12-1238 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
12-0 0 0 0123"8
Property Address:
54-58'5—AVENIDA_RAMIREZ
APN:
774-275-016-4 -000000-
Application description:
WALL/FENCE
Property Zoning:
COVE RESIDENTIAL
Application valuation:
909
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
/000`
VOICE(7610)- 7-701-2
FAX (76 0) 777 -
INSPECTIONS (760) 777-7153
Owner:
LUIS GRIEGO
54585 AVENIDA RAMIREZ
LA QUINTA, CA 92253
---------------------------------
Contractor:
Owner
Date: 10/17/12
OCT 171011.r
--------------------------- - CI7YOFLAQUINTA
(J I - - - . EIPIANCEEDEP T.
--------------
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penaltyof 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 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, for the performance of the work for which this permit is
_ issued. -
Date: Contractor: _ml have and will maintain'workers' compensation insurance, as required by Section 3700 of the Labor
Code, for the performanceof the work for which this permit isrissued: My workers' compensation
OWNER -BUILDER DECLARATION - - insurance carrier and Policy number. are:
I hereby affirm under penalty of.periury 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 QC,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 -T person in any manner so as to.become subject to the workers' compensation laws of California, .
permi6o file'a,signed statement: that he.or she is licensed pursuant to. the provisions of the Confractor.'s State and agree that,+if Fshould become subject to'theworkers' compensation provisions of Section
116eiise Law (Chapter 9' (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3700 of the Labor Code, I-shall'forthwith c' ly with those provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by _ /j� / r /, / .
any applicant for permit subjects the applicant to a civil penalty of not more than five hundred dollars IS5001.: ate: VV //'�f%plicant:
• 1�1 I; as owner of the property; or my employees with wages as their sole compensation, will do the.work, and
V— the structure is not intended or offered for sale`(Sec. 7044, Business and Professions Code: The WARNING:-FAILURE;TO SECURE WORKERS' COMPENSATION, cOVERAGE IS UNLAWFUL, AND 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,CIV,IL-FINES UP TO ONE HUNDRED,THOUSAND
and .who does'the work himself or herself through his or her own employees; provided that the DOLLARS 1$.100,0001. IN ADDITION TO THE.COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, theliuilding 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 ofproving 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 contractorls) licensed
pursuant to the Contractors' State License Law.).
(_ 1 I am exempt under Sec. , B.&P.C. for this reason
Date: ' 0 7 —1 2- ne-
CONSTRUCTION LENDING A ENCY
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
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 uponwhose behalf this.application is made, each person at whose request and for
whose.benefii 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 aresult of this application becomes null and void if work is not commenced
within 180 days from date of:issua_nce of such permit, or cessation of work for 180,days will subject
permit to cancellation.
I certify thatI 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 'nspection pur s s. %..
H3te.lO -17—/ Zature (Applicant or Agent):
Application Number
Permit . . .
Additional desc . .
Permit Fee . . . .
Issue Date . . . .
Expiration Date . .
. . . . 12-00001238
WALL/FENCE PERMIT
25.00
4/15/13
Plan Check Fee . . .00
Valuation . . . . 909
Qty
Unit Charge Per
Extension
BASE FEE
15.00
5.00
2.0000 HND
BLDG 501-2,000
10.00
----------------------------------------------------------------------------
Special Notes and Comments
42 L.F. 5'
GARDEN WALL TO
CREATE FRONT
COURTYARD,
INCLUDES GATE.
2010 CODES.
----------------------------------------------------------------------------
Other Fees
. . . . . . .
. . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged
Permit Fee Total 25.00
Plan Check Total .00
Other Fee Total 1.00
.Grand Total 26.00
LQPERMIT
Paid Credited Due
.00 .00 25..00
.00 .00 :00
::00 .00 1.0.0
.00 .00 26.00
W o r ► °' Fr -t;, p R ITY
CITY OF LA QUID`
BUILDING & SAFETY DC
APPROVED
FOR CONSTRUCTION
DATE BY
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P...Q.:Box, 1504
LA: Qb,iki A-. CALIFORNIA' 92247.-1504 . BUILDING & SAFETY DEPARTMENT
78-495' CA.LL,E Tmieico .
(760) 777-7012
LA OUINiTA, CALIFORNIA.92253 FAX (760) 777-7011
PROPERTY OWNEWST ACK , AGE
Disclosure's & Fbitms for P nek4; -for Construction . Permits
W ..BuHdei9App1.yW`g
Dear.PVDPeTty Owner
An application for a buildin ::permit.:
'ha beew 'suit 'ed 46 your naine, hitin 'If as the budder of theproperty
g )PUEse
-impr6yernents-specified -at 7KW % rFAW'!T.:Z"
We areproviding you wM-:an, Owner,.B , & J0
ildet A -66wl jinent."d'Itif tiA6.�v,
U . rifi A66h
c ed Form to make you awamof your
responsibilities and. possiWrisk..you may indui.6y.having flus pe . rinivis . M W.- irl,
your name as the.
your viiderstaitilin
Ownu-Builtler. . We will not issue a building'.perinit. 'ha,�e` r"ead - iii�iwd I uY
4n, you, g of e
signed, and returned this form to.us.at our aricialaddress, indicated, An agent.of thi owner 'cannot execute thi&votice
Unless YOU, the Property owner, obtain. the prior approval of The permitting authority.
youderjtandlorverifyWtsinforma(ion.
I. I unders:tand a .frequent practice of unlicensed .persons.. is to have, the property owner obtain an "Owner -Builder"
building permit that 'efronbousIy implies that theproperty owner is * h-'* or. her own labor and material personalty. 1, as
' provI'" & is
anowner uilder, maybe held liable and subject to serious. financial risk for any injuries* sustained by an unlicensed person
and his or her ejhploYees while wpiking on�'My
my property., h6meowin'er's insurance. may not provide coverage for those
.injuries. I am willfully acting as an Ownei-Builder'and
am aware of the limits of my insurance coverage for injuries to workers
on MY' property.
11�2 . I understand building. permits are not required to be sighed by property owners unless they are responsible for the
construction and are not'hiring a. licensed Contractor; assume this responsibility_
erstand as an"O'
J�. I understand wRet-,1pui der" J amthe.re i�l�paytyqf id. the-peimit.1-understand that I may protect
spons. MOP on
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 ticensed: and bonded in California and to list their license numbers on
permits and contract's.
5. 1 understand if I employ or b e
otherwise
seeng g any,persons, other than Cal - 6rnia, licensed Contractors, and the total value
of my construction is at,least five hundrL i!6111. ($500),- including 'labor.a.nd- materials, . I may be considered an "employer"
under state and federal law.'
6. I understand if I am considered * an "em pioy e,.. understate andfederalJaw,'. I must register with the state and federal
"
government, . withh
old payroll taxes 'provide.workers' -Wo eJrS
'* '-poq�hsation disability irs'uranceI
and contribute to unemployment
compensation for each "employee_" I alsounderstand''my fai14e to abide by theselaws
may subject me to serious financial
risk.
.J_ I understand under California'Contractors' tractors' State License Law, an Owner-Buildei who builds single-family residential
structures cannot Aegally build '.them ,'wA the intefiv;to offer *them, .for sale, unless,, all work is performed by licensed
subcontractors and structures Aoes
the Ur
fo- .. within any calendar or all. -of the work is performed
'
under contract with a licensed general building Contiictor.
P�8. I 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 W91ained by any subsequent owner(s). that result from any latent construction defects in the
workmanship or materials.
C�; 9. I understand I may obtain more information regarding my obligations as an "employee' from the Intel al Revenue
S cc, the United States Small Business Administration, the California De Partment of Benefit Payments, and the California
Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSI -13) at 1-
800-321-CSLB.(2752) or www.csib.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
party legally and financially responsible for proposed construction activity at the following address:
oC4 11. I agree that, as the party legally and financially responsible for this proposed construction activity -1 will abide by all
applicable Paws and requirements that govern Owner=Builders as well as employers.
12. 1 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 in'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 Contractors,
you will be responsible for verifying whether or not those Contractors are property licensed and the status of their wotkere
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. Now A copy of the property owner's driver's licensri form' notarzVatign; or
other verification acceptable to the agency is required .to be presented when the permit is issued to verify the, property
owner's signature.
Signature of property owner Date: 2_
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: 5q 535 UP0`1lZ 1'1 Y Ny7g 2 _
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:
i
�.
' Bin. #
.. .
C► .
�y. of La QO n
Building gL $4ety Division''
Permit # �•
P:O Box 1504 ':78 495 Calle Tainplco
..
1
14.Qulnta CA 92253 {760) 777-7012
Permit•Applrcation
Building and Tracking Sheet
Project Address: CJ^ $
O.wncr,'s Name:. I
A. P. Number.
Address:
Legal Description:
i
City, ST, zip: V _ 2�5.
i Contractor.
Telephone V �.�Taar 3.Ssay
Address:
i Project.Descripfion:
City, ST, Zip:
KA
I Telephone:
State Lic. #:
City Lic-
Arch., Engr., Designer.
1�� -�-
2 1
l� ✓^
Address:
City., ST, Zip:
Telephone:
; Gonstcudion Type: Occupancy:
State Lic. #:
.. _ L�
Project type.(circle one): New Add' Alter Repair Demo
Name of Contact Person:
Sq. FL: .9 Stories: #Units:
Telephone # of Contact Person:
'Estimated"Value of Project: .
APPLICANT: :DO NOT .WRITE:BELOW 1'HIS•1JNE
# Submittal Rcq'd
' Rcc'd TRACK G PERMIT,FEES
Plan Sets
Plan Check submitted.` item Amount
Structural Calm
Reviewed; ready for corrections Plan Check Deposit. .
Truss Calcs•
Called Contact Person Plan Check Balance -
Title 24 Calcs.
Pians,
picked up, Construction: -
----
-- Floodain Ian
P...P-- —
-Piaas�resotimitled. , _--. --Mechagical --
Grading plan
•Review, ready for correc6onsfissue
Electrical,
Subconmctor List
Called ContactTe*rson "'
Plumbing .
Grant Deed
Plans picked op: . `
S:M:L
H.O A Approval
Plans resubmitted
Grading
IN HOUSE:-
''" Review{ ready for corrections/issue -
Developer Impact Fee
Planning Approval
Called Coatact Person
Pub. Wks, Appr
Date of permit issue, '
School Fees
:•Total PermitTees