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14-0719 (BLCK)Xl,i�ii�, ti�P.O. BOX 1504 ��4 4 ^� VOICE (760) 777-7012 78-495 CALLE TAMPICO 'O '_ FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 5/30/14 Application Number: 14-00000719 Owner: Property Address: 51565 AVENIDA RUBIO HERRELL GREGG APN: 773-121-010-1 -000000- 9205 171 ST AVE NE Application description: WALL/FENCE LA QUINTA, CA 92253 Property Zoning: COVE RESIDENTIAL ( Application valuation: 2000 999 Contractor: Applicant:_ �/ Architect or Engineer: Owner D /V4 M AYi CTY -------------------------------------------------- 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 7000) of Division 3 of the Business and Professions Code) or that he qpahe is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by an1 icant 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 thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). 1 _) I am exempt under Sec. , B.&P.C. for this reason .0p Date: 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 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' compensati n pr isions of Section 3700 of thalabor Code, I s wi ompl wi h th . ose provis' s , Date: -J - Appli ant: WARNING: FAILURE 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 work for 180 days will subject permit to cancellation. I.certify that I have read this application and stat t the above information is correct. I a to comply with all city and county ordinances and state laws ting uild' onsg d hereby au ri representatives of thist`-co�u-n�t to enter upon�%t/pe above- -p y f insoses. Date: / - G Siggnnatute (Applica enfT Application Number . . . . . 14-00000719 Permit . . . WALL/FENCE PERMIT 2013 Additional desc . . Permit Fee . . . . 47.19 Plan Check Fee .00 Issue Date Valuation 2000 Expiration Date 11/26/14 Qty Unit Charge Per Extension 1.00 47.1900 LS MISC WALL, FIRST 100 LF --------------------------------------------------------------------------- 47.19 Special Notes and Comments 80 IN FT X 6 FT HT BLOCK WALL PER ORCO STANDARDS.APPREVED PER J.J. PRECISION CONCRETE BLOCK SHALL BE COVERED WITH STUCCO, PAINT, OR TEXTURED COATING WHERE VISIBLE FROM OUTSIDE THE PROPERTY. 2013 CBC. ---------------------------------------------------------------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 PLAN CHECK, WALLS 60.06 Fee summary Charged Paid Credited Due --------------------------------------------------------- Permit Fee Total 47.19 .00 .00 47.19 Plan Check Total .00 .00 .00 .00 Other Fee Total 61.06 .00 .00 61.06 Grand Total 108.25 .00 .00 108.25 LQPERMIT Bin # City of La Quinta Building 8L 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: S AV,5n% _Pp, 12 l) f2j� Lb Owner's Name lae G6 A. P. Number: AddressO 9 2 G J 7 / sI'IP- Legal Description: City, ST, Zip �� -� <� tr J^� Contractor: ? _ C3 W 1��1� W UI L. p �� Telephone. '� — .... ;:«.>s:>:: '?::< a :.�.:..::.::.0;::.r. Address 9 2 0 '7) ✓� `( f/ Project Description: LC7C l� City, ST, Zip k6c=/b r/y/ ds -V d -�Z De6J WA C i77 41 Telephone: G—Z� 7 T �a?y c /,<-- State Lie. # City Lie.#. Arch., Engr., Designer: .Y 6 - Address: City, ST, Zip: Telephone: '' '>°` `' -,:;>•:::••v.<:.:;<•;:•;::~' :.:::✓;;>:<>:::::<>:;::;.;<5:«: "`•`•. `•'# : < < : ` > < : #:>. < ; >? Construction Type: L Occupancy: State Lie. #: Project type circle one): New Add'n Alter Repair Demo Name of Contact Person: L YA (>)P- Sq. Ft.:N # Stories: # Units: Telephone # of Contact Person:, �o — (� Estimated Value of Project: (�D b APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rcc'd TRACKING PERMIT FEES. Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. 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 IiOUSE:- ''" Review, ready for correctionsCssue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees .T-0. Box 1504 LA QUINTA" CALIFORNIA 92247-1504 78-4.95 CALLS TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING &'SAFETY DEPARTMENT (760) 777-1012 FAX (760) 777-7011 PJMk"i -DPERTY, 0 MWER'S PACKAGE Disclo'sures & Fo*rms for 0Wn&-Buflders App mgfio'r.C.0 P4nos. LW0AT1WTLN0J1,1CK10 PRUERTY.OWNER Dear Property Owner An.. application 4or a .-.budding, -Permit has',bc-6n,submiaoUin your naa listing'. yourself as =the, budder of the.,f.prbpcdy improvements spocific-d4it We are providing yowwith an Owner -Builder Aclmow i , ledgment-and Information%Veffication,Form-to make you awa=,.of your respensibilitiesmulpossible . risk you may in= by h9ving -W&permitiss�djjb�your�namie, ais'the Owner -Builder. We wilt mot inue,a.building, - permit until you-liave read, ihifiatid yottr4jiderstaid -`of "ch,provision, signed, and returned this form to us at our official address indicated. An agent of the owner caraidt, excdUte:thiiAioiiCe unless YOU, the Property Owner, obtain the prior approval of the permitting authority. �•Reiid acid you UM I understand a frequent practice of unlicensed persons is to have the property owner obtain. an "Owner -Builder building permit that erroneously.implics 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 'on my building permits are not required to be signed by property owners .unless they are responsible for the construction ;=noUh*1r1119 a Licensed Contractor to assume this responsibility-, understand 'Ime -B d:�' 1.11111 the res: understand that I �ma protect If from responsible party ofreqord,on thevermit I u -Y �s "0 r i1hi g a Licensed Contractor and having the permit filed in his or her name instead of my potential financial risk buy A. -f -understand Contractors are -required -by4aw-to-be-licensed-and-b-onded-in-Cah'fomia-and-tb-list-their-lice-nse-numbm on P. rmits and contracts. 5. I understand if I employ or otherwise engage any persons, other than -California licensed Contractors, and the total value o my construction is at least five hundred dollars ($500), including labor and materials, I may, be,consider�.td.an. ".c[nployer" under tate and federal law. go em understand if I am considered an -employee, under state and federal law, I must register with the state and federal �o em ent,.withhold payroll taxes, - provide workers' compensation disability insurance, and contribute to -unemployment aompensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial 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 *ubco * ntraCtors and the number of structures does not exceed four within any calendar year, or all of the work is performed ordercontract with 'a licensed general building Contractor. J8. I understand as an Owner -Builder if I sell the ro ert for which this rinit is issued, I may be held liable. for any property Y I� , financial or personal. injuries sustained. by any subsequent owners) that' result from' any latent construction defects - in' the. wo anship or materials. 9. 1 understand I may obtain more information. regarding my obligations as an "employer" from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, a6d the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSI::B) at 1- 800- -I -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 party legally and f nancially responsible . for proposed construction activity at the following address: % 11. I agree that, as the party legally and fanapc411y responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owuer-Builders as weil as employers. 4I2. I agree to notify the issuer of this form immediately of any additions; deletions, or changes to any oftheinfo ma►tion I h e provided on this form Licensed contractors are regulated by laws designed to protect the public. If you,contract with someone who. does.nottacve a license,. the Contractors' State. LicenseBoa:dmaybe unable to - you may sustain as a result of a complaint Your only remedy against unlicensed Contractors may be iwcivil ccnut_ "It is-ab�% important for you to. understand that -if an uWiee ns6d Contractor or employee of that individual or firm is injured,wirile wortang on your property; you may be teld.liabie. for damages. If you obtain a permit, as .Owner -Builder and wish to-hirc.Contrnetors, you.will•be.rrsponsrble for.verrfying v4tedw .or:not4wse Contractors are:properly.licensed and:thestatus ofth6rrworkets' 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 issuhtg,&eperagiLXWe: A copyof dte. ropen er's driver'sl&oewsef fornn_nota opivnr;.or other verification aceeplwblG to 'the agency u required to be'preserifed wliitir fEhrt permit "ts: sued to 'verify the'prop" owner's signature. Signature of property owner / ( / Date:__S � 2 7 — Z 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 towner -Builder. AUTHORMATION OF AGENT TO ACTON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I undersV.tand. is my personal responsibility, I hereby authorize -the folio - - n s to act as m a wing Pciso () y . geuf(i:)'to apply for, sign, and file the documents necessary id obtain in Wner-Builder Permit for my projectJ Scope of Construction Project (or Description of Work): TDLC [L- W CSeLA L c_fj WALI L Project Location or Address:Tl'j�� U(y -- - - - - -- - - -- - -- - -- Name of Authorized Agent: zSjkA p CZL= Tel No Address of Authorized Agent: S4,5�) 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 ofthe owner's driv 's license, form notarization, or other verification acceptable to the agency is require e Y ed when the perm' "` issued to verify the property owner's signature. Property Owner's Signa Date: S 2