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11-0079 (BLCK)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 11-00000079 Tay,/ 4 ukw BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Property Address: 54465 AVENIDA RAMIREZ APN`., 774-243-023-12 -000000- Application description: WALL/.FENCE Property Zoning: COVE RESIDENTIAL Application valuation: .3500 Applicant: Architect or Engineer: . LICENSED CONTRACTOR'S DECLARATION I•hereby affirm underpenalty.of perjury that I arn9icensed 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•BUILDERDECLARATION . 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-anddProfessions Code: Any city or.county,that requires'a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance alsodequires'the applicant for the permit to filen signed' statement that lie or she is licensed pursuant to the provisions; of the Contractor's Staie License Law, IChapter 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. Anybiolation of Section 7031-.5 by af�y applicant for a permit subjects the. applicant to a civil.penalty of not more than jive hundred dollars ($500): I, as owner of the property, or my employees with wages as their sole compensation;twill do the work, and the structure isnot intended or offered for sale (Sec. 7044 Business and Professions Code: The Contractors' State License Law does not apply to an.owner of:pr6pertywho.buiids or improves thereon, ,and who,doesthe work himself, or herself 1.through his or her own employees, provided that the improvements are not intended or offered for sale. If,'however,tlie building or impro'Jement'is sold within . one yearof,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 1 I am exempt under Sec. , B.&P.C. for this reason 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: Lender's Address: LQPERMIT Owner: DE GRANDMAISO KAREN 54465.AVENIDA RAMIREZ LA QUINTA, CA 92253 (949)379-9556 Contractor: Wrier VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: • 1/24/11 JAS! 2.4 211 W ORKER'S'COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of -ii 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,permitis issued. - _ I have and will maintain workers' compensation 'insurance,as required by. Section 3700 of the ;Labor Coder,for the performance of the -work for which. this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier----=-------------=--.--Policy.Number _ 1 cemfy 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 iftshould become subject tb'the workers' compensation provisions of Section 3700 of the Labor Code4 all f0ep-ith complywith those provisions. ,WARNING: FAILURE TO SECURE WORKERS' MPENSAT61'COVERAGE IS UNLAWFUL, AND SHALL" , SUBJECT AWEMPLOVER TO CRIMINAL PENA TIES;AND CIVIL FINES1UP 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 fora 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-agreesto, 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 state that the a - e information is correct. I agree to comply with all City and county ordinances and state laws relating to buil ' g onstr ion, and hereby authorize representatives of this county to enter upon the above-mentioned prop y r ins ction purposes. D eat �/Signatur-� re -(Applicant or Agent) LQPERMIT Application Number . . . . . 11-00000079 Permit WALL/FENCE PERMIT Additional desc . Permit Fee . . . . .63.00 Plan Check Fee .00 Issue Date Valuation . . . . 3500 Expiration Date 7/23/11 Qty Unit .Charge Per Extension BASE FEE. .45'•.00 . 2.00. 9.0000 THOU ';BLDG.2,001-25,000 18.00 -------------------- -- Special Notes and Comments 140 LN 'FT GFT, &.8'.,FT HT PER PLAN GARDEN- .WAI;L PER ORCO. STANDARDS• AND APPRQVED "PLANS 'PER.:A A. J. .: ------- - - -•-.------------------------------- Othe-r _Fees .: _ BLDG STDS ADMIN . (SB1473) r. 00 - Fee summary Charged . Paid Credited Due Permit. Fee Total,;, 6-3-00 .,00 .00 63.,0,0 Plan Check _Total-: -.:0;0 0.0 ..00 :'00 r . Other Fee; Total" 1-.00 .00. 00 = :1.00' Grand Tgta1 .' `" 64 = 00 0.0 :.: ..00•.. _ 64;:-00- . LQPERMIT PO. Box 1504 LA Q(JINTA','CAL.t.l OkWik.'.92247'-'I:504 78-495, CALLS TAmpico LA QUI'NTA',-CAIIF0'RNIA 92253 PRO] BUILDING .& SAFETY DEPARTMENT C K__A_ G (760) 777-7012 FAX (7.60) 777-7011 Disclosures & Forms for Owner--B'H&rsA'ppIyin for Construction Permits' 9 IM"O TAIVL NOTIC 'TO PROPERTY OWN " Dear Property 0wner: 'An. application for at bwlding- permit has Wen% submitted'. your,, name listing. yourself as the builder of the property iniprovements specified;at We are providing you withafi3O'wner-Builder'Acknbwl6d'gvand, lilfaniiation-Ver&idafion- Form to make you aware of your men responsibilities and possible risk-ybd may incur by.'havin' g -&sl permit issued In your name as the Owner -Builder. Wiwill nottissue A-building.pikinit: 'your , e initial understanding of each provision, signed, and returned. this form to us at out official . a4dreissift'idicated. An.agent.61f the owner cannot execute this notice unless you, the -property owner, obtain the prio-r-'app . roval of the permitting authority. Read and -iii idail each. statement -b &oW'to' "sign fy you un`derstana or.v- I. I understand a frequent practice of unlic" ed ns,is to have tam an "Owner -Builder" ens, persons the property owner obtain building permit that'e'noneously 16pliesthat the. , properiy t' personally. I as owde.fi s- p'r'ovt*din'g his or her own labor and material an Owner -Builder, may be held'hab I le' , a 1 n4� subject ect to, serious . -financial risk for any injuries -sustained by an unlicensed person and his or her empjbyees while workingon my property�`My hom wner's insurance may not provide coverage for those . homeowner's ones. I am willfully acting as Owner -Builder *in aware of -the limits of my insuiance -coverage for injuries to workers 0i my an property - I understand building Iding . permits are not required to -be signed by 'property owners unless they are responsible. for the ction and, are -not hiring,a licensed Contractor to as"sume-this.rtst)onsibility... I understands an "Owner -Builder" I am the'. res, p9psibleparty of : record on the permit. I understand that I may protect from potential financial risk by hiring a licensed Contractor . and having the -permit filed in his or her name instead of'MY .4. 1 understand Contractors are required by law to be licensed. and -bonded in California and to list their license numbers on its and contracts. OUI -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 "employdr" \r state' and federal law. 6. 1 understand if I am. considered an . e "em. loye?' und r e and federal law, I must register with the state and federal p . , ta,t.. 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. 1 understand under California Contractors'.1,State License Law, an Owner -Builder who builds single-family residential structures cannot Aegally build there - with! the .:intent to 'offer them for sale, "Unless all work is performed by licensed subcontractors and the number of structures : d6eS"not exceed four within any- . calendar year, or all of the work is performed under contract with a licensed general building Cdn"ctdr. 8. 1 understand as an Owner -Builder if I sell the property for which this permit is issued, l may be held liable for any ficial or personal. igj.ades sustained. by any subsequent owner(s) that result from any latent construction defects in the manship or materials. 9. I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue ice, the United States Small Business Administration, the California Department of Benefit Payments, and the California sion of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at I- 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 legally and financially ponsible for proposed construction activity at the following address: ll /.1� el -7 �L t"�I' �� L'y' J�-� \ I IF. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all a�pp/lijcable laws and requirements that govern Owner -Builders as well as employers. 112. 1 agree to notify the issuer of this form immediately of any additions; deletions, or changes to any of the information I aver 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 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 Contractors, You will be responsible for verifying whether or not those Contractors are property 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 issuing: the permit. Note: A copy of the property owner's driver's Ucense; formnotarizatwn; or other verification acceptable to the gency is required to be presented when the permit is issued to verify the property owner's signature. ��� ,.C, Signature of property owner 4;. _ Date: / S`' / 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 agent(s) to apply for, sign, and file the documents necessary to obtain an Owner-Buildet Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of Authorized Agent: Tel No Address of Authorized Agent: 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 # Yof la-.Quinta Building 8t Safety DMilon P.Oioxj'504, 78495:01WTam 'Co U'Qiii66,'ZA 92i53.60)'777 -P11 2 and Tracking Sheet. J Permit # Project Kddress:9�!n�er's.Name-.. A. P. Number; rAddress: Legal Description: P Address: Pro'j-Disch tion:: ect T City, ST, Zip: -77 Telephone:M . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . oz— A7 State Lic. # . -Citi Lic. Arch., Engr., Designer. 412 W Address: City., ST, Zip: Telephone: InK 04 MM. 0.1 ',:'Constru Occupancy:. ttion Type: State Lic. #: Project type (circle one): N6w" ;kdd'h Alter Repair Demo Name of Contact Person: -Sq. Ft.: # Stories:. # Units: Telephone # of Contact Person: I Estimated Value o f Proj ect: 14"'1141-11) If APPLICANT: D.0.NOT .,WR.lTE BELOWTHIS LINE # Submittal R64'd Reed '.. TRACKING PERMIT FEES Plan Sets PlaiJCheck -iubmitted- -Itim Amount Structural Caics. Reviewed, ready for. corrections Viau Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Title 24 Ca Ics. . .Plans picked up Construction Flood plain plan Plaits resubmitted. Mechanical Grading.plan 2" Review-, ready for c6rrectioli/lisue Electrical Subcontactor List. Called Contact Person: Plumbing+ Grant Deed Pla6_ picked no S.M.I. H.O.A. Approval Platis resubmitted Grading IN HOUSE:- Review, ready for. correctionstissue Developer Impact Fee Planning Approval Called Contact Pefiop A.I.P.P. Pub. Wks. A:pp'r Date of permit issue School Fees I+Total'Permit Fees