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11-0130 (BLCK)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA,. CALIFORNIA 92253 Application Number: 11-=0.00.0.0-1-30 Property Address: 52700 AVENIDA RUBIO APN: 773-283-025-13 -000000- Application description: WALL/FENCE Property Zoning: COVE RESIDENTIAL Application valuation: 10646 . Applicant: Architect or Engineer.: i LOT LICENSED CONTRACTOR'S DECLARATION BUILDING & SAFETY DEPARTMENT BUILDING PERMIT " VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 2/07/11 Owner: FISHER CARL T. PO BOX 408 PALM SPRINGS, I hereby affirm undenpenalty ofperjury 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 thereby affirm under penalty -of perjury that I am.ezempt from the Contractor's State License Law. for the following reason (Sec. 703.1 `5, Business and Professions Code: Any.city or'county.fhat 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 fora:permitsubjects the.applicant to a civil penaltym of ore.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 (Set. 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 hmself or herself through his'or her own employees,,provided that the improvements are not intended or or "for'sale. If, however; the building or improvement is sold within one year of completion,.the,owne_r-builder will have the burden of proving that he or she did not build or improve for the. purpose of,sale.). (_) 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 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 LIVING TRUST CA 92263 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 oftheLabor Code, for the performance of the work for which this permit is ,issued: - .l 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'carriei 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, - andagree,that, if I should become subject to the workers'"'compensation provisions of Section 3760 of the Labor Code, I shall forthwith co tWthose provisions. 1 x214 l 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 (5100,000). 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, eachagrees 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. 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter upon.the above-mentioned.property IA inspection DatMe:. Z + • ` f r Signat�ure,(Applicam or Ag1 i - Application Number . . . . 11-00000130. Permit WALL/FENCE-PERMIT Additional desc . Permit Fee . . . . 126.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . 10646 Expiration Date 8/06/11 Qty Unit Charge Per Extension BASE FEE 45.00 9..00 9.0000 THOU BLDG.2,0.01-25,000 81.00 ,. Special:,. Notes,.• and.. Comments.... -- "----------------------- -------- '---- ..s .... 270. LN FT X 6FT HT.BLOCK WALL; 142 LN .FT X 5, Ft HT BLOCK WALL; '& 16 LN FT X 4 FT " HT ,BLOCK WALL—AL PER CITY STANDARDS & `APPROVED PLANS'PER S.T. other Fees BLDG STDS ADMIN._(SB14.73) - -- - ----- 1.0.0 rFee "summary Charged. Paid Credited. `:Due ------------------------ Permit'Fee Total 126.00 .00 ,:00" 126.00 `P1•an Check Total. .00 'A- 00: 00` 1. Other Fee Total 1.00 —.00- 00 `•" 1.00. Grand Total,.. 127.00 .00. . >00 127.0,0,. t i LQPERMIT m� F.��°8 iREAR DLOCK WALT. 5 'FOO ( HE[GHT "-..4'. FOOT AILL TO . _ FUTURE PAT%0 U'TION NnTES. ONSTR FUTURE i SPA ; Hl 6CK' `BALL FCOTb4G AND. STEET REIN6 GRCEMFNT DE"lf.I_S f cHALL CONFORM TO LA'o(JjNTA :?ESIGN STANDARDS 1S PER AT i'ACHED t PCIL'<E> BLIJCKS, Saa4Ll 9E 8'1(!6' 6°, iAN IN COLOR, CCNSISTEP"'WITH SAMPLE '. � � � i�ROVIDED. _11 • GATES SHALL. r+:aVE A.SPRtNG LOADED CCOSU!�'. DEVICE AND SHAIi V... i t0Cie AUTIJMATIC?LLY WHEN .CLOSED o 79,7 Ott, . n. •� t , s :y �. J • �, �,'%ter . r� ; o�� ®. 0 . MAN I : FENCE <E> 1��� �`��,•'.` t �""�� ..-„�`°�:a .. t GATE J FOUNT SIDE- YARD I BOC Lt: WALL _.. `y FOR CONSTRUCTION 6 N -- - - -- f RON'T BLOCK VIALL 55 6'CGT HFIGH;- DAT BY _ AVEwaDA RUBM_ --, i _.. f Tit P'.0. ROX41.5.04 LA QUINTA" CAL . IFORNiA,9224-771 -5.04 78-49;5 CALLE-TAMPICO LA QUINTA, CALIFORNIA 9.2253 P OWNEWS BOILD..IN G & SAFETY DEPARTMENT (760) 777-7012 FAX (760) 777-7011 ACKAGE Disclosures & Tormsfor Owner-Builldeirs kpply4ii', for Construction Permits 9 MI. ORTANT! NT. CE TOTkOPEP �,TYQWNE Dear Property Owner. - 'in . application- for '.a . building permit hasb&n submitted in -.your name listisig, yourself as the bifilder of the property improvements specified. at We are providing you with an Owne"r-Builder-Ac"Iknowledgment and'[nformation. Verification Form to make you aware of your responsibilities and possible:6skyou may incur I byUvmg_tliis.,pe the _rmit issued in your name as ,6&4iiiper read; initialed your un. Owner -Builder. We. va not, 6�.i mit'untit y641A-4 of each provision, signed, and returned this form to ui."at our official address 'indicati6d..An Agent of the owner cannot execute this notice unless You, the property 'Owner, obtain the prior approval of the permitting authority: DIRECITONS Read and initial each statement bilow tosignifyyou undiostando''r verifyikis infirmad. o on. �1. 1 understand a:kequent practice of unlicensed— r obtain "Owner-Buildee, persons -is to. .have the property , owner an building permit that erroneously imphisthai the prbperty owner . is'providing his or her own labor and material personally. 1, as an Owner -Builder, may be held.liable, and subject to seriousfbi.any.. injuries sustained ial risk by an unlicensed person and his or her employees *tole' working on `t' MY not provide de coverage for those y proper y. y injuries. lam willfully acting' anOwner-Builder -and a' in aware. -. of the limits. of, y ; insurance -coverage for injuries to workers g, as 'on my property. 6Al2. I. understand building -permits are not required to be signed by property owners unless they are responsible for the construction and are riot hiring responsibility. 6?5��3. 1 understand as.an ",Owrier-Builder' I Amdierespo",It. party of record. on the permit, A understand that I may protect myself from potential, financial.risk-by hiring a lkensed Contractor and'havinig &'pernut- filed in his or her name instead of my own. 4. 1 understand Contractors are required by, law to be licensed and bonded in Califoriiia and to list their license numbers on permits and contracts. C' _5. 1 un&rstand if I employ or otherwise engage any, persons, . other than California licensed Contractors, and the total value of my construction is at least five hundred dollars: ($500), tincAudihg -labor and - materials, .1 may be considered an "employee' under state and federal law. I understand if I -am - considered au "'46 loyee"wider state and federal law, I must register with the state and federal .government, withhold payroll "taxes; 1provide ,workers' compensauon disability .insurance, and contribute tounemP loyment compensation for each "employee." I also understand my tiflure to abide by theselawsmay subject me to serious financial risk. 41.;07. 1 understand under .California Contractors' State License.Law, an Owner -Builder who builds single-family residential structures can -not w legally build -them with the intent: to offer them for- sale, unless all work is performed by licensee subcontractors and the number of "Structures does' not exceed four 'Within any calendar year, or all of the work is performer under contract with a licensedgeneralbiillding-Contiactor. d8. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal. injuries sustained by any subsequent owner(s) that result from any latent construction defects in the wo hip or materials. gv I understand I may obtain more information regarding my obligations as an "employee" 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 (CSLB) at 1- 800- 1-CSLB (2752) or www.csib.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 financially responsible for proposed construction activity at the following address: ;d�l I. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all appliSpble laws and requirements that govern Owner -Builders m well as employers. 64 12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information i have 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 Evil court. It is also important for you tounderstand that if an unlicensed Contractor or employee of that individual or firm is injured while woddng on your property, you may be held hable 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 issuing.tlbe.permit. Note: A copy of eke property owner's daiver's "befise, form notar "lom, or other verification acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature. In _ Signature of property owner / I—V--, Date: Z. f 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 agents) 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 property owner's signature. Property Owner's Signature: Date: Bin # City of La Quinta Bldiding 8c; Safety Division Permit # 'P.O. Box 1504;J8495 Cale Tampico 9 La Quinta, cA 92253- (760) 777-7012 BuildingPermit. ` : lication and Tracking . .. App. , ckmg Sheet (� ProjectAddress: 52- 700 INvEjj.tD%k UI _Oovnt�'sName: �l, �� -F A. P. Number. 7 3 _ 28 _ CllS 'Address: 'PO . OX 400 Legal Dcscription:T'�T"i IDL e 1 64 •.'-Ti 17-4 / 3 cA - City, ST, Zip: "�� 52 S C4ZG3 Contractor: �� Telephone: ( Address: Project Description: (7 i�- C7CsL City, ST, Zip: ' r ofZ7'I� W At_.L- 26�- ®5 -go © e, Telephone: State Lic. # : City Lic. C Sv✓ T :f-� WAL , S6 ` p C, N ZD '(SP Arch., Engr., Designs: IQA Address: WALL- 31D � ®5 h4 City; ST, Zip: Telephone: ConstrucfionType: Occupancy: IZ( L State Lic. #: Project type (cicle one) Ncw Add'n Alter Repair Demo Name of Contact Person: CA— % /� # -Units: h Sq. Ft : /� #.Stories: N N Telephone # of Contact Person: - Estimated Value of Project: $O APPLICANT: DO:NOTWRITE BELOW THIS UNE # Submittal Req'd Recd' TRACKDVG PERMIT FEES Plan Sets Plan Check'286Wtted. Item Amount - Structural Cales. Reviewed, ready for Icorrections Plan Ctieek Deposit Truss Cales. Called Contact Person Plan Check Balance Tide 24 Cales. Plans picked up Construction Flood plain plan Plans resubmitted: ' Mechanical Grading plan 2'' Review, ready for correctioas/usue Electrical Subcootactor Uat Called Contact Person Plumbing Grant Deed; Plans picked -4p S.M.L H.O.A. Approval Plans resubmitted Gradi IN HOUSE:- ''' Review, ready for correedonvissne Developer Impact Fee Planning Approval Called Contact Person A.LP:P. Pub. Wks. Appr Date of permit Issue School Fees . Total Permit Fees i