10-0278 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:�1.O-0A:0.0.0+
2 8
Property Address:
53-1-25 AV IDA RUBIO
APN:
774.-042-018-6 -000000-
Application description:
WALL/FENCE
Property Zoning:
COVE RESIDENTIAL
Application valuation: 87
Applicant:
T i t 1 v / 4 1'w��rw
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
MUNOZ JUAN C
53125 AVENIDA RUBIO
LA QUINTA, CA 92253
Contractor:
Owner
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) '177-7153
Date: 4/02/10
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LICENSED CONTRACTOR'S DECLARATION
------------
WORKER'S COMPENSATION DECLARATION
I hereby:affirm under penalty.of perjury that 1 am licensed under, provisions of Chapter 9 (commencing with
I hereby affirm under penalty of perjury one.of the following declarations:
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
_ I have and will maintain acertificate of consent to self -insure for workers' compensation, as provided
License Class:. License No.:
for by Section 3700 of the labor Code, for the performance of the work for which this permitis'
-
issued.
'Date: Contractor:
_ 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
- OWNER -BUILDER DECLARATION••
insurance carrier and policy number are:
I hereby affirm under penalty*of perjury that I am exempt from the Contractor's, State License Law, for the ,
Carrier,. PolicyNumber
following reason (Sec. 7031.5, Business.and Professions Code: Any city or county._thet_requires apermit to
-,.[certify that, in the performance of the*workfor which this permit is issued, I shall not employ any
construct, alter, improve, demolish: or repair anystructure, prior to its issuance, also iequires the,'applicant for the
person in any manner so as to become subject to the workers' compensation laws. of California,
permit to file a signed statement ihat.lie or she is licensed pursuant to the provisions of theContractor's State
and agree that, if I should become subject to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
3700 of the Labor Code, I.shall forthwith comply with those provisions.
that he or.she is exempttherefromand 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 -($5001.:
ate: — 2- 1 ti scant: �(i6w--
( 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.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
1 Contractors' State License Law does not apply to an owner of,property who builds or impioves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself-or•herself through his or her own employees, provided that the
_DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or,improvement.is.sold within
SECTION 3706 OF THE -LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
one'yearof completion, the owner -builder will have the burden of proving that he or she did not build. or
improve I& 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
puisuant to the Contractors' State License Law.).
(_ 1 I am exempt under Sec. , B.&P.C: for this reason
ate:
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.).
Z— 'I0 ner:
Lender's Name:
Lender's Address: PIV
LQPERAI IT
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 state that the above information is correct. I 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 `for inspection purposes.
l�dfe: '10 nature (Applicant or Agent):
1_U, -AA, y/vim
LQPERMIT
Application Number . . . . . 10-00000278
Permit . . . WALL/FENCE PERMIT INV FEE
Additional desc .
Permit Fee . . . . 30..00 Plan Check Fee
.00
Issue Date Valuation . . .
. 87
Expiration.Date 9/29/10
Qty. Unit Charge Per
Extension
BASE FEE
30.00
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Special Notes and Comments
4 L.F. 4' GARDEN WALL &STUCCOED WOOD
'FRAMED ARCHWAY AT SIDE YARD.:
'Y.. ,. ... .{ INY/ESTIGATION--FEE«ASSESSED;- PER:.1997;:
UNIFORM ADMINISTRATIVE CODE §304.5 FOR
WORK -'BEGUN WITHOUT BUILDING PERMIT..
Other Fees . . BLDG•STDS ADMIN (SB1473)
1.00
Fee, summary,_ Charged Paid, Credited
Due
` Permit Fee'Total 30:00 .00 A0._
:30.00.
Plan_ Check Total .00 .00 .00
.00„
Other,. FeTotal 1.00 .00 :00
1.00
Grand -Total 31.00 .00 .00
31.00
LQPERMIT
P.O. Box 1504
LA QUANTA, CALIFORNIA 92.247-1504 BUILU7NG & SAFETY- DEPARTMENT
78-49.5' CAL LE TAMPWo (760) 777-7012
LA QUINTA,.CALIFORNIA 92253 FAX (760) 777-7011
PROPERTY -OVWNEWS PACKAGE
Diselosures & Forms for Owner=Binders Applyi4'for Coi istruction Permits
IMPORTANT! NOTICE TO PROPER•TX OWNER
Dear Property Owner.
Ari. application for a, building permit has been submitted in •your. name listingyourself as the builder of the .property
improvements specified at
We.are providing you with an..O.wner.-Buildei-Acknowledgment and:ldormation VerificatioifForm to •make you aware of your
.responsib.ilities and possible risk you may incur by having this pernut`issued itE your name as.ahe
Owner -Builder. We will not issue a:btdlding.pern it unUl..you.have.read, initialed. -our understanding of each provision,
signed, and returnedthis 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.
y.
DIRECTIONS: R'e'ad `und rnitial each: statement below to signify you uriders'taid or verify thrs`informaron.
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 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 property.
-�,/2. 1 understand building permits are not required to. be signed by'property owners unless they are responsible for the
construction and are not hiring a licensed Contractor to assume this responsibibty. °
4 ..
3. I understand as an "Owner Builder' Tam the responsible.pai'ty of record on lhe.permit. I understand that I may protect
myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my
ow74.
.
I understand Contractors are required by law to be licensed and bonded in California. -and to list their license numbers on
permits and contracts.
5i,.sl understand 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), including labor and materials, l may be considered an "erimployer"
under state and federal .law.
V/ 6. [ understand`.'if I, am-consrdeced'anemployer" under state and federal law, I must register with the state and federal
government, . Withhold' payroll'°taxes,` provide workers' co'mpensatiom.disability insurance, and contribute to unemployment
compensation for" each` "employee." I: als9'understand my failure'to abide by these laws may subject me to serious financial
risk.
J
7. I understand ,under California Contractors' State'License'.Law," an Owner -Builder who builds single-family residential
structures cannot .legally build them with the : intenttd ,o,'ffer ahem :for 'sale, unless all work is performed by licensed
subcontractors and the number of structures: does not exceed four within .any' calendaryear, or all of the work is performed
under contract with a licensed general
`building Contractor.
/8. 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 suseained by any subsequent owner(s) thA result from any latent construction defects in the
workmanship or materials.
_JLy. 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, and the California
Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at I -
800=3221-CSLB (2752) or www.cstb.ca.gov for more information about licensed contractors.
x/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:
agree that, as the party legally and financially responsible for this proposed construction activity,.I will abide by all
appl/icable laws and requirements that govern. Owner -Builders as well as employers.
V l2. I agree to notify the issuer of this. form immediately of any additions; deletions, or changes to any of the information 1
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 civil court. It is also
important for you to understand: that if an unlicensed Contractor or employee of that individual or firm is injured while 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 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, the permit. Note: A copy of the property owner's d iver•'s.Cieense;. form notarization; or
other verification acceptable too the agency is required to be presented when the permit is issued to verify the property
owner's signature.
Signature of property owner �G'G�Date:
,/-/-/0-
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 understand. is my personal responsibility, .1 hereby authorize
the following person(s) to act as, my agent(s) 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
,Building 8T'Safety Dh4slon
Permit #
P.O. Box 1504, 78.-495 Calle Tampico
'
6 Quinta, CA 92253 - (760) 777=7012
Building Permit Application and Tracking -sheet-__
Project Address: 2S '
A J, (J6r'aOwner'sNaine: �ifpn,/YZ
JV ��
A. P. Number:
Address: S3 12 . A v. k0bfo
Legal Description:
City, ST, Zip:
Contractor:
Telephone':
Address:
Project Description:
City, ST, Zip:
Telephone:
`" a 2
State Lic. # :
City Lic #: A �/2 Ti—
LArch.,
Arch.,Engr., Designer:
Address:
City, ST, Zip:
Telephone:<'
t
Construction Type: Qcc
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State Lic. #:
Ned ,type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.: #Stories: #Units:
Estimated Value of,Pioject:
Telephone # of Contact Person:
APPLICANT:
DO NOT WRITE BELOW THIS LINE•
#
Submittal
Req'd
Recd
TRACING
:. PERMIT FEES
Plan Sets
Plan Check submitted
Amount
Itun
Structural Cafes.
Reviewed; ready fortorrections
Plan Cheek Deposit
1Ynas Cates.
Called Contact Person '
Plan Check Balance
Titie 24 Cala:
Plans pitked.up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2~ Review, ready for eorreetions/iasue
Elcetrical
Subcontactor List
Called Contact Person
Plumbing
S:M.I.
Grant Deed
Plans oieked up
•
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
''' Review, resIdj for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P. .
Pub. Wks. Appr
Date of permit issue
School Fees
1 I Total Permit Fees