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12-1043 (BLCK)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: -12--_00001043, ---�, Property Address: 54455--AVENIDA RUBIO APN: 774-234-030-10 -000000- Application description: WALL/FENCE Property Zoning: COVE RESIDENTIAL AnDlication valuation: 1429 Applicant: T449� 4 4 Q" '' �­ Architect or Engineer: N4 r - 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 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. - , BAP.C.for this reaso2 *A. (Date: ! r /-2 — /Z Owner: I hereby affirm under penalty of perjury that there is a con work for which this permit is issued (Sec. 3097, Civ. C.1. Lender's Name: Lender's Address: LQPERMIT AGENCY agency for the performance of the Owner: PATRICIA A RINGGOLD 54455 AVENIDA RUBIO LA QUINTA, CA 92253 Contractor: Owner ---------------------- - - - - - - VOICE (76u - 0 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 IN Date: 9/12/12 SEP 12 2012 D TY OF LA QUINTA FINANCE DEPT. 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' compensation provisions of Section �f 3700 of the Labor Code, I shall fQcEhwfE omply,with those provisions. Date:!! �� /.Applicant: WARNING: FAILURE TO SECURE WORKERS' COIQISATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (5100,0001. 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 performedunder 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 i urposes. Date/`��Signature (Applicant or Agent): LQPERMIT Application Number . . . . . 12-00001043 Permit WALL/FENCE PERMIT Additional desc . Permit Fee . . . . 35.00 Plan Check Fee ;; .00 Issue Date . . . . Valuation 1429 Expiration Date 3/11/13 Qty Unit Charge Per Extension BASE FEE 15.00 10.00 2.0`000 HND BLDG 501-2,000 20.00 ------------------------------------7-------------------------------- Special Notes and Comments 66LF OF 5' GARDEN WALL AT FRONT PROPERTY LINE AND DRIVEWAY (CITY STANDARD] PRECISION.CONCRETE BLOCK SHALL BE COVERED WITH STUCCO, PAINT, OR TEXTURED COATING WHERE VISIBLE FROM OUTSIDE THE - PROPERTY. 2.010 CALIFORNIA BUILDING CODES. September 12, 2012 12:09:12 PM AORTEGA ----------------------------------------------------------------_----------- Other Fees . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged Paid Credited Due ----------------- ---------- ------ Permit Fee Total 35.00 .00 ---------- .00 _35.00 Plan Check Total .00 .00 .00 .00 Other Fee Total 1.00 .00 .00 1.00 Grand Total 36.00 .00 .00 36.00 LQPERMIT x • • � �� 12. toa3 ; _ CITY OF LA QUINTA BUILDING & SAFETY DEPT: ' APPROVE® ue vw DATEY G- (4-z l Ir i t s P.O. BOX 1504 LA QUINTA, CALIFORNIA 92247-1504 7$-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT (760) 777-7012 FAX (760) 777-7011 PROPERTY OWNER'S PACKAGE ` Disclosures & Forms for Owner -Builders Applying for Construction Permits. L11fJPf?lf! NOTICE TO PROPEI;TX OWNER Dear Property Owner. An. application for a building permit has been submitted -your name listing yourself as. -he builder of the property i improvements specified at 1_ "d/a We are . r-ovidin g You �� P an Owner- udder Acknowledgment -and. Information Verification Forcer to make you avaars:of your responsibilities and possible risk -you may incur by having this.penmit issued in your name as:the Owner -Builder. We will not issue a building permit until you -have read, initialed your understanding of each' provision, signed, and returned this 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. OV R'S ACKNOWLEDGMWNT AND VERMCATION OF IIWOR A N DIRECTIONS: Read and initial ea h: statemenrheforov to signify you understand or verify this information. 1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder" but ing 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.'y 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 Properh'- 1 understand building permits are not required to be signed by property owners unles3 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_ _ understand that 1 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 own. 4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on pe -ts and contracts. 5.1 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 ($500), including labor and materials, I may be considered an "employer" under state and federal law. V%6. I understand if I am considered an "employee" under state and federal law, I must re_;ister with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and' contribute to unemployment compensation for each "employee." I also understand 'my failure to abide by these laws may subject me to serous financial risk. S 7. I understand under California Contractors' State License Law, an Owner -Builder whc• builds single-family residentialtures cannot .legally build them with the .intent to offer them for sale unless all lwork is performed by licensed subcontractors and the number of structures does not exceed four' within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. 8. 1 understand as an Owner -$wilder if I sell the property for which this peri fit is issued, I may be held liable for any finMicial or personal. injuries sus%ained by any subsequent owners). that result from any latent construction defects in the workmanship or materials. 9. I understand I may obtain more information regarding my obligations as an "employee, from the b t m- I 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 (CS I.B) at 1- 800-321-CSLB.(2752) or www.cslb.ca.gov for more information about licensed contractors. 10. 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the P legally and fnann My respoxmb for proposed construction activity at the following address: 11. I agree that, as the pasty legally and financially responsible for this proposed construction activity,.l will abide by all app cable laws and requirements that govern Owner=Builders as well as employers. 12. I agree to notify the issuer of this form immediately of any additions; deletions, or changes to any of the information 1 hav 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 m* 'civd 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 ContrmOrs, 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 issts#ng. the: permit. Note. A copy of the property owner's driver's Gem fam "tar -X990 , or other verification acceptaKe to the agency is .required to be presented when the permit is issued to verify the. property owner's signature_ Signature of property Date. 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, 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 # Qty. of La Quinta Building a Safety DW6n P.O. Box 1504,78-495 Calle Tampico La.QLqnta, CA 92253 -:(760) 777-7012 Building Permit -Application 'and Tracking Sheet PetiWt # Project Address: Owner's Name:. P -.,42- A. P. N.umber. Address: Legal Description: City, ST, Zip: Contractor. Telephone: - Address: Project Description: 47'�9ADIc#A' L City, ST, Zip: 11 Telephone: n I I am - city", #1` State Lic. 4: Lie'. C Arch, Engr., Designer. Address: City., ST, Zip: Telephone: State Lia 4: Name of Courser Person: Construction Type: Occupancy: Project type (circle one): New Add'n. Alter Repair Demo Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: Estimated Value of Project APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Rtq1d Reed TRACKING PERMIT FEES Plan Sets Plan Check submitted item Amount' Structural Cafes. Reviewed, ready for corrections Plan Check Deposit. Truss Cates. Called Contact Person Plan Check Balance Title 24 Calls. Plans picked up Construction Flood plain plan Plans resubmitt.ed.'. Mechafilcal Grading plan 2'! Review, ready for correctionarmue Electrical Subcontactor L4st Called Cofitact Person Plumbing Grant Deed Plans picked up H.O.A.Approval 'OA ' Approval Plans resubmitted Grading IN HOUSE*.- I US I Review, ready for cormetio'nsfissuc Developer Impact Fee g �l Planning Approval. Cal led Contact Person A.I.P.P. P Wk._ i Pub. Wks. Appr Date of permit Issue School Fees Total otal Permit Fees