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10-1287 (BLCK)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA; CALIFORNIA 92253 Application Number: Property Address: APN: Application description: Property Zoning: Application valuation: %f0-0 0 012.8 7 54700 AVENIDA RAMIREZ 774-281-011_-14 -000000- WALL/FENCE COVE RESIDENTIAL 953 Applicant: Archite( BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: ROBERTS NETTIE 54700 AVENIDA RAMIREZ LA QUINTA, CA 92253 (760)880=2689 Contractor: Owner VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777=7153 Date: 11/23/10 LICENSED CONTRACTORS DECLARATION : WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that -1 am licensed:under provisions of'Chapter 9 (commencing with - I hereby affirm under penalty of perjury.one of the following declarations: - Section 70001 of Division 3 of the Business and Professionals Code, and my License is in full force.and effect. - _ I haveand -will maintain a'certificate of consent to self -insure for workers' compensation, as provided License Class: License No.: - for by Section 3700 of, tlie�Labor Code, for"the performance of the work for which this permit is ' issued. Dater./ Contr 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. tMyworkers' com_ pensation OWNER -BUILDER DECLARATION insurance carrier, and policy number are: I hereby affirm under penalty,of perjury that I am exempt from the Contractor's State License Law for the Carrier - - - - - - - - - - - - - r - - - r - - - - -Policy Number ' following reason (Sec: 7031 .5, Business and Professions Code: 1 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 laws 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 1 should become subject to the workeFs compensation provisions.of;Section' License Law (Chapter (commencing with°Section 7000) of Division 3 of the -Business and Professions Code) or . 3700 of the Labor Code; I,shall forthw' h com �hos�iprows' ' that he o she rs exempt therefrom and the basis for the alleged exemption. .Any violation of Section 7031..5 by any icant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: 1 1, as owner of theproperty, or my'employees with wages as'their'sole compensation, will do the work, and the structure is not,imended or offered for sale (Sec. 7044,:Business and Professions Code:. The Contractors' State -License taw does not apply.to an owner of property who builds or improves thereon, and who does the workhimself 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 ofcompletion;' theowner-builder will have theaurden of proving that he or she did not build or improve for the purpose of sale.). (_) 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.). (_ 1 1 am exempt under Sec. , B.&P.C. for this reason Date: L�lfl Owner. /-'�'✓� 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: Lender's Address: LQPERMIT WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIESAND CIVIL,FINES UP`TOANE HUNDRED THOUSAND DOLLARS 15100;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 AACKNOWLEDGEMENT 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 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 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 coup yy ttoo priter upon the above-mentioned erty for inspection pose Daft?/�r"'7'�Signature.lAppticanYor-Agent Application Number . . . . . 10-00001287 Permit . . . . . . WALL/FENCE PERMIT Additional desc . Permit Fee 25.00 Plan Check Fee 00 Issue Date. Valuation 953 Expiration Date 5/22/11 Qty Unit Charge Per Extension BASE FEE 15.00- i 5.=00 2.0000 HND BLDG 501-2,000 10.00 ---------------------------------------------------------------------------- Special Notes and Comments ` 5 --FT HT.X 44 LN FT GARDEN -WALL PER CITY STANDARDS &:APPROVED PLANS. Other.Fees ... . . BLDG STDS ADMIN (SB1473) 1.a Fee 'summary Charged Paid Credited Due Permit Fee Total 25.00 00 :00 25,:00. Plan Check Total .00 .00 .00 _ .00 Other Fee Total_ 1.00 .00 .00 1.00 ` Grand Total . 26...00. 00 ;,:•00: 26,. 00 A LQPERMIT Bin # C jtY' 0 f .La Quinta Building k Safety Dlvislon P.O. Boz .1504, 78-495 Calle Tampico La.Qulnta,-CA 92253 =, (760). 777-7012 Building -Permit Application and Tracking Sheet Permit # Project Address: J�70� j Owner's Nanie:CT774 / o C2T� A. P. Number. r %• -�// — �' Address. Legal Description: _ •2 City. ST, Zip:�fl�%rJ/�..�. Contractor: Telephone: / t' Address: Project Description: ��p�/Z City, ST, Zip: JT /�n i F7�i���asLr /7� V Telephone: ,�3"' •�.�.55)),' '"�: ~� , State Lie. # : City tic. Arch., Engr., Designer: Address: City., ST, Zip: Telephone:. r. s ' r y 'T Construction Type: occupancy: State Lie. #: Pro pct a circle on'e'): New Add'n ter Repair Name of Contact Person: /.2 T /� e%f . 'f 'Sg. Ft.: _ #-Stories: # Units: Telephone # of Contact Person-Z&­ erson:? ,V0 Estimated Value of Project: APPLI ANT DO NOT WRITE, BELOW THIS LINE # Submittal Req'd Recd• TRACKING PERMIT FEES Plan Sets Pian Checkisubmitted Item '- Amount Structural Cala. Reviewed,; ready for corrections Plan Check Deposit Truss Calcs. Ca11e&Contact Person Plan Check Balance. Title 2J Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 21" Review, ready,for corrections/issue Electrical Subcontactor List Called ContactPerson Plumbing Grant Deed Plans picked no, S.M.I. H.O.A. Approval Plans resubmitted Grading . IN HOUSE: ''d•Revlew; ready for,correctlonsftsue Developer Impact Fee Planning Approval Called Contact Person A.LP.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees P.O. Box 1504 LA QUINTA; CALIFORNI'A'.-92247-1504 '*495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 PROPERTY OWNER' S. BUILDING & SAFETY DEPARTMENT (760) 777-7012 FAX (760) 777=7011 GE. Disclosures & Forms, for Owner-Bullders Applying for Construction- Permits Me-Q&T'AYT I "NOTICE TO I'INJpFr T OWNEII Dear Pinperty Owner 'An. application for a buil!�qilder as Beit sub tted your name listing yourself as the builder of the .Property improvements specifiedat l" 1(�Z° We are .providing" you with an OwA ekn© vledgm nt and I4formation Verification Form to make you aware :of your responsibilities and possible risk you may incur byhavirrl this permit:issued. in your name"as the Ownes-Builder. We will not -issue a btdidfng.perin t`until you Dave read, initialed your•. understanding o€ each'pi ovislon, signed, and returned this form to us at our official addrsindicte.eAagent of the owner cannot execute this notice unless you, .the property owner, obtain the prior approval of the permitting authority. aruf it tidal each. statement orverify this formation. . I understand a frequent practice of unlicensed persons is ;to have the property owner obtain an "Owner -Builder" buildrng permit that erroneously implies that the property owner is -providing his or her own labor and material persoriat#y.1, as l ri an Owner -Builder, maybe held liable and subject to serious. financiask 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 property. 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" l am.the responsible.party,of record on the permit. I understand that I may protect myself from" potential financial risk by hiring a li"censed Contractor and -having the permit filed in his or her name instead of my _ --- --- — . �I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. 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" under state and federal law. . [.understand if I am considered an "employer. "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. 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. tab -I understand as an Owner -)wilder if I sell the property for which this pernut is issued, I may be held liable for any financial or personal. iyjuries su rained. by any subsequent owners) that result from any latent construction defects in the workmanship or materials. ' I -K understand I may obtain more information regarding my obligations as an "employer" from the Inter -nal 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 (MR) at 1- 800-321-CSLB (2752) or www.csib.ca.gov for more information about licensed contractors. i am aware of and consent to anOwner-Builder building permit applied for in my name, and understand that I am the � I/'��" —K party legally and/� financially �onsihle for proposed construction activity at the following address: I agree that, as the party legally and financially responsible for this proposed construction activity, .1 will abide by all �pplicabte liws and requirements that govern Owner -Builders as well as employers. U _ t 2.1 agree to notify the issuer of this form immediately of any additions; deletions, br changO to day 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 ;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 Cot actors are properly licensed and the status of their' workers' compensation insurance coverage. Before a building permit can be issued, flus form must be completed and signed by the property owner and returned to the agency responsible for issnftig; .permit. Now: A copy of the property owner's d6yer's Reartse, form n01adCa&14 or other verification acceptable to the agency is required to be presented when the permit is i+tsued to verify the Property owner's signature. C� Signature of propertyowner /L'x.� ,, Date: 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 OWNEWS 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: ,����% 1 ✓�lV/l_2f4r Name of Authorized 4 Address of Authorized Agent: 4g2 93y/S'TtT �L' ���'f�L� .�fl t 7 I declare under penalty of perjurythat 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'ib be presentee hen the p rMit is issued to verify the propertyowner's signature.. Property Owner's Signature: %GL� Date: a� aj