12-0091 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: (I 12 -00000091N--,
Property Address: `46800`HIGHLAND PALMS DR
APN: 643-193-001-15 -2117 .
Application description: WALL/FENCE .
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 3400
T4ht 4 4,4"' �
Applicant: Architect or Engineer:
------------------
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
I hereby affirm under penalty of perjury that 1 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, orrepair 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
a y applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
I 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 _ 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 co acts r the projects with a contractods) licensed
pursuant to the Contractors' State License L
(_ 1 I am exempt under Sec. , B.&P.2\fo this r s 1
CONST UC ION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a con uction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Fk
Lender's Address: 0 1.
-
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
KEN GARIBIAN
46800 HIGHLAND PALMS DRIVE
LA QUINTA, CA 92253
---------------------------------
Contractor:
Owner
Date: 2/01/12
I
- - --^- 12012
crry0"'a
1:1 �J63\4'QC- Ifa'S 4.
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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 thew r which this pe 'ssued, I shall not employ any
person in any manner so as to becom subje t to the wor ers' com nsation laws of California,
and agree that, if I should bI
0me su 'ect t the worker compensa ion provisions of Section
3700 of the Labor Co e, I II forth 't ply with t ose provis' ns.
te: _ pplicant:
WARNING: F�SECURE WORKERS' COMP TION 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 be es null a d voi work is t commenced
within 180 days from date of issuancahe
rmit, or ces atio of work for 1 0 days will subject
permit to cancellation.
I certify that I have read this application and state te informa on i correct. -I agreto comply with all
city and county ordinances and state laws relating ton an ereby authori a representatives
of this county to enter upo he above-mentioned p pe p es. e: �—� inature (Applicant or Agent)
1
Application Number 12-00000091
Permit .. . . WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 63.00 Plan Check Fee
.00
Issue Date . . . Valuation . . .
. 3.400
Expiration Date 7/30/12
.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
TOTAL OF 136 L.F. COMBO WALL, 21.
RETAINING, 6' GARDEN AT REAR AND PARTIAL
SIDEYARDS, ORCO SYSTEM. 2010 CODES.
--------------------------------------------------------------
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 1.0.0 .00 .00
1.00
Grand Total 64.00 .00 .00
64.00
LQPERMIT
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
P
APPROVED
0 C
FOR CONSTRUCTION
DATE BY
P•.O: Box 1504 `
LA QUINTA, CALIFORNIA 92247-15,04
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
r `
-BUILDING & SAFETY DEPARTMENT
(760) 777-7012
FAX (760) 777-7.011
PROPERTY OWNER'S PACKAGE
Disclosures & Forms for Owner-B.:uilders Applying for Construction'Permits
MTAAT.! .NQ... I Tn PRnP uTv CIWI`T1,R
Dear Property Owner
Ali. aPPlication .for a building permit has been submitted in your name listing yourself as the builder of the .property
-innprovements specified at
We are providing you with an Owner -Builder Aclmewledgment and. Information Verification Form to make you awam 0 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, initiated yourunderstanding of each-'provision,signed, and returried 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.
Read and Mitial each: stateurent-betmv to signify you unhrstand or vertry this informatimt
/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 and material persona ft. I, as
an Owner -Builder, may be held liable and subject to je-ri9us_financiaLrisl_foLany m1unes_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 andam aware of the limits of my insurance coverage for injuries to workers
on my property.
*k2. I understand building permits are not required to be signed by property owners unless they are responsible -for the
4struction and are not hiring a licensed Contractor to assume this responsibility..
3. I understand as. an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect
NYself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my
own.
t4. I understand Contractors are required by law to be.licensed and bonded in California and to list their license numbers on
milts and contracts.
c5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value
my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer"
under state and federal law.
c. [ understand if I am considered an "employer" under state and federal law, I must register with the state and federal
overnment, 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
.sk,
I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential
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.
tl understand as an Owner -Builder if I sell the property for which this permit is issued, I may, be held liable .for any
rnancial. or.personal: injaries sustained by any subsequent owners) that result from any latent construction defects in. the
workmanship or materials.
9. I understand d "may obtain more information regarding my obligations' as" an "employee" from the Intet�rat Ite*ehue
�rvJ States Small Business Administration, the California Department of Benefit Paym e the United eats and the California
Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (MB). at 1-
800-321-CSLB (2752) or www.csib.ca.gov for more information about licensed contractors.
{/t . N10. 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 Orrancially responsible . for proposed construction activity at the following address:
L I agree that,. as the Party legally and fuumially responsible for this proposed construction activity,.1 will abide by all
licable tiws and requirements that govern Owner -builders as well as'employers.
k12. I agree to notify the issuer of this form immediately of any additions; deletions, or chaoges to any of the information I
ave 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 lieenw,. the Contractors' State License Board may be unable to asst you with any 6naneial loss .
you may sustain as a result of a complaint Your only remedy against unlicensed Contractors may be in'civd court-' It is- also
important for you to: understand that if an unhoensod.Contractor or employee of that individual or firma is int white 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 r€spotmblo for verifying whether, or not those Contractors are prope€►y licensed and the status of thou wmkers'
compensation insurance coverage.
Before a building permit can be issued, this form must be
the agency responsible for issulltg; tI►e. Note: A col
other veriT ation acceptable to theais requireL
owner's signature.
Signature of property owner
:ed and signed by the property owner and returned to
property owner's MvWs lomseo farm n06arh7adV14 or
anted when the permit is iuwA to. verify the property
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 exec.ution of which I understand is my personal responsibility, I hereby authorize
the following persons} to act as my ageut(s) to apply for, siM 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 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 when the permit is issued to verify the property owner's signature..
Property Owner's Signature: Date:
Permit #
Project Address:
Cit}/ 0f 12 Quinta .
Bufiding.a Safety Division
P.O. Box 1504,:78-495 Caffe Tampico
La.Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Owner's Name:. C,ql f ♦ 1 .
A. P. Number.
`�
Address: G' Ga v � (_4a 0,141
Legal Description:
Contractor. Q
City, ST, Zip: C r
n
Telephone:
Address:
Project Description: ' s
City, ST, Zip:
Telephone
State Lic. # :
City Lic #
F ,
r
!�
Arch4 Engr., Designer
3 .�
Address:
City., ST, Zip:
.
Telephone:
State Lic. #:
Construction Type:. 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 UNE
#
Submittal
Req'd
-Reed
TRACKMG PERMITTEES
Play Sets
Plan Check submitted
Item Amount
Structural Cates.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Colics.
Called Contact Person
Plan Check Balance
Mile 24 Cales.
Plana picked up
Construction
Flood plain plan
Pians resubmitted
Mechanical
Grading plan
Review, ready for correctioas/issue
Electrical
Subeontactor 1.6t
Called Contact Person
Plumbing
Grout Deed
Plans picked up
S.M I.
H.O.A. Approval
Plans resubmitted
Grading
IN ROUSE:-
''" Review, ready for correctionslissuc
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees