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09-0600 (BLCK)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 09-00000600 Property Address: 46325 CAMEO PALMS DR APN: 643-181-020-18 -2043 Application description: WALL/FENCE Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 1750 Applicant: Tiht 4 XP Q" Architect or Engineer: BUILDING & SAFETY DEPARTMENT BUILDING PERMIT ---------------------------------------------------- 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 /f anlicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: I, 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.). 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 1 _) I am exempt under Sec. B.&P.I r thj reaso Dat d Owner: .4CpdfiflOCTrUW ENDING 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 Owner: HERNANDEZ JOE R 46325 CAMEO PALM DRIVE LA QUINTA, CA 92253 ( Contractor: Owner VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 ------------------ 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 _ 1 certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so o become subject to the workers' compensation laws of California, and agree that, if I sho d b come&we.worker compensation provisions of Section '�c[sypc.3s77000 of the Labor C e, I hall y wit se provisions. Date iL / rAPPlicant: WARNING: FAILURE TO SECU KERS' 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 ab a inf matio is correct. I agree to comply with all city and county ordinances and state laws relating to buildin cons cti and hereby aut ze representatives of IN c unty to enter upon the above-mentioned property or in a purposes. D 'I ignature (Applicant or Agent): \ /09 Application Number . . . . . 09-00000600 Permit WALL/FENCE PERMIT Additional desc . Permit Fee 41.00 Plan Check Fee .00 Issue Date . . . . I Valuation . . . . 1750- 750Expiration ExpirationDate 12/05/09 Qty Unit Charge Per Extension BASE FEE 15.00 13.00 2.0000 HND BLDG 501-2,000 26.00 ----------------------------7----------------------------------------------- Special Notes and Comments 70 IN FT X 6 FT HT GARDEN WALL PER CITY STANDARDS & APPROVED PLANS A TOTAL OF (4) PILASTERS. -----------------------------------------------------------7---------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged Paid Credited ----------------------------------------------- ---------- Due Permit Fee Total 41.00 .00 .00 41.00. Plan Check.Total .00 .00 .00 .00 Other Fee Total 1.00 .00 .00 1.00 Grand Total 42.00 .00 .00 42.00 LQPERMIT Bin # Qty Of La Quint' a "Building a Safety Division P.O. Boic 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # Project Address: z/,g S c'AA1,ff6 RAL NS -O)e.. 'Owner's Name: fLc ,Q, /��,t?�/�► �(/ t Z A. P. Number. Address: 5/6 _ 3ZS Legal Description 4a7 / <9 G'F %2,0c / 00 9� Contractor. By 0&f1J6R_ City, ST, Zip: 44 Qf 1XJ7A , Telephone• Address: Project Description: 61A 4,6 FEAJ Gv.4 L L City, ST, Zip: Telephone: y�11*1 h% U 76 i i State Lic. # : City Lic. #; y LS Arch., Engr., Designer. C40 N co ETM 1zo0-nNG i1�10 k 2 3 AW Address: #� R�/%fJF-6�C/4lG Rdp 6 ",4.,4 lW. City, ST, Zip: vv- 4 Telephone: � - A ' , �' -- - Construction Type: /3 10 Ck Occupancy* State Lic. #: = , . s2 . y.. n4 Name of Contact Person: ✓0 OAC IP,¢/tl9 44 , Project type (circle one): New Add'n ter Repair Demo Sq. Ft: # Stories: # Units: Telephone # of Contact Person: C<a-) SC �/- AF f/ 7 Estimated Value of Prc jecC-4� :2,6_60. APPLICANT: DO. NOT WRITE. BELOW THIS LINE # Submittal Req•d Recd TRACMG PERMIT FEES Plan Sets • Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance. Title 24 Calcs. Plans picked up Construction ' Flood plain plan Plans resubmitted Mechanical Grading plan 24" Review, ready for correctionwIssue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up. S.MJL H.O A. Approval Plans resubmitted Grading INHOUSE:- '^' Reyiew,.ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.LP.P. Pub. Wks. Appr Date of permit issue School Fees EXtS Ti M & .COUNTY' OF RIV-E-RSIDF- - �- 6t -'LoVil 8, OP TR A C7 klo.- 2 0 A-4 3 - Fds 8 ook*4 I 7 J-AAP5 - R F60P bS; R WERS lb 9 Co. OWNG PS - Xog wo PA M E W kE R MA&VIi, 46-329 CAIA60- PALMS DiZ.IV,F- :5 1 T'E- PL A P--4 LA. Qvi"TA. OrILITY Patr- L. al L 6-c-T-lz I c PROPC-54-71> GARDEN WALL W-0 ` X -70 0 -l-' 6.4� � ra"GAKDE"N \N ALL :04 9i 2-0 —Tor— 6A -. 1 356 Ptt* A.-'Ilawa ufll . Lf P T4 *49 M " v4P-'Tt CA'L TAi- .0 SIP 2-1-.;51 P:-6 I QRA-b V- A �LTf�� % IL4 li4 d 2'r -3,-1 P.O. BOX 1504 LA QUANTA; CALIFORNIA -92247-1504 78-495 CALLE TAMPICO LA QUANTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT PROPERTY OWNER'S PACKAGE (760) 777-7012 FAX (760) 777-7011 Disclosures & Forms for Owner -Builders Applying for Construction Permits - 09011"D NOTICE TO PROPERTY OWNER Dear Property Owner: Ari. application for a building permit has been submitted in your name listing yourself as the builder of the .property improvements specified at We are .providing you with an Owner -Builder Ackmowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur.. by having this permit issued in your name as the Owner -Builder. We will not issue a building permit until you: gave read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot, execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWL EDGMENT AND NEWICATI-ON OF M, ORMAMON DfREECTIONS: Read and initial each statement below -to signify you understand" or verify this information. V1/1. I understand a frequent practice of unlicense'd.pecsons`,is to have the property owner obtain an "Owner -Builder" building permit thit erroneously implies that the property owner•is providing his or her own labor and material personally. 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 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 ani aware of the limits of my insurance coverage for injuries to workers on my property. V/2. 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.. 3. I understand as. an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and leaving the permit filed in his or her naive instead of my own. V/4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on pe�rmmiits and contracts. V' 5.1 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. �6. I 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. /7. 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. 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 financial or personal. 4uries sustained. by any subsequent owner(s) that, result from any latent construction 'defects in the workmanship or materials, .. V1/9 .. I understand I may obtain more information regarding my obligations as an "employee' from the Internal Revenue Service, the United States Sniall 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 (CSILB) at I- 800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors.. 10. 1 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: r, eAmd-O S.­Z4i t/Z,_ Ily responsible for this p ill abide by all V/11. I agree that,.as�he party. legally andfinancia tivity,.1 wilt reposed. construction ac pplicab. tiws and requirements that govern Owner -guilders as well at employers. J_1�'12. 1 agree to notify the issuer of this form immediately of any additions- deletions, or changes to any of the informAtioia I have provided on this form. Licensed contractors are regulated by taws 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 �c'ivil 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. futile for r damages. If you obtain a permit- as Owner -Builder and wish to hire ConftarAoTs, you will be. responsible onsible for verifying whether or not those Contractors are property licensed and the status of their WOkers' compensation insurance beverage. 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 issuitigthe permiL-Note: A copy of the properqr owner's diiver?& Rcoftsei foam nOt4 M-4dOk Or other verification acceptable to. the agen is .required to be presented when the permit is issued'io, verify the property owner's signature. Signature of property, owner 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 OWNER'S BEHALF Excluding.the Notice to Property Owner, the execution of which I understand is my pe - responsibility, personal . bility7 I hereby authorize n the followirrgg pe�rsen(s)- to act as, my agent(s) to apply for, sign, and file the documents necessary to obMin 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 -above information and certify its accuracy. Note: A copy of the owner's driver's license, form, ho'tarization,.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: