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12-0775 (BLCK)P.O. BOX 1504 78-495 CALLE TAMP ICO LA QUINTA, CALIFORNIA 92253 Application Number: X12-0000077-5,� Property Address: 1 C 7751AI LE P:RROBA APN: 774-155-022-2 -000000- Application description: WALL/FENCE Property Zoning: COVE RESIDENTIAL Application valuation: 1850 T,it4t 4 4v -Q" Applicant: Architect or Engineer: ------------------ 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 i031.5 by any pplicant 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 thereo who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' St -cense La4v1 (_ 1 I am exempt under Sec. _ . _ or the reason f / /Cat=which =permitis 2ISec. CONSTRUCTION LENDING AGENCY I heat there is a construction lending agency for the performance of the wo3097, Civ.C.). Lender's Name: Lender's Address: Y\ LQPERMIT Owner: RICHARD VARGE 77811 CALLE ARROBA LA QUINTA, CA 92253 Contractor: Owner VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 7/12/12 -------------------- -----dry-L ��?O% ----------------------------------- -- --- 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. ate:plicant: WARNING: FAI RE 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 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 w w- su lect permit to cancellation. I certify that I have read this application and state th a above' ation is c erect. ' agre o comply with all city and county ordinances and state laws relati to bu' di structi ,and hereb auth a representatives of this county to enter upon the above -me ' ned pro or mspec ' purpos3l. 1?_ t re (Ap I�icant or Application Number . . . . . 12-00000775 Permit . . . WALL/FENCE PERMIT Additional desc". Permit.Fee . . . . 43.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 1850 Expiration Date 1/08./13 Qty Unit Charge Per Extension BASE FEE 15.00 14.00 2.0000 HND BLDG 501-2,000 -- 28.00 ------------------------------------- Special Notes and ------------------------------------- Comments 70 L.F. 6' GARDEN WALL WITH 2 COLUMNS, WOOD FRAMED STUCCOED ARCHWAY NOT TO EXCEED 9' HEIGHT, ORCO SYSTEM. 2010 CODES. ---------------------------------------------------------------------------- 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 IV P f � P.O. BOX 1504 LA QUINTA, CALIFORNIA 92247-1504 78-495 CALLS 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 OUNT! NOTICE Tfl >� OST TY a�VNTI 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 7 -/— 0-4L.86- We are providing you WM an Owner -Builder Aclmowledgment and Infotmation 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 Owns -Builder. We w01 not issue a buiiding.permit until yewhave read, inid" your 9nderstamdw.g of ea providen, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute "notice unless you, the property owner, obtain the prior approval of the permitting authority. D . CtWM. react and initial e�rdr: stm neem-bdW t4 signify you andtrstand or verify this mforraaticm. �1n 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 roil material personaltlr.1, 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 y property- 6172- rty- �J 61 I unless the are responsible for the 2. understand building permits are not required to be signed by property owners aril y P c nstruction and are not hiring a licensed Contractor to assume this responsibility. 3. I understand as an "Owner -Builder" I am the r ' i of record on the permit. I understand that I may protect espons ble party myself from potential Financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my 7' �r/ L 4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on F- and contracts. 75t.sl understand if I e��,employ or otherwise engage any persons, other than CaliforniaC lrfottua licensed Contractors, and the total value, of my construction is at least five hundred dollars ($500), including labor and materials, 1 may be considered an "employer" der 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 co nsation for each "employee." i also understand my failure to abide by these laws may subject me to serious financial 's 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. 1 understand as an Owner -builder if I sell the property for which this permit is issued, I may be bead liAk for any financial or personal_ it�nrics snslaked by any subsequent owners) that result from any latent construction defects in the rl. arashipor materials. alu. I may obtain more information regarding my obligations as -an "employer" from the tnierpai Benue Service, the United States Srtiall Business Administration, the California Depacnnutt of Benefit Paymetuta, and� California Divi 'on of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (C9M at I- �8-32 1-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 par y legally and brrancudly respousiMe fpr proposed construction activity at the following address: I agree that, as the party legally and Ilinamially responsible for this proposed construction activity, I will abide by all a licable lives and requiretrtents that govern Mier -builders as well as employers. ��l t/ - l2. I to no ' the issuer of this form immediate) of as additions, dsleAiM, er c tfl•4Wy of the info nattost I A' agree hfY .. Y Y have provided on this form Licensed contractors are regulated by laws designed to protect the public. If yon eontract with someone who does not have a" Imense, the Conbutors' State License Board may be unable to assist you with MY &MM`iat loss you may sustain as a result of a complaint. Your onipremedy against unlicensed Contractors May fie inVivil ootm. It is- also important for you to understand that if an salicensed Centrwor or "loyee of that individual or firm is i *UW vAdk wwUng on your property; you may be heli HaW for.damagm If you obtain a permit as Owner -Builder and wish to MM Contractors, you will be responwMe for verdymg why ornot :those Contractors are .pmpc* fivem ,ed and tlrt, stators of thug wortcets' compensation insurance coverage. Before a building permit can be issued, this form must be completed and signed by the property Owner =d returned to the agency responsible for tspoNote, A .copy of #wpr opergr owner's dkbdrV AWasaj fam nom or other verifreation accep.mbl o the adensy t +et bt prasenteA- when pt�mit_is_ sod -to xed '-theme - -- — —other - ---- - -- - - --- - - r Signature of property Date: r 2 u t '-- Note: The jollowing Authorization Form is it+equired to be completed by the property owner only when designating an agent of the property owner to apply for a construction pernrit for the Owner -Builder. Exchrding.the Notice to due Permit fofl Scope ofowiritg ' for Md is my persawd respowibility,.t hmby authorize documents necessary to obtain anOwner-Builder ., ., listed above and I personalty filled out the above information e, form notarization, or other verification acceptable4fihe?t-the pmtrit' is Jns ed to verify the property owner's signaarie. Property Owner's Signature: Date: 0 D r r m q O D AVENIDA GARRANZA ASS,BUILT RESIDENCE FOR CHRISTINA BERGSMA & RICHARD VARGE 77511 CALLE ARROBA LA QUINTA CA.92253 EXISTING SITE PLAN PLAN ARROBA CALLE CKLLON CALLE ARROBA RADON DESIGN 76527 CAUFORNIA DR PALM DESERT, CA.92211 (760)09-2541 pyllA osD ZW?ziO mPhl0i Ooz mD"mm ym z=mOl�ilpQ zTzy=z Oma°,1=m m O r�my�0i A p Ty ympA �'9z m o =—po fiaoao W zminmam i -zop�m Oy D"000� TSACfj"" m�mmrom �0�"A,Oyo ODOzvAm zzc0 T mO o"nomz VA isin T City of La Quinta 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 # wrier's Name: Project Address: 27 - I 11J PI-Ic- 4r,z- A. P. Number: 7 9 At Address: PC) P 01 ^Sl Legal Description: City, y, S T, Z i P, 4.4 �24' L f tracto elephon2!�r-�'e- .,,-7,2 —e,*' Con r: C Address: P,�) Project Description: City, ST, Zip/, Tele phonq.5—,�, -2-- 7- C-0 rs State Lic. # -0w*66e- $L,p2 City Lic, 9-xz� Arch., Engr., Designer: ec. - Address: City, ST, Zip: Jroo D t-A'O'A't Telephone: Construction Type: Occupancy .. .... ................. C ................ ... State Lic. i.- :.% ............ . ........ ...... . ........... ...... . . .. ... Project type (circle one): New Add'n Alter Repair Demo .... . ............ P ... . ............ Name of Contact Per AWO [/ 4 &-4 4��— I # Stories: J son: Sq. Ft.: # Units: 14 t Telephone # of Contact Person Estimated Value of Project: C, 10 - !� APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Rcq'd Ree'd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Cales. Called Contact Person Plan Check 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 Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- 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 I Total Permit Fees