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10-0407 (BLCK)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 10-00000407 Property Address: 53710 AVENIDA CARRANZA APN: 774-121-010-15 -000000- Application description: WALL/FENCE Property Zoning: COVE RESIDENTIAL Application valuation: 3248 Applicant: d'zvxAol_ lel'�A Architect or Engineer: BUILDING & SAFETY DEPARTMENT BUILDING PERMIT -------------------------------------------------- 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 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.). ( 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 C NSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that the 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: LQPERM!T Owner: LACROIX ROGER 53710 AVENIDA CARRANZA LA QUINTA, CA 92253 ( Contractor: Owner VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 5/10/10 D e a M (i 0 2010 CCP'1 Of: &rA QUINTA --------------------------7-------------------- WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 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. 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 LeCode, wit cam ith those provisions. Date. O Applica a WARNING: FAILURE TO SECURE W KERS' 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 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 state laws relating to building construction, and hereby authorize representatives of this county to enter upon the above-mentioned p p)ty for inspection purpos 1 D to 0 O Signature (Applicant or Agent). if LQPERMIT Application Number . . . . . 10-00000407 Permit . . . . . . WALL/FENCE PERMIT Additional desc . Permit Fee 63.00 Plan Check Fee -:00 Issue Date Valuation . . . . 3248 Expiration Date 11/06/10 Qty Unit Charge Per Extension BASE FEE 45.00 2.00 9.0000 THOU BLDG 2,001-25,000 18.00 ---------------------------------------------------------------------------- Special Notes and Comments 150 LN FT COMBO WALL 3 FT RETAINING & 5 FT GARDEN WALL -PER CITY STANDARDS. APPROVED PER S.T. ---------=------------------------------------------------------------------ Other Fees . . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged Paid ------------------------------------- Credited Due Permit Fee Total 63.00 ---------- .00 ---------- .00 63.00 Plan Check Total .00 .00 .00 .00 Other Fee Total 1.00 .00 .00 1.00 Grand Total 64.00 .00 .00 64.00 P.O. Box 1504 LA QUINTA, CALIFORNIA 92247-1504 78-495 CALLE .TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT (760)777-7012 PROPERTY OWNER'S PACKAGE FAX (760) 777-7011 Disclosures & Forms for Owner -Builders Applying for Construction Permits IMPORT-IYT! NOTICE TO PROPERTY OWNER Dear. Property Owner. . An. application fora building permit has been submitted in your naaW.e listing. yourself as the builder of the property improvements specified at 4 ) Ci �eF �,/N (N.7, (:!-,4Rrlr, z Weare .providing you with an Owner -Builder Acknowledgment and Informatio erifrcation 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. OM ER'S ACI N )N EDGMENT AND YERMCATION OF INFORMATION DIRECTIONS: Read acrd 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" bin that err g permit,oneously implies that the property owner is providing hisor 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 anOwner-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 v construction and are not hiring a licensed Contractor to assume this responsibility. P Y 3. I 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. OL 4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. 5. 1 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 "employee, 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. Cf8- I understand as an Owner -Builder ifhaell the property for which thisP ermit is issued, I may be held liable €or any financial or personal. injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. . I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue ervic9e, the United States Small Business' Administration, the California Department of Benefit Paym ents, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License. "Board (CSLR) at 1- 800-321-05LB (2752) or www.cstb.ca.gov for more information about licensed contractors. ul0. 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: L. l agree that, as the party legally and fmancially responsible for this proposed construction.activity,.I will abide by all p licable. laws and requirements that govem Owner -Builders as well as employers. 12. I agree to notify the issuer of this form immediately of any additions; deletions, or charges to any of the information I ave pro -ed on this form. Licensed contractors are regulated b laws designed to protect the public. If you contract with � Y !� P someone;o does not have a license,. the Contractors' State License Board may be unable to assist you with any financial loss you may s stain as a result of a complaint. Your only remedy against unlicensed Contractors may be.in civil court. It is also important f�r you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your prorty; you may be held liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors, YOU will .be7csponsible for verifying whether or not those Contractors are properly licensed and the status of their workers' 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. Now A copy of the property owner's driver's.ftgnsei form notarization., or other verification acceptable to. the agency required to be presented when the permit is issued to verify the property owner's signature. Z7 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 the following person(s) to act as. my agents) to apply for, sign, and file the documents necessary -to obtain an Owner -Builder Permit for my project. tI Scope of Construction Project (or Description of Work): / IFC.to, .lige }�- fir' - /� ��� 1i A J/% Project Location or Address: I? I% Z Name of Authorized Agent�o� cr' 'X? 4fxc-s , X Tel No 2E0 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 presented when the permit is issued to verify the property owner's signature.. Property Owner's Signature: Date: 7 1 C:f8. I understand as an Owner -Builder if 1 sell the property for which this permit is issued, 1 may be held liable for any financial or personal. injuries suaf hied- 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 Internal Revenue ervice, 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 -L13) at I- 800-321-05LB (2752) or www.csib.ca.gov for more information about licensed contractors. U, 0. 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: 1.L. 1 agree that, as the party legally and financially responsible for this proposed construction activity,.l will abide by all p licable laws and requirements that govem Owner -Builders as well as employers. 12. I; agree to notify the issuer of this form immediately of any additions, deletions, or chan&s to any of the information I ave pro 'ded on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you mays 1stain as a result of a complaint. Your only remedy against unlicensed Contractors may be.in`civil court. It is also important f�r you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while wofkirrg on your pro arty; you may be held liable for damages. If you obtain a permit as Owner -Builder and wish to hire ConUa tors, you will .be Iresponsible 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.ticerrset. farm hots tatrbn; or other verification acceptable to: the agency required to be presented when the permit is issued to verify the property owner's signature. Signature of property owner _0Date: 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. AUTIIORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BERALE Excluding, the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following persons) to act as, my agents) to apply for, sign, and file the documents necessary'to obtain an Owner -Builder Permit for my project. , / / l Scope of Construction Project (or Description of Work): �1/ / Project Location or Address: Name of Authorized Agent /cow ag erg , JC Tel No Address of Authorized Agent: I declare under penalty of perjurythat 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 whe the permit is issued to verify the property owner's signature.. Property Owner's Signature: Date: ---'>17 . May 10, 2010 Roger Lacroix 77186 Casa Del Sol La Quinta, CA 92253 I Roger Lacroix give Cynthia Thompson permission to sign all permits and any other forms from the City of La Quinta. Signed, QJV - Rog r Lacroix Date Din # Qty of La Q[uinta Building &r 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: 93;--7/0 Owner's Name: R c L- l- 4e, A. P. Number: -7 7 Ll- /91 ' 010 � ess: % !� �G e—A 1'r�: ° 1i ) JLegal-Description: Contractor: (� Q Address: Qip one: % %s.,, • •Y: Project Description: City, ST, Zip: 15-0 COe„i ,6 D 1414 l t Telephone: `%` <!� f?� r State Lic. # : City Lic. Arch., Engr., Designer. Address: City., ST, Zip: Telephone: .�.�• ��..:�: .:.; •�;.� v:.r;:{l''+.'+.7CiYii+f/Fyi.'��� Construction Type: Occupancy: State Lic. #: ProJect type (circle one): New Add'n Alter Repair Demo Name of Contact Person: �, Z— 1 9 Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: 2 %S J I:f Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACIMG 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 Tide 24 Cales. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan god Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading M HOUSE:- ''d Review, ready for correctlonsfissue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees EXISTING WATER DETER BOX wl CATE VALE FOR ON/OFF. P Lu m n- CD Ld N 0 TE: NO GAS OR PROPANE TO PE USED IN THIS �I RESIDENCE. :w. :I. 12 r_ Orr (FRONT OF CURB) 20'_a" 7' — 0" ECD EQ Gt� 5 2 .. A1.1 TYP. APN: 774-121- 010 LIVING LEECH. SQ. FT. AREA = SQ. FT. AREA = 1,622 14 SO. SO. FT. FT, EXISTING LOT MAX = 5,000 SQ, FT, x 60 % GARACF SO. FT. AREA = 431 Sty. FT. MAX TOTAL = 3,000 SO, FT, PATIO SQ. FT, AREA - 194 SQ. FT. — 3,000 SQ. FT. TOTAL OVERALL SQ. FT. AREA = 2,261 SQ, FT. EXISTING RESIDENCE = 2,261 SQ� FT. REMAINING SQ. FT, = 739 SQ. I' f. SQ. ET. AEA LOT #15 ZO\ D'fl C E r I Kir'W d" (',AKirQf7TF CI ❑R SEE T FOR N.T.S. 2 F.7 Il ` 8 TYP. FOUNDATION DETAIL EXISTING WOOD FENCE TO BE REMOVED AND REPLACED WITH NEW � MASONRY BLOCK WALL. -- EXISTING 4. NEW 200 AMP 0 RECESSED WOOD FENCE -rt A-W r WEATHERPROOF SUB -PANEL POWER LANE IN 2" CONDUCT W1 METER AND CIRCUIT 35" TO 40" DEEP BREAKERS- SET PANEL AT PHONE LINE I " CONDUCT +48" ABOVE FLUOR LINE TO JJ CABEK LINE IN 1CONDUCT F NEf SITE PLAN L�JIVI— METER. PROVIDE #4 C.U. CONCRETE ENCASED LIFER GROUND PER LATEST N.E.C. NORTH SCALE: 1 "=I'-o1 1 KEYNOTES 0 CONCRETE SLAB, COLOR TO BE DETERMINED BY OWNER. 1 ld I= a A CL d w U) 4" r cc AMP U) c 0 cn _ !L may J w Ln cr LLJ CL 5 3 CL PROJECT NUMBER DATE Q DSRAINING NUMBER A1.1