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12-0402 (BLCK)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 12-00000402 Property Address: 46800 CAMEO PALMS DR APN: 643-1947004-59 -2117 Application description: WALL/FENCE Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 1024 c&t!t 4 XP Q" Applicant: Architect or Engineer: (4, ------------------ LICENSED CONTRACTOR'S DECLARATION BUILDING & SAFETY DEPARTMENT BUILDING PERMIT 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 1 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 an applicant 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.). (_) 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�r this reasor(, 0 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 Owner: ROBERT MORIN 46800 CAMEO PALMS DRIVE LA QUINTAr.CA 92253 ----------------------------- Contractor: Owner VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 4/13/12 P[ I. ° EAPR16 2012 CITY OF LA t4WR1YA FINANCE DEPT. ------------------ 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 I certify 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, if I should come subje t9,*9 workers' compensation provisions of Section 700 of the Labor Cod hal orthw' m y it ose provisions. WARNING: FAILAE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP 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 Buildiag 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 t comply with all city and c unty ordinances and state laws relating to building nstru tion, an h y authorize epresentatives of thi ougty to�enter upon the above-mentioned property sp ion gums (Applicant or Agent): Application Number . . . . . 12-00000402 Permit . . . WALL/FENCE PERMIT Additional desc . Permit Fee . . . . 27.00 Plan Check Fee.. .00 Issue Date . . . . Valuation . . . . 1024 Expiration Date 10/10/12 Qty. Unit Charge Per Extension BASE FEE 15.00 6.00 2.0000 FIND BLDG 501-2,000 12.00 ---------------------------------------------------------------------------- Special Notes and Comments 64 L.F. MASONRY ADDITION TO CAP WALL, PER PLANNING & BUILDING DEPT. APPROVALS - RESOLVES CODE CASE 12-1713. 2010 CODES. Fee summary Charged ..Paid Credited Due Permit Fee Total. 27.00 •.00 .00 27.00 Plan Check Total .00 .00 .00 .00 Grand Total 27.00 .00 .00 27.00 LQPERMIT Bin. # .. � . � Crty Of. La Quina .:. '. Bull 09 & Safety Dw6n P.O. Box.1504,'78-495 Calle 7amplco 1.a •Quinta, CA -92253 -(760) 777-7012 Building Permit Application and Tracking Sheet Permit # 01/ \ Project Address: Ownees Name:. T Address: _ A- P. Nuinber. Legal Description: City, ST, Zip: Contractor Telepho Address: Project Description: City, ST, Zip: Telephone: State Lia # : City Lie', #; l Arch, Engr., Designer. Address: City., ST, Zip:(� Telephone: State Lie. #: Construction Type:. Occupancy: Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person: e= Sq. FL: # Stories: # Unita: Telephone # of Cont act Person: 6a --6 Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS UNE # Submittal Pign Sets Req'd Reeld TRACMG PERbffr FEES Pian Cheek submitted Item Amount Structural CaIcs. Reviewed, ready for corrections Plan Check Deposit. . Truss Calcs. Called Contact Person Plan Check Balance. Tithe 24 Calcr. Pians picked up Construction Flood plain plan Plans resubmitted.. Mechariieal Grading plan Z'! Review, ready for corrections/issue Electrical Snbeoateetor List Called Contact Person Plumbing Grant Deed' Plans picked up S hLL H.O.A. Approval Plans resubmitted Grading IN HOUSE:- ''' Review; ready for correctionvUsue Developer Impact Fee Planning Approval- Called Contact Person A".P. Pub. Wks. Appr Date of permit Issue School Fees Total Permit Fees P.O. BOX 1504 LA QUINTA; CAL[F.ORNIA 92247-1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT PROPERTY ONMER'S PACKAGE (760) 777-7012 FAX (760) 777-7011 Disclosures &Forms for Owner-Rallders ApplyIng for Construction Pelts Dea>r Property owner. 61n. nWlieation for a buildinghas ie name �g yourself as the budder of the pop" Specified at pel • We we PmViding You Vft an Owner$udder AohWw6 moat.aW- Infarmatien Veaification Poem to make )w am= of your immibilitm and pouible n* you may inion by in 1m mane as .am Oeaaa-Btaldear. we WW not issue a buildingpitrmit until have of eack �� : read; initia#esd yQur� mn�ctaudiafi pravidon, signed, and reformed this form to as at our.oi'tieW address indicated. An agent of the owner cannot exeefe t6i notice unless you, the prope7ty owner, obtain the prior approval of the permitting authority. Read &" ea ck suftnwgr WOWN signify you mafwstand orvfto dais hVbr=aWrr. understand a frognent practice of unlicensed persons is to have the property owner obtain an "Owner-Builde building permit that erroneously implies that the property owner is providing his or her own labor and material petwaaft.1, as an Owner -Builder, may be held liable and subject to serious financial nsk for any uguries sustained by an unlicensed person and his or her employees while wor(dng on my property. My homeowner's insuranoc may not provide eov+efte for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my invi ance-coverage for injuries to worimm on my property. I understand budding permits are not required to be signed by property owners unless they are respoaaibk for th construction and are not hiring a bomsed Contractor to assume; this c stbihty- . I understand as an "OwaEr-Builder" I am &e responsible party of woord on the Permit_ I understand that 1 easy prote myself from potential financial risk by hiring a licensed Contractor and having the permit Wed im ins or her nava instead of n own. I- U A I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers permits and contracts. 0_4 I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total `I Of my construction is at least five hundred dollars (5500), including labor and materials, I may be considered an "e t nplo. under state and federal law. [ understand if I am considered an "employer" under state and Ibdend taw, I must register with the state mad fen government, withhold payroll taxes, provide workers' compensation disability uvwaw&, and contribute to unemployi compensation for each "employee." I also understand my failure to abide by these laws may subject me to smions 6na risk . i 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 worts is performed by tic subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is pert, under contract with a licensed general building Contractor. 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. JgUntss szUked by.any subsequent owner(s) that result from any latent eonSUW60n defects in the worlcmanshipor mated4k . I understand [may obtain.more information regarding my 'obligations as an "employee" froth 09 I loeuus Servros, the Unitod States Small Business Administration, the California Department of Benefit PayrnMM. 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. 2DA 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: I agree that, as the party legally and furamially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Omer -Builders as well as employers. 2. I agree to notify the issuer of this form immediately of any ad&t[ons, dam, or cb@s@m twAny of rho [ have provided on this form.. Licensed contractors are regulated by laws designed to protect the public- If YM Fact with romoone who does not have a ho m. rho Contractors' State Lwease Board may be, ttoabie to aseaist YOU with any fhundd loss you may sustain as a tmdt of a complaint Your only remedy against unlicensed Contractors may ba Jn: 6" come. It is also imgartaat for you to wdustmd drat erg w&coasad 0ontractor % eaVloyoo of that W&vidaal or Diem ie i wtat woeung on your property; you may be held Trains for dima�we . If you obtain a pardt as O-Baildcr and � to him Cotfotors, you will be reVens��lo for vette tg or not dross CQRU=WM are pct amused, Wel dm tatus Qf tm vro&Me or aosation insurance ooze. Before a budding per mit can be kstted, ihls totem must be completed and signed by the property owner and retarned to the agency M"ndble for kvdft 6wgwtn tL Mot& A copy, of dwVVergt owner's 's 'r fsm other ver4kadon awe to the agmq is etaguhnd to be preaercted "!rare thea pts is LuarA to dw p owner's skmature. . Signattue of property owties Date— Note: ate Note: T he following Autfronzation frorm is required to be completed by the property owner early wh6n dO Pat r, an agent of the property owner to apply for a construction permit for the Owner -Builder. t�U'� R17,E T1QN OF A=ff TO AC'T ON > tOP__U OWNWS BEHALF Excluding the Notioe to Property Owner, the sxWption of which I understand is MY peraomsl cespomwlity, I lnxoby authon the following persowsi) to act as my pgeat(r') to aply for, sign, and file the dooumeata amomy to obtain an Owner-Bwtdc Permit for my pmlact Scope of Construction Project (or Description of Work): Project Location of Address: 41L; t6 v 6167 W try UJze Name of �luthoriaed Agent: Address of Audwrized Agent: Tel No I declare under penalty of perjurythat I am the property owner for the address listed above and I personally filled out the information and certify its accuracy. More: A copy o e owner's driver's license. form notarization, or other vacation acceptable to the agency is requir be p en the permit is issued to verify the property owner's signature.. Property Owner's Signature: Date: