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12-0139 (BLCK)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number:12-00000139 Property Address: 54480 AVENIDA CARRANZA APN: 774-243-011-13 -000000- Application description: WALL/FENCE Property Zoning: COVE RESIDENTIAL Application valuation: 2988 Tiht XP " BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Applicant: Architect or Engineer: 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 70001 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 n 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 contractor(sl licensed pursuant to the Contractors' State License Law.). 1 —) I am exempt under Sec. , B.&P.C. for this reason Date: ner: 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 Address: 1/• LQPERMIT Owner: MCNALLY KATHERINE 54480 AVENIDA CARRANZA LA QUINTA, CA 92253 ---------------------------- Contractor: Owner VOICE (760) 777-7012 FAX (760) 777-7011. INSPECTIONS (760) 777-7153 Date: 2/15/12 �i 2�i�� =, ,v+� e' ►�t�:3 1.,, �� ------------- .---------------�---- 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 V 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 f forth ' h comply with thos�11LAWIUL, pplicant: WARNING: F�SECURE WORKERS' COMPENSATION COVERAGSHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS 1$100,0001. 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 state laws relating to buil ing ppnstruction, and hereby authorize representatives of thi county to enter upon the above-mentioned prop fo inspec ' n purposes. ate: 1 1 �gna[ure (Applicant or Agent): Application Number . . . . . 12-00000139 Permit . . . ELEC-MISCELLANEOUS Additional desc . Permit Fee . . . . 16.50 Plan Check Fee 4.13 Issue Date . . . . Valuation . . . . 0 Expiration Date 8/13/12 Qty Unit Charge Per Extension BASE FEE 15.00 2.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20 ------------------------------------------7---------------------------=----- 1.50 Permit . . . WALL/FENCE PERMIT Additional desc . Permit Fee . . . . 54.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 2988 Expiration Date . . 8/13/12 Qty Unit Charge Per Extension BASE FEE 45.00 1.00 9.0000 THOU BLDG 2,001-25,000 .9.00 --------------------------------------------------------------------7------- Special Notes and Comments .138 L.F. 5' GARDEN WALL AT FRONT OF RESIDENCE & 2 ELECTRICAL FIXTURES AT POSTS,.CITY STANDARD. 2010 CODES. ---------------------------------------------------------------------------- Other Fees . . . . ... . BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged Paid Credited ------------------------------ Due --------------------------- Permit Fee Total 70.50 .00 .00 70.50 Plan Check Total 4.13 .00 .00 4.13 Other Fee Total 1.00 .00 .00 1.00 Grand Total 75.63 .00 .00 . 75.63 LQPERMIT R' 7 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 RWM TA11li'1 No ecu lm P)titOl'SRTY n�I11Ri� Dear Pu perty Owner: An application for a building permit has been -kni tied in your name listing yourreif as the buddet of the property inqm"naaw spoafi«L at 5.44 8o 1""y G� We are pmviding you Wi& an Owner -Builder Admwtedgment and Infetotmaa n Verification Form to make )vu awaw of your des and possible risk you may inters by having d its permit -issued. in your frame as the Owner -Builder. We wig" a bcdidbog.pwinit renin you-bAve read, h tiaW your. andefcb►ndir� of Back prvddou, signed, and returned this form to us at our official address indicated. An agent of the owmr cannot execute ibis notice unless Yom the PaoPe ty owner, obtain the prior approval of the permitting authority. ' �A1 FSS � .i.. E•���� � 1• t-� j '?d• t :. ! t n t , >.a t 1. I understand a requiem practice of unlicensed persons is to have the property owner obtain an, "Owner-Buildee budding Permit that erroneously implies that the property owner is providing his or her own labor and material personalty. 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 woddug on my property My homeowner's insuraac a may not provide caveta e- for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to wodmn on my property. IG° I understand building permits are not required to be signed by property owners unless they are responsible for th construction acrd are not hiring a Licensed Contractor to assume this responstbihty- 3. I understand as an "Owner -Builds" I am me resgonsibk party of reoord on the permit. I understand that I may prole myself from potential financial risk by hiring a licensed Contractor and having the permit filed in ins or her name instead of o own. V *4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers pernuts and contracts. A5. 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. 4IW6. I understand if I am considered an "employee" under state and federal taw, I must register with the state and fel government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unamploy compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious fn& risk 7. 1 understand under California Contractors' State License Law, an Owner -Builder who builds single-family resid struc 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. Jr `, I understand as an Owner -Guilder if I sell the property for which this pewit is issued, I may be held liable for any financial or personal. .priessauteed: by any subsequent-ownrr(s) that result. from any latent• construction defects .in the woriananship.or materials '14444-9:11 understand I.may'olstain.more information regarding my obligations as'an•"employe[" from the Internet revenue Servroe, the United States Small Business Administration, the California Department of Benefit Paymeots. and the California Division of Industrial Accidents. I -also understand I may contact the California Contractors' State License Board (CSM at 1-. 800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. 0. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the PAY legallY and financially responsible for proposed construction activity at. the following address: X44 �QAI�' INtt:"�� 2t4 1M1 1. I agree that, as the party legally and ftaaucially responsible for this proposed construction activity, I will abide by all applicable laws and mquirentents that, govern Ow, ner-Builders as well as employers. 12. 1 agree to notify the issuer of this form immediately of any additions; deletions, or ohm WARY Of the inforaration 1 have provided on this form. Licensed contractors are regulated by taws designed to protect the public. If YM eoniract with someone who door not have a license, Gro Contractors'State License Board may be unable to asses you with any 6nanclai loss you may Sustain as a result of a complaint, Your only remedy against unlicensed Contractors tray bo tnvtvd court. Itis also for You (Sunderstand Owt if as wgiocesed Contractor of ewployee of that individual or fin is inkned wldle woffing on Your Property, You may be herd IMM for damages. If you obtain a permit as Owner -Builder and wilb to bW Coatactors, you will be responn-elofor or not those Coutmma arepoepedy icensed and d1r, a"W's of &W wottce W oompensation insurance covempe. Before a building permit eau be issued, 0& form must be completed and signed by the properly owaer and returned to the agency responsible for issue dw f erg, Notre A can of elar WVcrW owsw's diaiveass Abwci,ftm a )M w other verification aftq"k to the rrg_ancy is requh-ed to be prwaded when. tha pgratit iss hs=& to v&* the ptoP en owner's signature_ Signature of property OWUM Date: F -el& 1 C 17— Note: Z Note: Me following Authorization Form is required to be completed by the property owner only when designatin an agent of the property owner to apply for a construction permit for the Owner -Builder. AiT UORZATfON (W AGMT To AOT ON rROPERTY OWNEWS BEHALF F.xcluding.the Notice m Property Owner, the execution of which I understand is my pereamal rosponaibility, I htMby authDn the following pis) to act as my ogeat(s) to apply for, sign, and file the documents necessary to obtaiin an Owner-Buitdc Permit for my Prolcet. 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 penalty of perjury that 1 am the property owner for the address listed above and I personalty filled out the information and certify its accuracy. Note: A copy of the owner's driver's license, form notarization, or other ver0catioi 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: Bin # City of La Quinta Building 8r Safety Division Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit #P.O. 3 Project Address: Owner's Name: �� r u J t Acj j A. P. Number: —7-7 4 _ -L,4 '3 = (3- i I Address: g 0 l L l Legal Description: City, ST, Zip: fJ 0) O 61 Contractor: i.�i-,r= - Address: ((, ( Jev_� E, OfLo- 0-71— Telephone:'j� 34-123 '�s•�>z��;.^�.�,,.j�„�:� }'s{ Project Description: City, ST, Zip: J N 0 1 L) �� , Cl Z2U � C.ot-S-rO-UUT . S' l 4 F� U34`? 23 {.:.,}FF:;CTelephone: : : �.;;CUl1C- My ezlo (� E -CG (�() lC i�}f1�1�State Lic. # : Arch., Engr., Designer: Lic. #; l L, Q PIj Pat) /J a_ -r Y U Q, / L Address: City., ST, Zip: Tele hone: p State Lic. #: PIX Consiniction T e: Occupancy: Project type (circle one): New Add'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 it 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 Caics. Called Contact Person Plan Check Balance Title 24 Calcs. Pians picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2p° Review, ready for corrections/issue Electrical Subeontactor Last Called Contact Person Plumbing Grant Deed Plans picked up S.M.L H.O.A. Approval Plans resubmitted Grading IN HOUSE:- Review, ready for correctionsfissue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees 11F 11� i 1 .1-11 r-P-,y J � � � J ILn z 4 Q 3 0 Z W kN i � o C t S 6 a n � 1 .1z' rj J J a� qr" LI. 1 I 1 �ti{1l t y �J } 01