13-0768 (BLCK)It
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
'4'
Application Number: 13-00000768
Property Address: 44120 CARMAN
APN: 604 -151 -009 -
Application description: WALL/FENCE
Property Zoning: LOW DENSITY
Application valuation: 2000
Applicant:
PL
RESIDENTIAL
Architect or Engineer:
aiK
o �
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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 ISec. 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
Li ante Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
t t h or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
plican[ for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
E ' 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 contra ing with li sed contractors to construct the project (Sec.
7044, Business and Professions Code: The C tractors' ate license Law does not apply to an owner of
property who builds or improves thereon, a ho con a r t , projects with a contractorls) licensed
pursuant to the Contractors' State License
).
) I am exempt under Sec. B.&P.C. o % is rea
i / IF
,,Pate:, t
Owner /
t�
I r TRUCTION/LENDTNG AGENCY
I hereby affirm under penalty of perjury that th is a construcCion lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
1,QPERMiT
Owner:
ABEL NAVARRETE
44120 CARMAN PLACE
LA QUINTA, CA 92253
(
Contractor:
Owner
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/20/13
Lr"'
U
JUN 212013
QUINTA
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
nE
n the performance of a work for which this permit is issued, I shall not employ any
y manner so as to come ject to Ae wjrkers' compensation laws of California,
hat, if I should su ' t to th orltk'rs' com tiorrp7ovisions of Section
Labor Code -ort th co w ((h pro isions.
Datant:
WARN NG: FAILURE TO SECURE ORKERS' 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 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 word 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 abov orm i n is c rrec I agree to comply with all
city and county ordinances and state laws relating to building ruc o , and e b authorize r sentatives
of this cou ty to Hier upon the above-mentioned property f r ' ec purp
Date: ignature (Applicant or Agent):
i
Application Number . . . . . 13-00000768.
-Permit . . . WALL/FENCE PERMIT 2013
Additional desc . .
Permit Fee 47.19 Plan Check Fee
.00
Issue Date• . . . . Valuation . . .
. 2000
Expiration Date 12/17/13
Qty Unit Charge Per
Extension'
1.00 17.1900 LS MISC WALL, FIRST 100 LF
47.19
----------------------------------------------------------------------------
Special Notes and Comments
90LF OF 6' GARDEN WALL AT SOUTH PROPERTY
LINE (PROTO II SPECIFICATIONS] PRECISION
CONCRETE BLOCK SHALL BE COVERED WITH
STUCCO, PAINT, OR TEXTURED COATING WHERE
VISIBLE FROM OUTSIDE THE PROPERTY. 2010
CALIFORNIA BUILDING CODES.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
PLAN CHECK, WALLS
60.06
Fee summary Charged Paid Credited
---------------------------------------------------------
Due
Permit Fee Total 47.19 .00 .00
47.19
Plan Check Total .00 .00 .00
.00
Other Fee Total 61.06 .00 .00
61.06
Grand Total 108.25 .00 .00
108.25
LQPERMIT
Bin #
Qty of La Quints
Building 8r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address:'
Name:
A. P. Number: �P`� V)t�
Address: \20
Legal Description:
City, ST, Zip: U I j_ l CIA -/ 5
Contractor:
Contractor: &U
Telephone: ...............P%1'8:$ '.: jy^?P{ v`{ r`s•C'
Address:
Project Description:
City, ST, Zip:
pG C
Tele hone:
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;:.}:•:: ;•i;:;.•};.:;.... .. .
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State Lic. # : City Lie.Ll
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
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Construction Type: Occupancy:
YP
State Lic. #:
Project a circle one New Add' AlEe Re air Demo
1 type ) P
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cales.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2•” Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'^' Review, ready for corrections/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
4--
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P.O. BOX 1504
LA QUINTA, CALIFORNIA 92247-1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
PROPERTY OWNER'S PACKAGE
(760) 777 -70 12
FAX (760) 777-7011
Disclosures & Forms for Owner -Builders Applying for Construction Permits
LW -0-4 11►7! NOTICE°TO PRQPER Y OWNER
Dear Property Owner.
An application for a buildinpermit has been submitt in your name listing yourself as the builder of the property
impro+^ements specified at � 1 t c c—t1h in
LAC a ,j&�tL CA�Uas-3
We are providing you with an Owner -Builder Acknowledgment 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
Ownet-Builder. We will not issue a building permit until you have 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.
OZ'S ACEMWLEI)GAMM AND VERIFICATION OF UWOIRAT'ION
DIRECTIONS: Read and initial each statement below to signify you understand or verify this information.
1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Buildee'
building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, 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 am aware of the limits of my insurance -coverage for injuries to workers
on y party
2. I understand building permits are not required to be signed by property owners unless they are responsible for the
co truction 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 having the permit filed in his or her name instead of my
Oder4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on
its and contracts.
5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value
y construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer"
state and federal law.
6. 1 understand if I am considered an "employee' under state and federal law, I must register with the state and federalrnment, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment
co enation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial
k.
7. 1 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
f ancial or personal. b4tiries sustained by any subsequent owner(s) that result from any latent construction defects in the
o"anship or materials.
. I understand 1 may obtain more information regarding my obligations as an "employer" from the internal 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 (CSLB) at 1-
800-3711-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:
will abide by all
the information I
uo.v r•�•.aw va. u,•., .vtuL &,1%,Vuacu t,v11u4t,tv15 tuc acguldmu vy wwzi ucsigucu tv p[vtwt UM FuvuM. a lou COntraCt Wlth
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 heldliable 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 woekers'
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 hmdit persuit. Note: A copy of the property owner's driver's trcemw, farm notaiai 491014 or
other verification acceptable to gency is required to be presented when the permit is issued to verify the property
owner's signature.
S tore of
rgna 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 _BE F
Excluding the Notice to Property Owner, the execution of which 1 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 -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 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: