12-0071 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 12-00000071
Property Address: 79685 BUTTERCUP LN
APN: 604-081-041-78 -22982 -
Application description: WALL/FENCE
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 808
T4,ht 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/25/12
Owner:
DON FISCHLEIN
79685 BUTTERCUP LANE
LA QUINTA, CA 92253
Contractor:
Applicant: Architect or Engineer: Owner
^�' � al a
o
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under 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 am exempt from 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 pplicant 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 the work himself 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 _ I 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
ate:
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:
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 for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier Policy Number
LI c=at, 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, if I should become subject to the workers' compensation provisions of Section
3700 of the Labor ee, II shall forthwith comply it those provisions.
WARNING: FAILU EE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS 1$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 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 county to enter upon the above-mentioned propeplfor
inspection purposes ID,�
Signa e (Applicant or Agent):
_ V%
Application Number . . . . 12-00000071
Permit . .
. WALL/FENCE PERMIT
Additional desc .
Permit Fee
23.00
Plan Check Fee
.00
Issue Date . . .
.
Valuation
808
Expiration Date
7/23/12
Qty Unit Charge Per
Extension
BASE
FEE
15.00
4.00 2.0000
FIND BLDG
501-2,000
8.00
----------------------------------------------------------------------------
Special Notes and
Comments
REPLACE &'REPAIR
95 L.F. 6' WOOD
FENCING
DUE TO WIND DAMAGE. 2010 CODES.
-----------------_-_-------------------------------------------
Other Fees .
. . . .•. . BLDG STDS ADMIN (SB1473)
1.00
Fee summary
Charged
Paid Credited
----------
Due
-----------------
Permit Fee Total
--------------------
23.00
----------
.00 .00
23.00
Plan Check Total
.00
.00 .00
.00
Other Fee Total
1.00
.00 .00
1.00
Grand Total
24.00
.00 .00
24.00
LQPERMIT
P.O. BoX 1504
LA QUINTA; CALIFORNIA 92247-1504
.78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
PROPERTY OVMER'S PACKAGE
(760) 777-7012
FAX (760) 777-7011
Disclosure's & Forms for Owner -Rudders Apples for Construction Perlmits
419M I No
DeaF Fr+aperty OwneF: .
filo application for a building permit has been aubmittecl in as the build% o€ the
impmV ements. specified at Y 1 Y
We nee pmviding you WW1 an Owner -Builder AAWWledgmeat and lnfotmatien Vai€catien Form to make year ami ma of your
resPOnsibilities and possible risk you may incur by having this peat-iowd. ig Your nam 'as .the
Owner-Badderwe wit Qct Ism a bcdldbM per".
ymr� : read., i yaw. andersbla o€ eadt'ptcsviidon,
signed, and returned this form to us at our.oftidal address indicated. An agent of the owner cannot execeft this%notice
unless YOU, the property owner, obtain the prior approval of the permitting authority.
Fri a tis`, *ri '��i�� J� i i'a. � JS!�- � :�!'-•7� . � � � Oii�i�ls_li_ .'�' �
0
t/ L 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 interial persOGAY. I, as
an Owner -Builder, may be held liable and subject to serious financiat 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 coveMe for those
injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my kmrance coverage for injuries to worimn
on my property.
2. I understand building permits are not required to be signed by property owners unless they are reponsibk for th
construction and are not hiring a Licensed Contractor to assume this respionstbihty.
3. I understand as an "Owner -Builder" I am & responsible party of record on the permit I understand trim I may prole
myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of o
own.
`/ 4. I understand Contractors are required by law to be licensed and bonded in. California and to list their license numbers
permits and contracts.
L-"'5- I understand if I entptoy or otherwise engage any persons, other than California licensed Contractors, and the total yr
of my construction is at least five hundred dollars (5500), including tabor and materials, I may be considered an "amnio,
under state and federal law.
- 6. 1 understand if I am considered an -employee,
ands state and fbderal law, I must register with the state and fa
government, withhold payroll taxes, provide wodmrs' compensation disability insurance, and contribute to unemployi
compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious fora
risk
7. 1 understand under California Contractors' State License Law, an Owner -Builder who builds single-family resid
structures cannot legally build them with the intent to offer them for sale, unless 'all work is performed by tic
subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is perli
under contract with a licensed general building Contractor.
�C
1 . 8. 1 understand as an Owner -Builder if 1 sell the property for which this permit is issued, I may be held liable for any
financial or personal. bouries atsTAked, by -any subsequent ownei(s) that result from any latent construction defects in the
workmansiap, or materi*k
9.. I
-understand I may obtain more information regarding my obligations as an "employer- from the tdcmd i€ervecine
Service, the United States Scull 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 (CSM 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
Party legally and financially responsible for proposed eonstruetion activity at the following address:
11_ i agree that, as the party legally and futamially responsible for this proposed construction activity, I will abide by all
applicable laws 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 clraneea taany Of the inforatation 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, trio Contractors' State Lioeme Boren d may be unable to assist you with MY ll=Udid loss
YOU tray sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be iQv" court. It is also
iamportaat for You to understand dw if am u ddweosed ConUsoor or CWVtoyoe of teat individual or fm is Wpjmd wWk woedag
on your property, you may be Add fbr damages. If you obtain a permit as Oww-Builder and wi* to bite Ctrs,
you wilt be ICV0M_Wfar or not those Cam at tors are propedy Poeaaed and the Mum of 61W was'
oompensation it oc coverage.
Before a building permit can be issued, itis form must be completed and signed by the property owner and returned to
the nmcy responsible for ISINIft tlwfersniL Note: A copy, of tlha owsw's MweW c4baugi f&M XfOiCk"W4 Of
other verification aocq** a to tiro jWwcY is r UJW to be pr+s meted when rhes permit iss issued to ' (he
owner's skmatu e .
Signature of property owner �OiWL Date:
Note: The following Authorization Form is required to be completed by the property owner ottly when designatitt
an agent of the property owner to apply for a construction permit for the Owner-Builder-
AAT$ORMTI MN OF AGMT TO ACT ON PROPERTY R'S lM F
Fxcluding.the Notice to Property Owner, the execption of which I understand is cry persoml. mWOUSibilitY, I herrby authori
the following person(q} to act as my Wats) to apply for, sign, and file the documents nocessafy to obtain an Owner-Buitcle
Permit for my project.
Scope of Construction Project (or Description of Work):
Name of Authorized Agent:
Address of Authorized Agent:
Tel No
I declare under penalty of perjury that l am the property owner for the address listed above and I personally filled out the
information and certify its accuracy. Note: A copy of the owner's driver's license, form notarization. or other 11011ti0i
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:
L-- 8. 1 understand as an Own"uilder if 'I sell the property for which this perrY►it is issued, I may be held liable for s
financial -or personalm, . t ued by any subsequent owner(s) that result from any latent coostrudion defects in the
worianaas8ip, or matrxi$ls .
9. I -understand I may obtain 'Mort information regarding my, 'obligations as an "employee" from &0d uo
Service, the Unitod States Small Business Administration, the California [kpartment of Benefit Payments. and the California
Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (M) 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 bdilding 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.
11. 1 agree that, as the party legally and huxially responsible for this proposed construction activity, I will abide by all
applicable taws and requirements that govern O mx-Builders as well as employers.
12.1 agree to notify the issuer of this form immediately of any additions, Wdioas, of a*%W toany of tttie information I
have provided on this form Licensed ecmtmctors are regulated. by laws designed to protect the public- U you co""" with►
somoone who does not have a twouse, the Contmotors' State License Board may be unable to asst you with any 8nsaaid toss
you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be ta�vd court. It is alar
important for you to understand that if aa udliooased Contfmcmor at employee of that Wd. iduad of &M is *sod WbRe
on your property, you may be htU liar far damages. If you obtain a permit as Owner -Bu"" std Wi3b to b'M n
you will bo muton ible Ser vaiPying or not those Caatr tors arepmpck lleensed and tbn =tamtus of 6ar wotket3
oo on,iasruaaoe 4WVC ago.
Before a building permlt cm be lamed, tdmis form must be completed and signed by the property oRner and retained
the agency responsible for bmift Ow V&= . Noiw A copy of dwr properV ow+rw's ms's fn't °�
Other ver4leadon aaeep**& to dw OSWWY is ah+ed to k pr"aat.-4 when 00 paw Is lis to *"* the pr°Fp
owner's skmature.
Signratusa of property ovrM �9'�% �l�i�'/a�.(�O - Daxe:
Note: The following Autlhorization Form is required to be completed by the' property owner early when designatS
an agent of the property owner to apply for a construction permit for the Owner -Builder.
Excluding the Notice to Propa
the following person(s) to act 4
Permit for my project
Scope of Construction Project
Project Location or Address:
Name of Authorized Agent:
Address of Authorized AIS
a=ptable to the agency is required to be presented when the permit ra hssuea
Property Owner's Signature: Date:
reWomibility, I hereby authc
Wv to obtain an Owner -Built
we and I personally filled out d
notarization, or other verj (meati
the property owner's signature
Bill # :.
Peanit #
\�.
Project Address:
Cl/ O� QE1lI1ta
Buttft a Safety Division '
P.O. Box 1504,79-495 Calle Tamptco
LA.Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Owner's Name:. ' eg &2 r ch Lc /1J.:
A. P. Number.
Address:
Legal Description:
City, ST, Zip:
Contractor.
y _
Telephone: % �
Address:
Project Description:
City, ST, Zip:
Telephone:
t
State Lic. # :
City Lic. #;
Arch.; Sngr., Designer.
Address:
City., ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person:
Construction Type:. Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: # Stories: # Unity:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Plan Sets
Req'd
Recd
TRACMG PERMLT FEESS
Pian Check submitted Item Amount
Structural Caies.
Reviewed, ready for corrections Plan Check Deposit. .
Truw Cala.
-Called Contact Person Plan Check Balance
Title 24 Cafes.
Plans picked up Construction
Flood plain plan
Pians resubmitted Mechanical
Grading plan
V Review, readyfor corrections/issue Electrical
Subeontactor List
Called Contact Person Plumbing
Grant Deed
Plans picked up S.NLL
H.O.A. Approval
Plans resubmitted Gradlag
IN ROUSE:-
''" Review; ready for cormctions/issue Developer Impact Fee
Planning Approval
Called Contact Person A I P.P.
Pub. Wks. Appr
Date of permit Issue
School Fees
Total Permit Fees