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14-0576 (BLCK)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 c - Application Number: 14-00000576 Property Address: 54100 AVENIDA RUBIO APN: 774-202-005-19 -000000- Application description: WALL/FENCE Property Zoning: COVE RESIDENTIAL Application valuation: 1250 T419� 4 4 Q" BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: ESTRADA IRMA M' 54100 AVENIDA RUBIO LA QUINTA, CA 92253 ( Contractor: Applicant: Architect or Engineer: Owner F VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 5/05/14 D i agar 05 zona D ------------------------------------------------------------------------------------------------- LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that I 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 a certificate 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 permit is Z, 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 - - - - - - - - - - - - - - - - - - - - - - - Policy Number following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to _ 1 certify that, in the performance of the work for which this permit is issued, I shall not employ any construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires 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 that he or she is licensed pursuant to the provisions of the Contractor'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 de, I shall forthwith comply wi th a provi ions. that he or�she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by//�t/-t,. for the to five hundred S S -) LI , any.applicant a permit subjects applicant a civil penalty of not more than dollars ($500).: (� I "as owner of the ro art or m em Io ees with wa th 'r I m n t 'll d h k d Date: Applicant: 1 ,� 1 _ P p y, y p y gas as ei so a co pe sa on, wi o t e wor , an the structure is not intended or offered for sale ISec. 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 1, 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. , q.&P.C. for this reason 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 ISec. 3097, Civ. C.). Owner: Lender's Name: _ Lender's Address: LQPERA1IT 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 1 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 thiscounty "ccounty to enter upon the above-mentioned prop y for inspection rposes. / Date'Signature (Applicant or Agent): .PA r IJ`7 Application Number . . . . . 14-00000576 Permit . . . WALL/FENCE PERMIT 2013 - Additional desc . Permit Fee . . . . 47.19 Plan Check Fee 00 Issue Date . . . . Valuation . . . . 1250 Expiration Date 11/01/14 Qty Unit Charge Per Extension 1.00 47.1900 LS MISC WALL, FIRST 100 LF 47.19 ---------------------------------------------------------------------------- Special Notes and Comments 50 IN FT X 6 FT HT PER ORCO STANDARDS & APPROVED PLANS.PRECISION CONCRETE BLOCK SHALL BE COVERED WITH STUCCO, PAINT, OR TEXTURED COATING WHERE VISIBLE FROM OUTSIDE THE PROPERTY. 2010 CBC. ---------------------------------------------------------------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 PLAN CHECK, WALLS 61.06 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 62.06 .00 .00 62.06 Grand Total 109.25 .00 .00 109.25 LQPERM IT 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: Owner's Name: A. P. Number: Address: 6 Y 16D Legal Description: City, ST, Zip: L f} U Contractor: Telephone: Address: Project Description: City, ST, Zip: 1 Telephone: State Lic. # : City Lic. #: Q Arch., Engr., Designer: Address: City., ST, Zip: Telephone: State Lic. #: :.:.:..;;;r,.:;;.::.:.»:::•.::: "•`•"'''""' '''`"' ""''>' "' Construction type: Occupancy: Project type circle one): New Add'n Alter Re 'air Demo Name of Contact Person: ` Sq. Ft.: #Stories: #Units: Telephone #,of Contact Person: Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'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. Pians 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 HOUSE:- '"' Review, ready for correctionstissue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees SITE REQUIREMENTS INTERIOR LOT- (7 OT diaNzf4.s—j- A/ P.O. Box 1504 LA QUINTA, CALIFORNIA 92247-1504 BUILDING &SAFETY DEPARTMENT 78-4.95 CALLE TAMPICO. (760) 777-7.012 LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011 ]PRkJ ERT Y OWNER'S PACKAGE Disclosures & Forins for Owner -Builders Appl ng for Con$truc_,onT0 ..."t , rJVP04T'AAT! N0- CET.. kl2QPERTX O 'i�TER Dear Property Owner An. applicationfor :a. building permit has '.been submitted in your riame'-listing:. yourself as the builder of the Tioperty improvemexits specifiod at We are providing you with an Owner -Builder Acknowledgmeat aril Infoiusatiou'Verifieation•Form to make you awave of your responsibilities and possible risk -you may incur by hAving lhis-permit is, ivyour rause as'the Owner -Builder. -We waiuDt:issue,a buiiding.:permit until yeti�hive read; initial d youF`anderstAndiiig of eaiah'provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot exec(rte:this.riotice unless you, the property owner, obtain the prior approval of the permitting authority. "XXZW.;r43�e Ai'!trtl:Tr xsF,is:avr:.i.�..;,.�,..;..;��......� �...��__.�_�.�..�._��.. •ir; DiRl:{:T 1!lNS: Read ariiliififal each'staleiKen? Gelow'ta sigiii�y you irraderaYarrd or vezfy` fife infbriirdfion. F1. 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 pesonallq. 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- T12. roperty T12. I 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 responsibility.. �3. I understand as an "Owner -Builder" I am the responsible party of.record.on.the,permit I understand that !,may. protect myself from potential financial risk by hiding a licensed Contractor and having the permit filed in his or her flame instead of my own. r14. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. TE 5. I 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, 1 may be considered.an "employer" under state and federal law. P6- I understand if I am considered an "employer" under state, and federal law, I must register with the state and federal ;overnment, withhold payroll-taxes,.provide workers' compensation disability insurance, and contribute to unemployment ;ompensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial isk. J A �7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential tnrctures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed ubcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed order contract with a licensed general building Contractor. E8.1 understand as an Owner -Builder if I sell the property for which this pert -Mit is issued, I may be hed liable. for any financial or personal. igjaries sustained by any subsequent owner(s) that- result from' any latent construction defects in' the workmanship or materials. i 9.'l 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 1- 800-321-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 financially. responsible . for, proposed construction activity at the following address: agree that, as the party legally and financially responsible for this proposed construction activity,.1 will abide by all applicable laws and requirements that govern Owmier-Builders asweil as employers. 12_ I agree to notify the issuer of this form immediately of any additions; deletions, or changes to any of the infornQatiou I have provided on this foam. Licensed contractors are regulated by laws designed to protect the public. If you -contract with someone who.does. notkAve a Iicensa, the Contractors' State. License Board may.be unable to assist' oss . . you may sustain as a result of a complaint Your only remedy against unlicensed Contractors may be in�avil cotuL-it is:,also important for you to. understand that if an nrilicambd Contractor or employee of that individual or firm is injured, while working on your property,' you may be:hcld Ii" for damages. If you obtain a permit -as .Owner -Builder and wish to-birc.Contraetors, you. .will•be vesponsmble .for. verifying vvltcthcuor:" 4wse Coutractors-are-property licensed and,the status of.tkir wockm' compensation instuanoe coverage. Before it building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for isst 4e. pff. - Xaie: A copyof•,&epr erty gwner.'s:drIVer'XAbewSe# fornrc nota rooib+!r; -or other verification aceepte6lc to ike agency is "aired to be rescrit ii when the permit is issued 60, 'Verify .the.prWerty owner's signature. Signature of property owner Date: -S ~ Note: The following Authorization Form is required to be completed by the property owner only when designdting an agent of the property owner to apply for a construction permit for the towner -Builder. AUTHORIZATION OF AGFNTTO ACT QN PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand. is my personal responsibility, I hereby authorize the folloNA4 pei�san(s) to act as my'ageuf(s) to apply for, sign, and file`ti a documents necessary to obtaun'in Owner -Builder Permit for iiny project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of tAuthorized 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 drivers 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: