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10-0531 (BLCK)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 10-00000531 Property Address: 45415 ASHWOOD CT APN: 604-405-005-25 -23995 - Application description: WALL/FENCE Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 825 Applicant: --------- -- . _.. +- - -- -�- ------ T,d* 4 4 Q" BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: KINGDON CHRIS P 2461 BRIARWOOD DR BOULDER, CO 80305 -- -- - - - - - -- ---- - _..._.Contractor: Architect or Engineer: Owner /•-*— ARCHITECT 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: 5380 License No.: , CA 92253 =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).: (_ 1 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 aw.). (_ I I am exempt under Sec. , B.&P.0this reason Date: - Zo .+�A 0wner: / ++� - 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: LQPERMIT ------------------------ Lic. No.: , CA 92253 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 6/17/10 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 NYS Policy Number WOOD CT 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 t ecome subject to the workers' compensation laws o�fCalifornia, and agree that, if I should o e subject to the worker compensation provisions Section 700 of the labor Cod sh o om ly with ose provisions. �- Date: Applicant: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVE GE IS UNLAWFUL, AND SHALL 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 abov formation is correct. I gree to comply with all city and county ordinances and state laws relating to building on -ruction, and hereby a horize representative 4of this,co my enter upon the above-mentioned property f r i action pur Dater lB W 0 Signature (Applicant or Agent): r — 1 LQPERMIT - ', Application Number . . . . . 10-00000531 Permit . . . WALL/FENCE PERMIT ' Additional desc . Permit Fee 23.00 Plan Check Fee .00 Issue Date Valuation . . . . 825 Expiration Date 12/14/10 Qty Unit Charge Per Extension BASE FEE 15.00 4.00 2.0000 HND BLDG 501-2,000 8.00 - ---------------------------------------------------------------------------- Special Notes and Comments 33 LN FT X 6 FT HT BLOCK WALL PER CITY ----.-__—._--.---__-._______._-- -.._ —_ __�� -• STANDARDS -AND APPROVED PLANS -ALSO 4 COLUMNS NO HIGHER THAN 6 FT. ------------------------------------------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) --------------------- 1.00 Fee summary Charged Paid Credited --------------------------------------------------------- Due Permit'Fee Total 23.00 .00 .00 23.00 t -Plan Check Total .00 .00 .00 .00 Other Fee Total. 1.00 .00 .00 1.00 Grand Total 24.00 00 .00 24.00 1 LQPERMIT - ', Y44 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 fo.r Owner -Builders Applying for Construction Permits LMEQATANT! NOTWE TO PROPERTY OWNER Dear Property Owner. Ari. application for a building permit has b en submitted in your name listing yourself as the builder of the property improvements specified at m5:/� / sit so We.are.providing you with an -Owner -Builder Acknowledgment and Information Verification Form to make you awaie of your .responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We will not issuea 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. Readd an&initial each. statement below to -signify you understand or verify this information. 41. 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 PDAnly property - .2. I understand building permits are not required to be signed by property owners unless they are responsible for the Vction and are not hiring a licensed Contractor to assume this responsibility. V--1 k I understand as. an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect se from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my 4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on its and contracts. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" er tate 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 ernment, withhold payroll taxes, provide workers' compensation disability inswance, and contribute to unempoyment Comnsation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial s. .?. 1 understand under California Cont actors' State License Law, an Owner -Builder who builds single-family residential s tures 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. d8. I understand as an Owner -guilder if I:sell the property for which this permit is issued, I may be held liable for any ancial or personal. igjaries sua fined by any subsequent owners) that result from any latent construction defects in the IceSranship or materials. Vi9, 1 understand 1 may obtain more information regarding my obligations as an "employer" from the Internal Revenue 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 -LB) at I- �8 p21-CSLB (2752) or www.csib.ca.gov for more information about licensed contractors. I am aware of and consent to an. Owner -Builder building permit applied for in my name, and understand that 1 am the legally and financially responsible for proposed construction activity at the following address: l.l. I -agree that, as the party. legally and fmagcially responsible for this proposed construction activity,.I will abide by all cable laws and requirements that govern Owner-Builders'as well as employers. U12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license,. the Contractors' State License Board may be unable to assist you with any financial loss you may 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 Contractor or employee of that individual or firmis injured while working on your property; you may be held liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible 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.iss ing,tlEre mit Note: A copy of the property owner's driver's.iCcense; form notamattbn; or other verification acceptable to a cy is required to be presented when the permit is issued to verify the property owner's signature. r A J. % / 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 understandis my personal responsibility, I hereby authorize the following person(s) to act as, my agent(s) to apply for, sign,. and file the documents necessary -to obtain an Owner -Builder Permit for my project. 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 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 propertyowner's signature.. Property Owner's Signature: Date: Bin # Qty of La Quinta Building 8E Safety Dlvlslon P.O. Box 1504, 78495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # Project Address: 5 W Owner's Name: A. P. Number. P o Cj ©� rj --(� Address: - tl 14 kkLemC Legal Description: City, ST, Zip: L, u, Contractor: ' R,A CO -Vi Telephone 2 0 fb 6 Address: 451-4.16 W o Gd.� �' Project/ Description: �' r re- "VA -t ��/ City, ST, Zip: LA U l ✓► (rA C� to Tel hon %t o City Lie. #: N p - -t-r t� C Ctva State Lic. # : N Arch., Engr., Designer: Address: Ff .'r City, ST, Zip: Telephone: U . s N B ©d- ;rte C f ConstrLtion Type: Occupancy: State Lic. #: f ' Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person: !tof -c r1�' Sq. Ft.: # Stories: f #Units: Telephone # of Conta" Person: 760 vo -.S3p'D 71r0 -r7Yx Estimated Value of Project:(� !� APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'd TRACKING PERMIT FEES Plan Sets Pian Check submitted Item Amount Structural Cales. Reviewed, ready for corrections Plan Check Deposit Truss Cales. Called Contact Person Plan Check Balance Title 24 Cates. Pans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2'! Review, ready for correctionAssue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- 3'4 Review, ready for correctionstissue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees