0.00.
rf ,r
ONT
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'CITY
PUNT
PAID
AID DATE'DESCRIPTION
p
t„
WALL/FENCE - EA ADDITIONAL 50 LF
101-0000-42404
0
$76.86
$0.00
'METHOD ".
4
RECEIPT #
r CHECK#
CLTD BYa'°-
r 'DESCRIPTI IN Ci r
ACCOUNT t;t. "
SC3TY`
AMOUNT
PAIDµ
rPAIU DATE
,.r;
»«.:
_
3 k.
WALL/FENCE - FIRST 100 LF
101-0000-42404
0
$47.86
$0.00
Hw? q YpPAID BY +, k
, METHOD'M'
r "•RECEIPT# ;
a CHECKj#
CLTD BY:
Y
x
F DESCRIP-TIONr,". a ^` 1;;
`' s^{'ACCOUNT i` `
-QTY
R xV'AMOUNT '
Y PAID- i p
PAID DATE:
Si
WALL/FENCE - FIRST 100 LF PC
101-0000-42600
0
$60.91
$0.00
`" .'° PAID.BY j ' " <,'
; `r :METHOD "= r
>;4 Y"itECEIPTy#_ `'-
"'` CHECK #z+'
CLTD BY''
Mn t
Total Paid forFENCE OR FREESTANDING WALL- $185.63•- $0.00
TO •
Description: BLOCK WALL CITY STANDARD
Type: WALL/FENCE Subtype: Status: SUBMITTED
Applied: 12/15/2014 PJU
Approved:
Parcel No: 774103004 Site Address: 53590 AVENIDA MADERO LA QUINTA,CA 92253
Subdivision: SANTA CARMELITA AT VALE LA QUINTA Block: 193 Lot: 21
Issued:
UNIT 19
;; PAID
Lot Sq Ft: 0 , Building Sq Ft: 0 Zoning:
Finaled: '
Valuation: $5,000.00 Occupancy Type: Construction Type:
Expired:
No. Buildings: 0, No. -Stories: 0 No. Unites: 0
Details: BLOCK WALL CITY STANDARD & PER APPROVED PLANS 71 LN FT X 5 FT HT 95 LN FT X 6 FT HT BLOCK WALLS SHALL BE PRECISION
CONCRETE BLOCK SHALL BE COVERED WITH STUCCO, PAINT, OR TEXTURED COATING WHERE VISIBLE FROM OUTSIDE THE PROPERTY.
2013 CALIFORNIA BUILDING CODES.BLOCK WALL
ADDITIONAL SITES
CONDITIONS
','DESCRIPTION ' ;
R "AMOUNT
`PAID
-ACCOUNT
QTY
;; PAID
DATE RECEIPT # CHECK # ;METHOD PAID BY .
4 .
BSAS SB1473 FEE 1 101-0000-20306
0
$1.00
$0.00
Total Paid forBUILDING STANDARDS ADMINISTRATION
$1.00
$0.00
BSA:
Printed: Monday, December 15, 2014 12:01:24 PM 1 of 2 C
SYSTEMS
.,6
`)K
77
TION
VA CCOUNT
AMO-
PAIUDATE",'RE
C EIPT#
HEC
t
41
WALL/FENCE - EA
101-0000-42404
0
$76.86
$0.00
ADDITIONAL 50 LF
WALL/FENCE - FIRST
101-0000-42404
0
$47.86
$0.00
100 LF
WALL /FENCE - FIRST
101-0000-42600
0
$60.91
$0.00
100 LF PC
Total Paid forFENCE OR FREESTANDING WALL $185.63 $0.00
TOTALS: $186.63 $0.00
I PARENT PROJECTS
ATTACHMENTS
Printed: Monday, December 15,2O14zZ131:24PK4 'ZofZCRWIYSTEMS
'-
47,
FOOTINGS
BOND BEAM
I PARENT PROJECTS
ATTACHMENTS
Printed: Monday, December 15,2O14zZ131:24PK4 'ZofZCRWIYSTEMS
'-
Bin #
City of La Q uin to
Building & Safety Division
P.O. Box 1504, 78-495 Calle Tampico .
La Quinta, CA 92253 - (760) 777-7012
• Building Permit Application and Tracking Sheet.
Permit #
Project Address: CJ 0 1`Y dam.
wrier 'sName:
Address: 2Z-7 % jt (yvvl
A. P. Number:
Legal Description: 21 11kiJIM661
City, ST, Zip:
49 l %
Co or:
Contractor:
%»
Tele hone: //__ -" ' o!' ' t•
P lo
Address:
Project Description:
City, ST, Zip:
Telephone:
<?'. « >`#;: #'%>.
&4' 4tz& Z)
State Lie. # :
City Lie. #;
Arch., Engr., Designer: _ ^
'` - ' T ,5 •%'
Address:
City., ST, Zip:
v
Telephone:
:,<<::<::'>.<;<•;: •rc>:''>.s<:
s:•. ----:::::::. •----:.-::::«« > :
Construction Type: Occupancy:
State Lie. #:
Project type circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:
#.stories: 11 Units
Telephone # of Contact Person:Estimated
Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
Submittal
Rcq'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Pian Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
'Plan Cluck Deposit
Truss Ca1e5.
Called Contact Person
Plan Cheek Balance_
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2°" Review, ready for corrections/issue
Electrical
•Subcontactor List
Called Contact Person
Plumbing
Grant Decd
Plans picked up
S.M.I.
Ii.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
i
'`d Review, ready for correctionstissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees