12-0137 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
12-0 0 00 013 7
Property Address:
46800 HIGHLAND PALMS DR
APN:
643-193-001-15 -2117 -
Application description:
WALL/FENCE
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
2991
Applicant: Architect or Engineer:
01-111 aIA
------------------
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 7031.5 by
an applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
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 contracts a projects with a contractorls) licensed
pursuant to the Contractors' State License Law
1 _ 1 I am exempt under Sec. , B.&R.C. for is ason
S_
CONS R TION LENDING AGENCY.
I hereby affirm under penalty of perjury that there is a c ruction 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
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 2/15/12
Owner:
KEN GARIBIAN �D 4
46800 HIGHLAND PALMS DR
LA QUINTA, CA 92253 1,
-------------------------------
Contractor:
-----------------------------Contractor: Gl�y,�p9
Owner
---------------------------7-------------------
WORKER'S COMPENSATION DECLARATION
1 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 beco ct to the worke mp ation laws of California,
and agree that, if I should or bject to he workers' ompensation rovisions of Section
3700 of the Labor Code, I a for with co ply with th • se provisions.
\1, nt.
WARNING: FAILU TO WORKERS' CP SATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTI CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TO THE CAR 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 c of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the a e inf rmation is rrect. agree to co ply with all
city and county ordinances and state laws relating to building c nst coon, a hereby thorize repres ntatives
of this unty to enter upon the above-mentioned property for i spe ion rposes.
//po
ate
e: 1 S_t ZSign re (Applicant or Agent): `
Application Number . . . . . 12-00000137
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee 54.00 Plan Check Fee .00
Issue Date . . . . Valuation . . . . 2991
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
------------------------------------------------------- --------------------
Special Notes and Comments
" 55 L.F. 5' GARDEN WALL AT SIDE & FRONT
AND - 72 L.F. 6' GARDEN WALL AT
SIDEYARD, BOTH ORCO SYSTEM. FRONT GATE
TO BE MOVED. 2010 CODES.
----------------------------------------------------7-----------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00
Fee summary Charged Paid Credited Due
------=--------------------------------------------------
Permit Fee Total 54.00 .00 .00 54.00 r
Plan Check Total .00 .00 .00 .00
Other Fee Total 1.00 .00 .00 1.00
Grand Total 55.00 .00 .00 55.00
e
LQPERMIT
CITY OF LA QUiNT'A
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DATE_4n /S-/aY A.Y
R
7 _-;, 'Ic
P•.O. Box 1504•' I
.
LA QUINTA, CALIFORNIA 92247-1504
78-495 CALLS TAMPICO
LA QUI NTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
PROPERTY OWNER'S PACKAGE
(760) 777-7012
FAX (760) 777-7011
Disclosures & Forms for Owner-Rullders Applying for Cowtructlon Perrin
WTJF IeiQ r'R '[Yl i RfTU i?'i`��7
Deur Property Owner
An application for a building permit has been submitted in your name Iisting yourself as the budder of the' .psopeaty
improvements, specified at
We we providing you with as Owner -Bu rider. Admawl .
ruzspQnsigilar®s and po�bi@ rislt � edgmest-and. infF,tmatierr Y�%aticn forun to make you awsna of your
May ice` by h4ving Ws peanut isuftd. in your name as the
O nes-Binder. We will sot ince a buitding.permit until y,=l have Iditiaied your undavtanding of each'prw4den,
wed, and thin form to us at our oMdal address indicated. An agent of the owumr cannot execute tbir-notice
unless You, the property owner, obtain the prior approval of the permitting authority.
Read aftd acitW stat QOW t4 sigr* you wwherataad or d Y das irtJ•bm lion_
understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder"
V "building Permit that erroneously implies that the property owner is providing his or her own labor and material pars. I, as
an Owner -Builder, may be held liable and subject to serious financial risk for 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 ar aware of the limits of my insurance coverage for injuries to workers
on my property.
11 understand building permits are not required to be signed by property owners unless they are responsible for the
onstruction and are not hiring a licensed Contractor to assume this responstbihty.
3. I understand as an "Owner -Builder" I am the responsible party of r000rd on the permit I understand that I may protea
yself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of tn,
own.
tmy
. I understand Contractorsare required by law to be.licensed and bonded in California and to list their licepse nuunberso
is and contracts.
. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total val
construction is at least five hundred dollars ($500) including labor and materials, I may be considered an "employe
de(r state and federal law. '
�. I understand if I am considered an "employee, under .state and fbderal I with e
law, must `cerate` the state and fade
40vcmmentl withhold payroll taxes, provide workers' compensation disability insurance, and.contribute to unemploym
compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious furan
I understand under California Contractors' State License Law, an Owner -Builder who builds single-family resider
tures cannot. -legally build them with the intent to offer them for sale, unless all work is performed by lica
subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is perfor
under contract with a licensed general building Contractor.
&�I .understand as as Owner -Builder if I sell. the Property for which this permit is issued, I may be held liable for any
..ancial or personal Mi > rod by any subsequent owner(s) that result from any latent construction defects M the'
wori�anship or materials.
�I ,unOmtand I may -obtain more informationard'
reg ing my obligations. as an "employer" from the Itrtctuat'iVen ua•
the United States Scriall Business Administration, the California Department of Benefit Paymedts, and the California
Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (C at 1-
8000-,3/21-CSLB (2752) or www.cslb.ca gov for more information about licensed contractors.
.�'t�a0. 1 am aware of and consent to an Owner -Builder building permit plied for in m name, and understand that I am the
party legal) and applied Y
Y fnar�cially responsrbte for proposed construction activity at the. following address:
11 [ agree that, as the party legally and Onaucially responsible for this proposed construction activity, [ will abide by all
iic:abk laws and requirements that govem Owner-Ruilders as well as employers.
k12. I agree to notify the issuer of this form immediately of any additions; c1EEfetions, of changes ltt ray. of 1Lc inn 1
ave provided on this form Licensed contractors are regulated by laws designed to protect the public. If you cetrtract with
someorro who does not have a lid, ttto C7onitacrtors' State License Board may be unable to assba you with any loss
You may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may bo iw6ivA comrL It is also
itapoz .&r You to WAMAWd drab if an mdiamod Contracwr or emptoyee of that infivt&W or firm is ivjmd vARe vrmicing
on your property, you MAY be held HAW far damaps. If you obtain a permit as Owner -Budder and wish to him Contactors,
You wdl be for at not those Contractors are pwpc* Boeasod and the xbWz of %* wnti c&
00ion bounace oovexrtgo.
Before: a building permit can be issued, this form must be
the agency responsible for issulft.tllm . q
other verifn k to the
owner's signature.
Signature of property owner
Note: Ae folloVng Authorization Form is required to be
an agent of
personally filled out the ab
information and Certify its aadxaauacY. Abtr- A caopy of the owner's drivers license, form notarization. or other verification
acceptable to the agency is required 10 be presettted when the permit is issued to verify the property owner's signature.
Property Owner's Signature:
4
Date:
Bin #
,
I Of la.. uth .
Buikfing & 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:
Owner's Name:. f 1
A. P. Numbe.-
Address:
Legal Description:
Contractor: Contractor:
City, ST, Zip: Z. ic� ;2 -
Telephone:
Address:
Project Description:
City, ST, Zip:
Gc.
Telephone:
State Lic. 4:
City Lie'. M.-
.Arch.,
Arch.,Engr., Designer
Address:
City., ST, Zip:
Telephoner
State Lic. #:'j _
Construction Type:. Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: # Stories: #Units:
Name of Contact Person:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS UNE
N
Submittal
Req'd
Recd
TRACKING
PERMrP FEES
Plan Sets
Plan Check submitted
Item Amount
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Cates.
Called Contact Person
Pian Check Balance
Title 24 Cake.
Plans picked up
Construction
Flood plain plan
Pians resubmitted..
Mechanical
Grading plea
r' Review, ready for correctionsfissue
Electrical
Subcontactor List .
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S,M,I,
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
+
3w Review; ready for correctionsliissue
Developer Impact Fee
Planning Approval.
Called Contact Person
A,LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Ltal Permit Fees
F