10-0574 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
1.0=0.0.0.0.0.5.74
Property Address:
5.3.95.3.9�AVBNIDA'RAMIREZ)
APN:
774-162-024-14 -000000-
Application description:
WALL/FENCE
Property Zoning:
COVE RESIDENTIAL
Application valuation:
4650
Applicant: Architect or Engineer:
)J*
BUILDING �_ ':: ,11EVY
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011 "
INSPECTIONS (760) 777-7153
Owner:
BARNETT FAMILY TRUST
PO BOX 1749, PMB 140
BIG BEAR LAKE, CA 92315
---------------------------------
-_-__._Contractor:-.
Owner
Date: 6/28/10
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
hereby affirm. under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
I hereby,�ragffirrm 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
p1N' 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, fortheperformance of the work for which this permit is
- 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: -
Ihereby 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 -
_ I 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 avis 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' compen n 'ons 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, 1 s II fo hwith comply with th io
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
�f
'
any, applicant for a permit subjects the applicant to a civil penalty ofnotmore than five hundred dollars ($5001.:
Date: i2 -'�� `Applicant:
. -{/1w as owner of the property,, or my employees with wages as their sole compensation, will do the work, and
..'��.��/
- - -
—01,
the structure isnot intended or offered for sale (Sec. 7044, Business and Professions Code: The
WARNING: FAILURE TO SECURE WORKERS' COM PENS. N COVERAGE IS UNLAW NO SHALL
.. Contractors' State License -Law does not apply to an owner of property who builds or improves thereon,
SUBJECT AN;EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the 'work himselflor herselfthroughhis 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 interided 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 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.).
I am exempt under Sec. , B.&P.C. for this reason
Date: U Owner:
CONSTRUCTION LENDING AGENCY
1 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: _
Lender's Address:
LQPERA11T
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
whosebenefit 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 LaQuinta, 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 constructioRanereby authorize re entativ
of this county to enter upon the above-mentioned pro erty for ' spa tions.
,Dater 1'V� '(d Signature (Applicant or Agent):
Application Number . . . . . 10-00000574
Permit . . . ELEC-MISCELLANEOUS
Additional desc .
Permit Fee . . . . 18.75 Plan Check Fee
4.69
Issue Date . . . . Valuation . . .
. 0
Expiration Date 12/25/10
Qty Unit Charge Per
Extension
BASE FEE
15.00
5.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20
----------------------------------------------------------------------------
3.75
Permit . . . WALL/FENCE PERMIT
------------Additional---desc_...-.---_------------------------- -
Permit Fee . . . . 72.00 Plan Check Fee
.00
Issue Date Valuation . . .
. 4650
Expiration Date 12/25/10
Qty Unit Charge Per
Extension
BASE FEE
45.00
3.00 9.0000 THOU BLDG 2,001-25,000
27.00
-----------------------------------------------------------------------------
Special. Notes and Comments
186LF OF COMBINATION 1!-4" RETAINING +
5' GARDEN BLOCK WALL [CITY SPEC] AT
EXTERIOR SIDE, FRONT AND INTERIOR SIDE
PROPERTY LINES WITH 9' HIGH -ENTRYWAY AT
CORNER. ENTRYWAY TO INCLUDE ELECTRICAL
INSTALLATION PER PLAN. [MAX BLOCK HEIGHT
TO BE 5 FEET FROM EXTERIOR FINISHED
GRADE - PER DETAIL] 2007 CALIFORNIA
BUILDING AND ELECTRICAL CODES.
June 28, 2010 11:00:40 AM AORTEGA
----------- ----------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
---=-----------------------------------------------------
Due
Permit Fee Total 90.75 .00 .00
90.75
Plan Check Total 4.69 .00 .00
4.69
Other Fee Total 1.00 .00 .00
1.00
Grand Total 96.44 .00 .00
96.44
LQPERMIT
CITY OF LA QUINTA
BUILDING & SAFETY DEPT
APPR0VEp,.,-..---..-..
FOR CONSTWiION
DATE L 13Y--&-
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CITY OF LA QUINTA I----
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
t DATE B
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V0. Box 1°504
LA ,QU.INTA, CALIFORNIA. 92247-1504 BUILDING & SAFETY DEPARTMENT
78-495 CALLE TAMPICO- (76-0) 777-7012
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011
!ROPERTY.OM NEWS ACRAGJUJ
Disclosures & Forms for Owner-DuRders Applying for Construction Pet mite
MWTA TI NO CSS TO k0Rhk '(��VI�II
Dear Pry! Owner'
An. apglieatiou for ,it builFtiDg permit has been submitted m Your name listing yourself as the buddef of the property
oin
inerts specified at ` g L
V,i v are g1Qv1dM_ .YOU v °an Owner Builder Aclmowi t;and.[afpimatien Veri&itianForm to make l ttwen+e o€ your
eesponsrbilities
and pdosttl te' rslc you'may incur by T - , VMS this pe=t iced m,:your oasa as the Owner -Budder. We ill not issue a bald ,p mit:"W yewhsve read, initiaW your. ta�derstanding of each provhslon,
signed, and returned this form to us at -otic :of cigl -address indicated. An, agent of the owner cannot execute "i -notice
unless you, the property owner, obtain the prior approval of the permitting authority.
tanmi befoii a sikn6 you wnfe umut or *coy d6s
LhIl I understand a frequent .practice of unlicensed persons is to have the property owner obtain an "Owner -Builder"
permit that erroneously umplies'ttiat the property owner is "providuig his or her own labor and material personaft-1, 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 loyees.wtide wd* Y property, y y p coverage emp clang on m . M. homeowner sinsurance- ma not rovide ca a 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 peopetty-
>�I understand building permits are; not required to be. signed by propertyowners unless they are respontsible for the
etion and are not . -a. h ensed Contractor to: assume ili _
hrnng .... flus responsib ty .
understand as an "Owner=Builder" I am the responsible party of eecord on the permit. I understand that 1 may protect
V3f
om potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name.instmd of my
own.
^�Q 4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on
g6ts and contracts.
I understand if I employ or otherwise engage any persons other.than California licensed Contractors, and the total value
Way
C� construction is at.least<five hundred dollars ($500); including labor and materials, I may be considered an "employer
under state and federal law.
C6. I understand if -i' am considered an "empioyei" under estate and federal law, I must register with the state and feder
rnment, withhold paycolttakes, provide workers' compensation disability WsuFance, and contribute to un
�employme
compensation for each "employee." 1. also understand my failure to abide .by these'.1aws may subject me to serious f rani
risk
understand under California Contractors' State License Law, an Owner -Builder who builds single-family resident
cannot legally build them with the. .intent to offer them for sale unless all worts is performed by licen
subcontractors and the number of structures does :not exceed four within any calendar year, or all of the work is perforu
under contract with a licensed general building Contractor.
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
cial or personal. 4uries suMkod by any subsequent owner(s) that result from any latent construction defects in the
worlananship or materials.
i9. I understand I may obtain more information regarding my obligations as an "employer" from the bAclUd ROWnue
s 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
Penh' legally and financialiv responsible for proposed construction activity at the following address:
I L I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all
a ie liws and requirements that govern Owner-Budders as well as employes.
12.1 agree to notify the issuer of this form immediately of any additions; deletions, or clams to any of dw i2f�011 I
Rvv& provided on this form. Licensed contractors are regulated by taws designed to protect the public. If you ceatract with
someone who does not have a leen,. Bre Contractors' State License Board may be unable to assist you with anY Snandal 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 undrstand that if an wilkonsed Contractor or employee of that individual of fan is muted while woes ng
on your property; you may be hold for damag¢s. If you obtak a permit as Owner-Builderand wish to hire ContraEtors,
you will be rsspotis to for va*ing whtdm or not those Contmaors are pwpedy licensed anus the stars of 63tr wottw&
compensation ice 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 issubg. #&epw=tL Now A copy of Or properW awjc's dWvw.'n farm reotw 14 or
other verijkadon acceptable to die Vency is regu&wd to b when tike permit is in ed So va* dw pr+v(QertY
owner's signature.
1►J! i v 1 1/ 4 i� 1 I r �� t) � I
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.
&MILORIZATfON OF AGENT To ACT ON rROPERTY OWNXR'S BMRALF
Excluding the Notice to Property Owner, the excwtion of which I understand is my personal responsibility, I heroby authorize
the following person(sy 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 abo'
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
BLOCUP9 Sdety'DWon
P.O. Box 1504, 7#495 Calle fampko
U Quina, CA ' 92253 -- (76.0).777-'7012
Buitdiqg Permit'AI�11�t1oh and
" d Tra6king Sheet
Permit #
PmProjectct Address: S I Oif
A. Rom t.er's Name:
ge 922 BARK. eTT FA^. I q TA.
='
t4.s-r
A. P. Number- 7_ 7,V-
/4 2- - 0 2 cl Address:4 %
Po Be A 17911 FIVA I o
Legal Description: Ags
13 04 81batc xy?. 6pity.r- ST; 7�p: 17!3 Scott- I-'* re-- C*A%31
-31
Contractor:
Address:
0 Telephone: K
LA5 Iq 19 're Ar 3 1
Project Description,
%
City, ST, Zip:
•
-*Af
Telephone:
IV- -
State Lic,
ArcIL, FjW-, Designer
City Lie
94 At 9F tZ
I OW r-A. BMA 6
Address:
City., ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person
B A . — C
VL &L LC 7' 7
-tdistructi.oh Type: 09cupancy:
Project type ,(cirde'Onc)--Repair
6c,5'Add'n Alter
Demo
Sq. FL: T#
stories:
# units:
Telephone N of Contact Person:
I Estimated Value. of Project
APPLICANT: DO NOT
#
Submittal
Req-d
Reed
PERMT FEES
Plan Sets
Plan Check submitted Item
Amount
Structural CRICS.
Reviewed; , ready, for contedous Plan Check Deposit
Truss Cala.
.'Called, Contact Person *Plan Check Balance
Title 24 Cales.
Plans picked up Const metion
Flood plain plan
Plans res'abruitt.ed Mechanical
Grading plan
2! Rcvfew, ready for cormctionzAssue Electrical
SubcoutactDr List
Called Coitict Person Plum-bing,
P Gmat Deed
Plans picked up -SM.L
H.O.A. Approval.
Plans resubmitted Grading
IN HOUSE:-
Review, ready for cormetio Developer Impact Fee
Planning'Approval
Called Contact Person
f ALP P.
Pub. Wks. AIRpr
Date orperinit issue
School Fees
---.L—
Total Permit Fees