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09-0088 (BLCK)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 09-00000088?-' Property Address: 51650 AVENIDA` RUBIO APN: 773-122-006-9 -000000- Application description: WALL/FENCE Property Zoning: COVE RESIDENTIAL Application valuation: 2727 T44-4Q�A& Applicant: Architect or Engineer: BUILDING & SAFETY DEPARTMENT BUILDING PERMIT -------------------------------------------------- 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 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 ownevdf 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 yeai 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.). I _ 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.). A (_ 1 I am exempt under Sec. , B.&P.C. for this reasyp/ moi/ CONSTRUCTION LENDING AGENCX,:,— 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 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 2/06/09 Owner: DEBRA CARRILLO 31910 LUPIN PLACE LAGUNA BEACH, CA 92651 --------------------------------- Contractor: //D/ Owner -------------P----� a< _ �B-� 0109 Cl Op ------------ WORKER 'S COMPENSATION DECLARAT 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 sub' t to th orkers' compensa ' n provisions of Section �j 370 of the Labor Co I shall f wi c p with those prov' ns. Date: ` icant: WARNIN FAILURE TO SECURE WORKERS' COMPENSATION COV EIS UNLAWFUL, AND SHALL SUBJEC 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 pursant 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 above information is correct. I agree to comply with all city and county ordinances and state laws relating to building nstruction, a� herd authorize represent as. of this county to enter upon the above-mentioned property or ' specti `�(So €s: Da 0 Si ure (Applicant or Agent): Application Number . . . . . 09-00000088 Permit WALL/FENCE PERMIT Additional desc . Permit Fee. . 54.00 Plan Check Fee .00 Issue Date . . . Valuation . . . . 2727 Expiration Date 8/05/09 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 59 L.F. 5' BLOCK WALL, 58 L.F. 6' BLOCK WALL, 4 5- COLUMNS, CITY STANDARD.. -------------------------------------------------------------- Other Fees . . . . . . . BLDG STDS ADMIN (SB1473•) 1.00 Fee summary Charged Paid Credited Due ------- ---------- ----.------ ---------- Permit Fee Total 54.00 .00 .00 54.00 Plan Check Total .00 .00 .00 .00 Other Fee Total 1.00 .00 .00 1.00 Grand Total 55.00 .00 ..00 55.00 LQPERMIT Bin # City of LaQ uinta Building a Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # 0 Project Address: , 14; j- Q 1464E, leu,610 Owner's Name: �� ff2 /G z- v A. P. Number: Address: , j j!//O GUf �� iQGT Legal Description: City, ST, Zip: Contractor: Telephone: Address: Project Description: City, ST, zip: .Telephone: City Lic. #: State Lic. # ; Arch., Engr., Designer: Address: 10' X /4o X ICv City, ST, Zip: Telephone: State Lic. #: mow Name of Contact Person:/Ga Sc— #eV79ZTZ G L .040ef46X�k�lOT�AI.5—z Construction Type: Occupancy: Project type (circle one): New Add'n Alter Repair Demo Sq. Ft.: # Stories: # Units: Telephone # of Contact Person:530 Z.SB &L56 3 Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Ree'd- TRACKING PERMIT FEES Plan Sets Plan Check submitted a1qpJ Item Amount Structural Cales. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Energy Cales. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2n° 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 Total Permit Fees 02/04/2009 12:58 02/04/2009 14:40 FAX 714-896-7180 DV COURT g, wcv 1. P.O. Box 1504 , PAGE 02/03 /1004 LA QUINTA, CALIFORNIA 92247-1504 BUILDING & SAFETY D6RARTMENT 78-495 CALLS TAMPIC.'t (760) 777-7012 LA QUANTA, CALIrORNIA 92253 CAX (760) 777-7011 PROPERTY () WNER.' S PACKAGE Disclosure's & Forms for. Owner, -Builders Applying For Construction Permits W"_ ANTI NOTICE TO FROPERTX OWNER Dear Property Owner; An application for a building permit has beet« submitted in your name Iisting yourself as the builder of the property improvements specified at. We are providing you with an Owner -Builder AcknoN;ledgment and luffaft"tion. verification Form u> malw yAu Awase of your respei sibili2ies and possible risk you may incur by ha- Ang this permit issued in your name as the Owner -Builder. We will not Issue a building permit until you have read, initiAled your undcrstgadiing *f each provltll<Att, signed, and retarned this form to us at our officLd address indicated. Au agent of the owner Cann% execute tlllils police unless you, the property owner, obtain the prior approval of the permitting authority. OW R'S ACKNOWI EDGMEW AND VEMFICATfON OF XNFORMT>FON DMECTIONS: ,Read and initial each. swernent below to signify you undersrand or variA this inforMation. DL 1. 1 understand a frequem practice of uulicca sed persons is to bane the ptopc►rty owner obtain an "Owner -Builder" building permit that momously implies that the pro; 4mly owner is providing his or lter own labor and material personally. I, as an Owner -Builder, may be held liable and subject tc• seriou,9 financial risk for any injuries sustained by ani unlioemsed person and his or her employees while world ng on my pa t,perty. My homeowner's insurance may not provide coverage for those Wurios, l am willfully acting ay an Owner -Builder atui am aware of the limits of my insw•ance coverage for injuries to workers ou My property, G2_ l understand building permits are not requii ed to be signed by property owners unless they arc responsible for the constriction and are not hiring a licensed Contractor to assume this responsibiliry. 'DG3. I undartartd as an "Owner -Builder" I arra the rcv* onsible party of record on the permit- I understand that I may protect myself from potential financial risk by hiring a licen:a;d Contractor and haviiag the permit filed in hum or her name instead of my s,% ^4. 1 understand Contractors are required by law to be Licensed and bonded in California and to list their license numbcm on permits and contracts. �5,1 understand if 1 employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at Least five hundred dollars ;6500), including labor and materials, I may l e considered an "employee, uadet state and Nderal law, 6. I understand if, I. am considered an "employer" under state and federal law, l must regisnr:r with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "'employee" I also understmd my failure to abide by these laws may subject me to serious financial risk , I understand under California Contractors' State License Law, ani Owner -Builder who builds single4amily residential str ctures cannot .legally build theta with the intent to offer them for sale, unless all worle is performed by licensed subcontractors and the number of structures does sot exceed four within any calendar year, or all of ft work is perfoMed under contract with a licensed general building Contractor_ 02/04/2009 12:58 714-896-7180 DV COURT PAGE 03/03 02/04/2009 14:47 FAX 5DO05 8. 1 understand as au Owner -Builder if F sell tins property for which this permit is issued, I may be. held liable for any financial or personal injuries sustained by.any sub oquent owner(s) th-ar result from arty latcnt' coastruction dafects in the workmanship or mateiials. 9. 1 understand I may obtain more informatiiori regarding x,ay obligatiens as an "employee' from the Internal Revienue Service, the United States Sn all Business Admiuisaraion, the California Department of bsenefit PaYMCnts, and the California Division of Industrial Accide aw..I also understand I may contact the California Contractors' State Liectnse Board (CSLB) at I - 8M321 -MB (2752) or www.cslb.ea.gov for more information about licensed contractors. 10. I am aware of and consent to an Owner -Builder building permit applied for in ray came. and understand that I am the party legally and financially responsible lbr proposed construction activity at Ole following address: 11. I agree that, as the party legally acrd Beane; ally responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govertr Ovmer Bu:ildecs as well as employers. 12. I agree to notify the issuer of this form W=vD6ately of any additions, deletions, or changes 10 any Of the infotnratiom t havre provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not bave a license, the Corrwicto .s' State License Board maybe unable to assist )rou with any financial loss you may sustain as a result of a complaint Your ornLy remedy against unlicensed Contractors may be in civil• court It is also important for you to understand tint if axe unlieeased Cownemr or employee of that individual or #irsu is injured while working on your prvperty; you Array be held liable for darnag es. If you obtain a permit as Owner -Builder and wish to hire Coatxavtots, you will be mWousble for vvffyixq whether or n(4 those Contractors are properly licensed. and Iiia status of dxiK warkets' Compensation insurance coverage. Before a building permit can be issued, this form imust be completed and signed by the property owner and returned tv, tiro agency respoutsible for isawi ig We permit Na de: A copy of otic property owner's driver's l cent, form detaricadeety or other veriflcardon aeseptable to 00 agency is rejuired to be presented when the permit l9 iasaed to Verify theProPeft1' owner's signature. f (/ Sigrratcrze of prnperty owner Note-, 77te following Authorization Form is req Riled to be completed by the'property ownt:r only when deJignating an agent of the property owner to apply for a c )nstruction permirfdr the Owner -.builder, AUTF. 099% .MWQF AGE [r TO ACT ON PROPERTY OWNEWS BEHA E Excluding the Notice to Property Owner,, the execulOn of which I understand is my personal responsibility, I hereby authorize -the followins person(s) to act as'my agent(s) to app* for, sign, and file the documents ntcemuy to obmiit an, Owner-bluildec Permit for my project. Scope of, Construction Project (or Description of W ark):n/%ge Project Location or Address: SPp "Sylo Name of Authorized Agent: �© Al S(' t`l✓.� 1 Tei No �� Address of Authorized Agent: I declare under penalty of perjury that I am the prof arty owner for the address listed above and I pLMonaily filled out the above irafbnnation and certify its accuracy, Note: A copy 4 rf the owner's dr&er's license, form natarbacuiwa, or other verifwation acceptable to the agency is required to be presence f when the permit is issued to verb rhe properly owners signature. Property Owrwer's Signa Date_ _�• / SITE REQUIREMENTS INTERIOR LOT SIDEYARD: 5 FEETREARYARD: 10 FEET bUNM M EACH SIDE' b'III4D4UM I, S8 7-a7;4Z 45,- 3. F3. 4 FRONTYARD: TO 20 FEET; z lAt1DS ED ¢� t -/�� sa Gf�Dl�A M64miuM o 6' PROPERTY 5�fii6A//,o LINES - ,c2o,�w �2oal�` - ---- � 1.•.L�11 _:. , /6 X a: VG CURBLINE o --------------------- 4-C 7 - � ��'�