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12-0404 (BLCK)rA. 's P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 12-00000404 Property Address: 52665 AVENIDA CARRANZA APN: 773-285-021-8 -000000- Application description: WALL/FENCE Property Zoning: COVE RESIDENTIAL Application valuation: 1250 Applicant: Architect or Engineer: OiP •4 �7� I�IIN� VOICE (760) 777-7012 FAX (760) 777-7011 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 4/13/12 Owner: ALLA TITENSKY 52665 AVENIDA CARRANZA LA QUINTA, CA 92253 --------------------------------- -------------------------------------------------- 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 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 anyPpplicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500)•: 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and YYY 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 _ 1 I, as owner of the property, am exclusively contractin ith licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Cont ors' State License Law does not apply to an owner of property who builds or improves thereon, and w contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law. 1 _ I I am pxemptmunder Sec. , B.&P.C. for thi eason ate: � ner: I hereby affirm under penalty of perjury that then work for which this permit is issued (Sec. 3097, Lender's Name: Lender's Address: LQPERMIT AGENCY agency for the performance of the Contractor: D Owner -------------------- --=-Arbwt � Z01z ----------- - ------ 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 whi this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier Policy Nu r certify that, in the performance of the work hich this permit is issued, I shall not employ any person in any manner so as to become Bubo the workers' compensation laws of California, and agree that, if I should become subject the workers' com sation provisions of Section IP700 of the Labor Code, I shall forthwith omply with th provisions. WARNIN�: FAILURE TO SECURE WORKER ' CO COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PEt,ALTI S �VON VIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (S100,000). IN ADDITION TO TE C SoPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INT REST, ORNEY'S FEES. APPUJ#NT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Dir tar of Building and Safety for a permit subject to the conditions and restrictions set forth on this applicati n. 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 void if work is not co menced within 180 days from date of issuance of such permit, or c tion of work fort days will subject permit to cancellation. I certify th I have read this application and state that the above infor on is correc agree to comply with all city and co my oidinances and state laws relating to building constru ' n, and her y authorize representatives of tbecoy ty tolenter upon th"bove-mentioned property for inspect n purpos (Applicant or Agent): Application Number . . 12-000.00404 Permit WALL/FENCE PERMIT Additional desc . Permit Fee . . . . 31.00 Plan Check Fee .00 Issue Date . . . . Valuation 1250 Expiration Date 10/10/12 Qty Unit Charge Per Extension BASE FEE 1.5.00 8.00 2.0000 HND BLDG 501-2,000 16.00 ---------------------------------------------------------------------------- Special Notes and Comments 50 L.F. 6' GARDEN WALL AT REAR PROPERTY LINE, CITY STANDARD. 2010 CODES. ---------------------------------------------------------------------------- Other Fees . . . ... . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged Paid Credited ---------- ---------- Due ----------------- Permit Fee Total -------------------- 31.00 .00 .00 31.00 Plan Check Total .00 .00 00 .00 Other Fee Total 1.00 .00 .00 1.00 Grand Total 32.00 .00 .00 32.00 LQPERMIT C'T IF LA QUI[STA BUILDING & SAFETY DEPT. APPROVE® FOR CONSTRUCTION Q DATE !qCY � - �, ��65�✓ewida Ca,�'rau��G ha q do Gl+ 9aas 4 4•�°t � P.O. Box 1504 LA QUINTA, CALIFORNIA 92247-1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT PROPER Y O WNER' S p`ACKAGE (760) 777-7012. FAX (760) 777-7011 Disclosures & Forms for Owner -Builders Applying for Construction Perndts ! NOME Tn tyear Fropefty Owner: An. a�ptieation for a building pesrr>ilt been uttmitfed is y name as the bnilda of the property is specified at We me youV46 an Owner -Builder Acleapvlrtedgment imd.Infertmatien Verification form to mako year avma:of your mobilities and possible nsk you may inaw by 'elispcMW.isted RE pow mase as .tire OwneF-Builder. W10 act issoue a bed! dWglit_ eras yauhave read, initiatesl pour uadi..... of oaedr°pmvisioa, dg,*d, and Warned thk form to us at our. OtUCW addrexs indicated; An agent of the owner cannot eAecttte die, notice unless you, the property owner, obtain the prior approval of the permitting authority. Read amd irk east rtf� v tg sRgrd�y yr�u awfaumd or*s* this hVbrm zdoh. 'V 1. I understand a t practice of unlicensed Persons is to have the property owner obtain an `Owner -Builder' building permit that mmDously implies dint the property owner is providing his or her own labor and material pemonaft.1, as an Owner -Builder, may be held liable and subject to serous financial ride for any injuries sustained by an unlicensed Pasco and his or her employees while w0*uIg on my property My homeowner's km anoe may not provide covefte, for dim injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my i nsuance coverage for injuries to worlmn 7Property. 2.1 understand building permits are not required to be signed by property owners unless they are respo its for th 00 on and are not hiring a howsed Contractor to assume this 'bility. - 3: [-understand as an "Owner-Budderw E am the cespousi6le party of reoord on the permit. I un&rstand that f may prate myself from potential financial risk by hiring a licensed Contractor and havin tt►e perm oit filed in iiia or her name instead of o --- 4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers per its and contracts. 5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total vi of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "emplo. under state and federal law. 6. 1 understand if I am considered an " o ' empi yea' under state and Enteral, law, I must register with the staft. and fes government, withhold payrotl taxes, provide wofieer-s' compensation disability. insurance, and contribute to unemploy compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious fina 7. 1 understand under California Contractors' State License Law, an Owner -Builder who builds single-family resid structures' cannot legally build. them with the intent to offer them for sale unless all work is performed by tic subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is perf under contract with a licensed general building Contractor. \/8. I understand as an Owner-Buii;det if I sell the property for which this permit is issued, 1 may be held liable for any financial- or personal. io.ur'*$ sustained.by'dny subsequent,ownef(s) that.'result from any latent construction defects in the wo • ' or materi4k 9.; I understand I may obtain.more information regarding my obligations as an employee" frotp ilte lfiownue . Service, the United States Small Business Administration, the California Departinent of Benefit Payment&. and rho California Division of Industrial Accidents. f also understand I may contact the California Contractors' State License Board (CSM at I- 800 21-CSLB (2752) or www.cslb.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 party legally and financially responsMt for proposed construction activity at the following address: I Ll agree that, as the party legally and fmancially responsible for this proposed construction activity. I will abide by all app ' I¢ laws and regaireaneats am govern Owner-8uildees as well as employers. l2. l agree. to notify the issuer of this Corm immediately of any additions; moms, or QbW1@M to -say of ft information L. have provided on this. form.: Licensed factors are regulated by laws designed to protect. the public. If your c and act with somome who does not bave a Boise, fire Contractors' State Liceme Bcatd many be Unable to &%Ut* yriu wig► any finandat loss you may sustain as a result of a comptuniL Your only remedy against unlioeased Contractors may be in` COWL It is also for you to wdwftW d at if =wed Contractor of employee of td i&►i&..d at thm is fwd wwlo woeung on your ply. you rnsy be hdd Wft ra daa� If you obtatua permit as 0wner-Builder and verist to him Coors, year wdl be a for verifft v&dbw or nat those Coare Wised and'; fee stays cif then wO&Ms' cOHpensafioninsurance covenw. Before a building permit can be.issvted, the agency respons�ibk for .t14e ot&er ver on ago la to die owner's shute. Signature of property owner rm must be completed and signed by the property owner and returned to . !1foW A copy of � owjw's MverV R r f4m � w e+ ah-a+d to 4e � rahen ao yam& is &SUe f to the propen Note: 771e following Authorization �orm is required to. be completed by the property owner only when desig"atin• an agent of the property owner to apply for a construction permit for the OUYner-Builder. - • Eaecluding.the Notice to Property Owner, the txe%don of which I understand is my perso and b'hh`, I herby authoei Bre fonewing Person(s) to act as my og8ags) to gply for, sign, and file do documents 8000SSU741D obUin an Ow=-Buiide Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of Iluthoria®d Agent:. Address of Authorized Agent: Tel No I declare Under penalty of perjury that I am the property owner for the address listed above and I personally filled out the information and Certify its accuracy. Note. A copy of the owner. 's driver's license, form notarization. or other ver0catial aocwtable to the agency rs required to be presented when the permit is issued to verify the properly owners signature.. Property Owner's Signature: Date: 1 understand as an Owner-Buider if I sell the property for which this permit is issued, I may be held tiabl for any . financial ox personal_ it.tu3es sustalned by any subsequent owner(s) that result from any latent construction defects in the wo nanship. or materisis, 4.. I understand I may ebtain.tuom information regarding my obligations as an employe[" from the l erne . Service, the United States Small Business Administration, the California Depactmeut of Benefit Paymedtr. and the:'California Division of Industrial Accidents. l also understand I may contact the California Contractors' State License Board (CM.B) at I-- 800 800- 21-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. 10. I am aware of and consent to an Owner -Budder building permit applied for in my name, and understand that I am the PAY legally and financially responsrble .for proposed construewn, activity at the following address: 11. t agree that, as the party legally and financially responsible for this proposed construction activity, I Kill abide by all 712 ielawn and requirements tat govern Ovmer-8uitders as well as employers. .1 agree to notify the issuer of this form immediately of any ad Minos, dam, at oht8e WMAY of dw h6matiOn t have provided on this form Licensed contractors are regulated by taws designed to protect. the public. It Yam Don ract with somoom who dom not have a Imeas k tiro C)oatraators' State Liveme, Board may be unable to asGM You with MY finmdd tom you may sustain as a result of a compW at. Yotu only remody against unlicensed Contractors tart bo in . It is alst itup0rma4 for you to *a0waahoomod Contractor ix evoployee of tidal iBriividuaY ©r flu is idmtqd mile wait* on Your MWerty. you any be bcU tkW frdamSm If you obtaiu-a permit as Owner-Btdder tmd Vi* tb I>M COWSODWn year will be reVounVo. Ew v0dryin VhQ&V m rat ilmso Comers we Beeased and .am auto oft a on ineurme covecam Before a building permit can be.is&%* i the agmey respmudwe for tup other verYkaden aceta to tfra no owner's skwaarue. SignWroofpropertyowner rm mast be com pitted and signed by the property 91mer sad retuutd No*: A can qf*c properV awir=s i fMM "C46bNOM Mwar d to be gmsewed Where. AV pandt is USMA t& the pmt Note: the following Authorizationorm is d to. be completed by the property owner 091Y when dmVwu an agent of the property owner to appty for a construction permit for the Owner -B Wer- Excludin .the Nation to Property Owner, the exe�on of which I understand is my personal y I y antra d W foll®wirig peraot (R) m act as mry sg=*) to apply for, sign.. and file the domneuta neomatrY D an Owner -Build Pem t for my project - Scope of Construction Project trot Description of Work): Project Location or Adds= - Name of Authorized Agent: Address of Authorized Agent: Tel No I declare under penatty of perjury that I am the property owner for the address listed above and I personally filled out th information and ocxtify its accuracy. Note. A copy of the owners drfver s license, form notarization- or otker wr*,atu acceptable to the agency is required to be presented when the permit is issued to verify the property owvrer s signawre. Pioperty Owner's Signature: Date: rBin.ity of..Building a Safety Divisionit P.O. Box. 1504,78-495 Gale Tampico La.Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet # p l a'. Project Address: \ /%n 6 �/ `' Owner's Name: tVG (�C. A. P. Number. Address: Legal Description: City, ST, lap: �. Contractor. Telephone: � Address: Project Description: j City. ST, Zip �� )C Telephone: c State Lia # : City Lia #: 0-4 .&IJ / ` Arch., Engr., Designer: Address: City., ST. Zip: Telephone: Construction Type: , Occupancy: State Lie. #: Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person: Sq. FL: # Stories: #Univ: Telephone # of Contact Person: Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS UNE # Submittal Req'd Reed TRACMG PERMrP FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit. . Trass Calcs. Called Contact Person Pian Check Balance. Title 24 Calci. Plans picked up Construction Flood plain plan 1 Plans resubmitted.. Mechanical Grading plan 2'! Review, ready for correctious/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 correedoasl muc Developer Impact Fee Planning Approval. Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees