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BLCK (09-0066)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 09-00000066 Property Address: 52120 AVENIDA MENDOZA APN: 773-233-006-17 -000000- Application description: ' WALL/FENCE Property Zoning: COVE RESIDENTIAL Application valuation: 1825 Tit!t'4 4 Q" Applicant: Architect or Engineer: PIP ------------------ LICENSED CONTRACTOR'S DECLARATION BUILDING & SAFETY DEPARTMENT BUILDING PERMIT 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 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, 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 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 I�Ql 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 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.). (_ 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.). (_) I am exempt under Sec. , B.&P.C. for this reason Date:V wner: CONSTRUCTION LENDING AGENCY ` I hereby of um 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: LQPERMIT Owner: SAM DONLEY 52120 AVENIDA MENDOZA LA QUINTA, CA 92253 Contractor: . Owner VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 1/28/09 -----------------------------------`c--'--------- 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 37PO of the Labor Code, I shall f hwi mpl with those /Date:2/ icant: WA ING: /AILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SU JECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS 15100,0001. 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 correct. I agree to comply with all city and county ordinances and slate laws relating to building construction, and hereby authorize representatives of this coun y�tio e r upo a above-mentioned property f finspecti rposes ate: / Za gnature (Applicant or Agentl: c/ Application Number . . . . . 09-00000066 Permit . . . WALL/FENCE PERMIT Additional desc . . Permit Fee . . . . 43.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 1825 Expiration Date . . 7/27/09 Qty Unit Charge Per Extension BASE FEE 15.00 14.00 2.0000 HND BLDG 501-2,000 28.00 --------------------7------------------------------------------------------- Special Notes and Comments 73 L.F. 6' GARDEN WALL, CITY STANDARD ---------------------------------------------------------------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary ----------------- Charged Paid -------------------- Credited -------------------- Due Permit Fee Total 43.00 .00 .00 43.00 Plan Check Total .00 .00 .00 .00 Other Fee Total 1.00 .00 .00 1.00 Grand Total 44.00 .00 .00 44.00 LQPERMIT v _._ ..e.+3.s'�'�,q.-�MlAµi+`'u :'�,.'�Grc ��,'�fxa. 5%, 't c• AE +'-`-�n�la4x'�ri�P.c:�rs'"'C^' _�t{ b,��fz '�+'.3' 7. Ki &'` -''.S �ri-v �x�y✓ t•ti.1 �p�� ucy' • i e� � �� L !'fwd i YYYYyW . w ^ i 3 . ..�. raa.,w, i• .i. `'£ G itl - aST ,_.. •_ yl .. -A i 113... _t..... _. i • .i..._. ... �, f.. _ .I ._ __ `+. f ! , f i i� 1 �•v � � -, CITY OF l.NQUINTA Ski:.} .BUILDING & SAFETY DEPT. e APPROVED z ` FOR CONSTRUCTION ZZ _.... i ' � • � -,DAT � E3Y.. .. �1 1 FF • 1 . : f ,� � ..Ywi" _'�6T+i1'I.?'F.�.1W''+.�,a�i.;3;Y.ae�llu ''� Jf-�i.�k� a� 1rJ.'*,:��,�'s>e�:f h+�E :l•.,i i � S �.%'�'F'4�-f-'--�a. ' �...n.:...e�a=aaa�.�.a..a_r...am. -.. ._ .tuNdkM�"�'+•w.-+ �'Y^.: .. .a.i..•+..-'^:"� - �- - ,.. �__..__._....ri-d-�� ..W' , / Lam' r ; I t i Tihf 4 44u&rw 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) 777-7011 Disclosures & Forms for Owner -Builders Applying for Construction Permits IMPORTANT! 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 `j 2 120 ,n M(_ 0 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 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 property owner obtain an "Owner -Builder" building 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 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. („�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. 11 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. (--T(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. C75. 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 ($500), including labor and materials, I may be considered an "employer" under state and federal law. 6. I understand if I am considered an "employer" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. �kj. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential structures cannot .legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. -_ �•I 'VI �uU9 1:r1L lc: Jk rru La UU1UTa BU11Ging/SaitV LafJ002/o02 I understand as an Owner -Builder if T•.sell the property for which, this permit is issued, I may be hold liable fort any financial or personal. jWuries. susl'aivaed. by •any subsequent owacr(s) that- result from any latent construction defects in. the workmanship or materials. �9. I understand i may obtain more information regarding my obligations as an "cznployef .firom the Internal Rev. Service, the Vnited States Small Business Administration, the California Dcpartment of Benefit Payments, and tho Califbmia Division of Industrial Accidents, I also understand I may contact the California Contractors' State License Board (CSLB) lat 1- 800 -321 -CSL$ (2752) or www.csib.ca.gov for 'more information about licensed contractors. 0_�11 10. 1: arts aware of and consent to art Owner -Builder building permit -applied for in trty name, and understand that I afn the party legally and financiakly responsible for proposed constru ton actio ty the (lowing address: �j 11. I• agree that, as the party legally. and 6 ancially responsibic for this proposed construction activity, .i will abide by all applicabio laws and requirements that govern Owner. -Builders as -well as employers. � Li 12.1 agree to notify -the issuer of this, form immediately of any additions- deletions; or ;ha�ogea to any of the inforcndtiori I have provided. on this form. Licensed contractors arc regulated by laws designed -to protect the public. If 'you contract with someone who does not have a lb*se,- the Contractors' State License Board maybe unable to assist you with any financitil loss YOU tray 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 Qvitraetor or ei niptoyee of that individual or f m is injured while we ddng on your property, you may be hold li.ablts for damages. If you obtain a permit as, Owner -Builder and wish to hire Contractors, you wM be responsible for verif�ring whether or not those. Contractors arc properly licensed and the status of their workers' compensation insurance coverage. Before a hujlding permit can be Issued, this forth must be completed and signed by the property owner and returned to the agency responsible for issuing the permt. ,Note: A copy of die property fWAer's deiver's &06$e, form notarizatW4 or ot/:cr vcrifcca[ion acceptable to the agency is required to be ,presented when the permit is issued to verify the Property orncr's siggatltrG. Signature of property owner pate; 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. A.UTHORIZAUON OF AGE, NT ACT ON PROPERTY O'WNER'S BE' HALF Excluding the Notice to Property Owner, the execution of which I understand iR nay pet5on.al responsibility., I hereby authorize the following) persons) to act as my agent(5) to apply for, sign, and file the documents necessary to obta an.Owraet-l3ttildcr Permit: for my project. u n1 r Scope of Construction Project (or Description of Work): p! t-?{ •Q,A� Z' , t Prcjei t Location or Address: 2120 tic' w ' 1u`- Ud2.� • C \fin Name of Authorized .Agent: � V, Aa (7 C O C t _ O _—_ _ Tel No 3 � 3 , -3 � � ` 706 -3 o_7V 7,a - t; f G 7 :i Address of Authorized Agent: S Z d - �.V_ . /� C N P0 �_ L&A_u t ,Q T 6 �4 q �� I declare under penalty of perjury that 1 am the property owner for the address listed above and I personally filled out the above 'information and certify its accuracy. Note; A copy pfthe owner's driver's license'. arm notarization, or other veri�cation acceptable to the agency is acquired to be pr en thepermIt is isssrted to verily the property owner's signature, Property Owner's signature: Bin # City of La Quinta . Building u Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # � OR Project Address: Owner's Name: >° A. P. Number: Address: 2 o , I 41 Legal Description: 22 City, ST, Zip: 2`25 7 Contractor: Telephone: 3?0 Cp6 3 I Q�2 Address: Project Description:73 City, ST, Zip: Telephone: City Lic. #: State Lic. # : Arch., Engr., Designer: Address: City, ST, Zip: Telephone: State Lic. #: Construction Type: Occupancy: S� , ew Project type (circle one Ndd'n Alter Repair Demo Name of Contact Person: Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # 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. Called Contact Person Plan Check Balance Energy Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2id Review, ready for correctionsfissue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. N.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 Ll I I Total Permit Fees