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12-0692 (BLCK)P.O. BOX 1504 78-495 CALLE TAMPICO. LA QUINTA, CALIFORNIA 92253 Application.Number. ---"-12'00000692-1 Croperty-Address:''52520 AVENIDA RAMIREZ APN: 773-292-002-22 -000000- Application description: WALL/FENCE Property Zoning: COVE. RESIDENTIAL Application valuation: 375 Applicant: Architect or Engineer: 4 4 " BUILDING & SAFETY DEPARTMENT BUILDING PERMIT ------------------ LICENSED CONTRACTOR'S DECLARATION VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 6/22/12 Owner: PINSCORP INC D� "'x-.5.2-520 AVENIDA RAMIREZ fnQUINTA, CA 92253 AN' 2.2 2012 !„ A I hereby affirmunder 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— m=exempvfrom 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 1, 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 theworkhimself 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, 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.). (_) I am exempt under Sec. , B.&P.C. for this reason Date:%' fir: 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: _ f Lender's Address: s LQPERMIT ------------------ 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 forwhich 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, it I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. 0.10 Applicant: 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 0100,000). 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 ouinta, 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. Application Number . . . . . 12-00000692 Permit . . . WALL/FENCE.PERMIT Additional desc . Permit Fee . . . . 15.00 Plan Check Fee .00 Issue Date .'. . .• Valuation . . . 375 Expiration Date.. 12/19/12 Qty Unit Charge Per Extension BASE FEE 15.00 Special Notes and Comments 15 L.F. X 61SLUMPSTONE BLOCK WALL WITH WROUGHT IRON GATE. Other Fees . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged Paid Credited Due, Permit Fee Total 15.00 .00 .00 15.00 Plan Check Total .00 .00 .00 00 Other Fee Total 1.00 .00 .00 1.00 Grand Total 16.00 .00 .00. 16.00 ' h j CITY OF LA.QUINTA BUILDING & SAFETY DEPT. APPROVED FOR CONSTRUCTI DATE /o`�/ /02 B 0f -r �.� f I i j CITY OF LA.QUINTA BUILDING & SAFETY DEPT. APPROVED FOR CONSTRUCTI DATE /o`�/ /02 B 0f -r �.� f I i U moo, -MAC r"Ar, re —2 WW Mt P.O. Box 1504 LA QUINTA, CALIFORNIA 92247-1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT PROPERTY OWNER'S PACKAGE (760) 77 7-70 12 FAX (760) 777-7011 Disclosures & Forms for Owner -Builders Applying for Construction Permits I WORT.9[dYI! NOTICE TO P — PERTY OWNER Dear Property Owner. Aa. application for a building permit has been sAbmitted in,your name listing yourself as the builder of the .property impraoVMents specified at � '2- — ,S' t.i We are .providing you with anOwner-Builder Acknovi+ledgment andt Information Verification Form to make you aware_of your 'responsibilities and possible risk you may incur by having this pewit -issued in your name as the Owner -Builder. We will not issue a building. permit until yew4ave read, initialed your understanding of each'prevision, 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. Read and initial -each 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' 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 injures. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers `'ohn my. property. V f 2. 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. . 11 understand as an "Owner -Builder" I am .the responsible party of record on the permit. I 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. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits 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" aw_Vunder state and federal law - VC 6. 6. I understand if I am considered an "employee' under state and federal law, I must register 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 serious financial risk. 7. 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 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. kJ- 8. 1 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 constriction defects in the workmanship or materials. V 9. I 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, Californiaand the Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CS.LR) at 1- 800-321-CSLB (2752) or www.csib.ca.gov for more information about licensed contractors. 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 ai the following address: V i 1. I agree that, as the party legally and financially responsible for this proposed construction activiiy,.l will abide by all applicable laws and requirements that govern Owner -Builders as well as employers. V 12. 1 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 anutilicensed.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 insurancecoverage. 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.. Mite: A copy, of the prop".o,vner's dciver.'s l&v tse-t faun' notar,;ic n; or other verification acceptable to the agency is req' uired to be presented when the permit is issued to verify the prop" owner's signature. Signature of property owner Date: Z1-- �z 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 drivers license, form notarization, or other verification acceptable to the agency is required Co be presented when the permit is issued to verify the property owner's signature.. Property Owner's Signature: Date: um # Permit # a A - Project Address: A. P. Number: Legal Description: Contractor: Address: City, ST, Zip: 4 Telephone: State Lic. # Arch., Engr., Designer: Address: City, ST, Zip: Telephone: State Lic. #: 0 Name of Contact Person: u Telephone # of Contact Person:-) (N C o nstr u ction Type:P e : ). Occupancy: P an cv• Project 11 �circleoneNew Add'n Alter Repair Demo Sq. Ft.: # Stories: # Units: Estimated Value of Project: S d d Total Permit Fees I 1 (fl. APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERiMIT FEES Plan Sets Structural Calcs. Plan Check submitted Reviewed, ready for corrections Item Amount 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 plan2nd Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S. M.1. H.O.A.Approval Plans resubmitted Grading IN HOUSE:- 7rd Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.LP.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees I 1 (fl.