BWFE2016-01987$-495 CALLE TAMPICO
'LA-QUINTA, CALIFORNIA 92253
Tww 4ZwQuMrw
DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: _
BWFE2016-0198
Property Address:
52500 AVENIDA RAMIREZ
APN:
773292001
Application Description:
DEVOE / BLOCK WALL AT FRONT YARD
Property Zoning:
Application Valuation:
$5,000.00
Applicant:
OWNER BUILD
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 Professions 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 subjec the applicant to a civil penalty of not more than five hundred dollars
(� owner of the property, or my employees with wages as their sole
Apensation, 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 onp year of completion, the owner -builder will have the burden of proving that
FL
e did not build or improve for the purpose of sale.).
as owner of the property, am exclusively contracting with licensed contractors
truct the project. (Sec. 7044, Business and Professions Code: The Contractors'
cense Law does not apply to an owner of property who builds or improves
thereon, and who contracts for the projects with a contractor(s) lic sed pursuant to
t Factors' State License Law.). �
am exempt under Sec. B.&P.� TPr this reason
CONSTRUCTION LMDINMGENCY
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. Q.
Lender's Name:
Lender's
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/9/2016
Owner:
LYNNE DEVOE
52500 AV EN I DA RF M I REZ
LA QUINTA, CA 9253
Contractor:
OWNER BUILD
Lic. No.:
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of fie following declarations:
I have and will maintain a certificate :)f 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' conpensation insurance, as required by
Section 3700 of the Labor,Code, for the perforn-ance of the work for which this permit
is issued. M work compensation insurance carrier and policy number are:
Cjarrier — olicy Number: _
-_ rtify that in the performance of tF•e work for which this permit is issued, I
sh n t employ any person in any manner so a: to become subject to the workers'
compensation laws of California, andagree th i should become subj the
workers' compensation provisions of Sectio 770 f the Laborall f hwith
comply with th se pro Bions.
Applican`ti'.
WARNING: FAILUR TO SECURE WORKERS' ENS COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMIN<.L PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,0006. IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR <N SECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWILEDGEMENT
IMPORTANT: Application is hereby made to the Building Official 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 stare that the a ove information is correct.
I agree to comply with all city and county ordinances and a laws relating to buifdg '
construction, and hereby authorize representatmes of this to enter up • th
above- ntio ed pr erty for inspection purposes.
D ignature(ApplicantcrAgeni)_
r
Date: 9/9/2016
Application Number:
BWFE2016-0198.
Owner:
Property Address:
52500 AVENIDA RAMIREZ
LYNNE DEVOE
;APN:
773292001
52500 AVENIDA RAMIREZ
Application Description:
DEVOE / BLOCK WALL AT FRONT YARD
LA QUINTA, CA 9253
Property Zoning:
Application Valuation:
$5,000.00
Applicant:
Contractor:
OWNER BUILD
OWNER BUILD
LIc. No.:
Detail: 20LF OF 6' BLOCKWALL AT FRONT -SIDE YARD [CITY SPECIFICATIONS] PRECISION CONCRETE BLOCK SHALL BE COVERED WITH STUCCO, PAINT, OR
TEXTURED COATING WHERE VISIBLE .
r
DESCRIPTION ACCOUNT CITY
AMOUNT
BSAS SB1473 FEE 101-0000-20306 0
$1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: -$1.00
DESCRIPTION
ACCOUNT
CITY"
AMOUNT
WALL/FENCE - FIRST 100 LF
101-0000-42404
0
$47.86
DESCRIPTION
ACCOUNT
C+TY
AMOUNT
WALL/FENCE - FIRST 100 LF PC
101-0000-42600
-0
$60.91
Total Paid for FENCE OR FREESTANDING WALL: $108.77
-
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Pzrmit ;;
Project Address:``] Z" - S O d
e
C►ty. of La Quinta
Building a Safety Division
78-495 Calle Tampico
La Quinta; CA 92253 - (760) 777-701,2
Building Permit Application and Tracking Shut ;
e v� vy� 'f Owner's i lame: Lh N Q Q -"J U
A. P. Number:
Address: SZ -SG Q
Legal Description:
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o tact
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Address:
City, ST, Zip: La
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Project Descriptiori ` We, �� xG ...LVWN
city,.ST, Zip:
Ir
ne•
TeleP ho .
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State Lic. # :
Arch., Engr., Designer:
City Li c:
Address:
City, ST, Zip:
Telephone:
one:
t ic. #
State a L
Name of Contact Person:
ecu
acYon
traction Type: O
t tyPe circle one)• Add'n Alter Repairair
New Demo
Sq. Ft.: # Stories: # Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO.NOT WRITE BELOW THIS LINE
#
Submittal
Rcq'd
Rcc'd
TRACKING
PE3MIT 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.
Plans picked up
Construction '
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2nd Review, ready for corrections/issue
r
Electrical
Subcontnctor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
I-I.O.A. Approval
flans resubmitted
Grading
IN ROUSE:-_
'"' Review, ready for corrections/issue
Developer Impar Fee
Planning Approval
Called Contact Person
A.I.P.P. '
Pub. 1Yks. Appr
Dale of permit issue
School Fees,'
Total Permit Fee
1
TdY . 4'�Qlah -a
P.O. BOX 1504
LA QUINTA, CALIFORNIA 92247-1504
78-4.95 CALLE.TAMPICO
. LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
PROPERTY OWNER'S PACKAGE
(760)777-7012
FAX (760) 777-7011
Disclosures & Forms for Owner -Builders Applyingfor COIIStructiDn Permits
IMPORTANT! NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application for a building permit has been submi ed in your name listing yourself as the builder of the property
improvements specified at 52 ' Oo
We are providing you with an Owner -Builder Acknowledgment.and Information Verification Form to make you aware of your
responsibilities and possible risk you may incur by having this permit 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:
DIRECTIONS: Read and initial each statement below to signer you understand or verify this information.
07
I understand a .frequent practice of unlicensed persons is to have the
p property owner obtain.•: an "Owner -Builder"
building permit that erroneously implies that the property owner is providing his or her own labor and m. terial 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 p'rrooperty.
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.
�I understand as an"Owner-Builder" I am the responsible party of record on the 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 hrr name instead of my
own.
W44 -.-
I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on
permits and contracts.
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, I may be considered an "employer"
understate and federal law.
I� L l understand if I am considered an "employer'under state and federal law, I must register with the state and federal
govemment, withhold payroll taxes, provide workers; compensation disability insurance; and contribtte to unemployment
compensation for each "employee." I also understand my failure to abide by these laws. may subject me to.serious financial
risk.
I understand under. California Contractors' State License Law; an Owner -Builder. who builds single-family residential
structures cannot legally build them with the intent to offer them for sale, unless all work isperformed 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.
:4L�82.
derstand as an Owner -Builder if Iell
s 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 coins suction defects in the
workmanship or materials:
I understand I may obtain more information regarding my, obligations as an "employer" frorn 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.
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 activityat the following address:
1. 1 agree that, as the party, legally and financially responsible for this proposed construction activity, I will abide by all
ap 7icable laws and requirements that govern Owner -Builders as mell as employers:
AV12. 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 Lz civil court. It is also
important for you to understand that if an unlicensed Contractor or employee of tthat individual or m is injured while working
on your property, you may be held liable for damages. If you obtain a permit as Owner -Builder and. wuh to hire Contractors,
you will be responsible for verifying whether or not those Contractors are properly licensed and the s-atus of their workers'
compensation insurance coverage.
Before a building permit can beissu this form must be:completed and signed by the property owner and returned to
the agency responsible for issuing a ermit. Note. A y of the property owner's driver's license,. orm notarization, or
other verification acceptable to th ency is requir to a Pres. rated when the permit ed7.o'
verify the property
owner's signature. ' 7� j'
;4gnature of property owner
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 ACTON 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 agent(s) to apply for, sign; and file the documents necessary to obtair_ 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 owne- s signature.
Property Owner's Signature:
Date:
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