13-0169 (BLCK)4 P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT �J INSPECTIONS (760) 777-7153
BUILDING PERMIT
Application Number:
Property Address:
APN:
Application description:
PIUPeILy FUllilly.
Application -valuation:
Applicant:
Date: 2/13/13
13-00000169 Owner:
78611 SAGEBRUSH AVE TONY & ROSE ZAMARRIPA
646-311-012-12 -000000- 78611 SAGEBRUSH DRIVE
WALL/FENCE LA QUINTA,. CA 92253 D A
MDDIU1_7 DENCITY RES (
2700 FEB 13 2013
Contractor:
Architect or Engineer.. Owner CIWOFWNYA
FINANCE DEFT.
--------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm underpenalty 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.:
Data t Contract
OW R -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
L�..a,ny applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500).:
tlI, 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.).
(L IGam exempt under Sec. ,.B.&P.C. for this reason '
r . ' • 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
----------------------------------------------—
WORKER'S COMPENSATION DECLARATION
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.
1 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 become subject to the workers' compensation provisions of Section
3700 of the .Labor
�Cod e, I hall forthwith comply with those provisions.
Dat? Applicant:(
WAR NIDI �E TO SECURE WORKERS' CO NSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTI SAND 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 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 herebyauthorizerepresentatives
of this county to enter upon the above-mentioned property for i ction purDes s.
Dat/ Signature (Applicant or Agen /
Application Number . . . . . .13-00000169
Permit WALL/FENCE
PERMIT
Additional desc .
Permit Fee . . . . 54.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. . .
. 2700
Expiration Date.. 8/12/13
Qty tnit,Charge Per
Extension
BASE
FEE
45.00
1.00 9.0000 THOU BLDG
2,001-25,000
9.00
-----------------------------------------------------------------------------
Special Notes and Comments
52 L.F. 6' GARDEN WALL. TO ORCO
STANDARD. 2010 CODES.
Fee summary Charged
Paid Credited
Due
Permit Fee Total 54.00
.00
.00
54.00
Plan Check Total .00
.00
.00
.00
Grand Total 54.00
.00
.00
54.00
tsin ff
Permit #
JC Project Address: -4
A P. Number:
# Submittal
Plan Sets
Structural Calcs.
Truss Calcs.
Title 24 Calcs.
Flood plain plan
Grading plan
Subcontactor List
Grant Deed
II.O.A. Approval
IN HOUSE: -
Planning Approval
Pub. Wks. Appr
School Fecs
City Of La Quinta
Building &I Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit APPlication and Tracking Sheet
L A-1 wner's Name: ,n , ,
Occupancy:
Add'n Alter Repair Demo
# Units:
6�
iih rl
PERMIT FEES
Contractor:
40
Address:
-4
Cit)'. ST, Zip:
-4
Telephone:
jC
State Lic. #
EJPlan
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person:
Telephone # of Contact Person:
# Submittal
Plan Sets
Structural Calcs.
Truss Calcs.
Title 24 Calcs.
Flood plain plan
Grading plan
Subcontactor List
Grant Deed
II.O.A. Approval
IN HOUSE: -
Planning Approval
Pub. Wks. Appr
School Fecs
City Of La Quinta
Building &I Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit APPlication and Tracking Sheet
L A-1 wner's Name: ,n , ,
Occupancy:
Add'n Alter Repair Demo
# Units:
6�
iih rl
PERMIT FEES
Total Permit Fees
Amount
--_......� .
Item
Reviewed, ready for corrections
EJPlan
Check Deposit
Called Contact Person
Plan Check Balance
Plans picked up
Construction
Plans resubmitted
Alechanical
2" Review, ready for corrections/issue
Electrical
Called Contact Person
Plumbing
Plans picked up
S. M.1.
Plans resubmitted
Grading
'N Review, ready for corrections/issue
Developer Impact Fee
Called Contact Person
A.I.P.P.
Date of permit issue
Total Permit Fees
Amount
�r�
of LA
QUINTA
C0� D
lJ
�BUILDiNG & SA
�pCONRS®
VED
FOR
DAT
10 -
TO 8' -CMU SITE WALLS
DEUGN CRITERIA: PER THE 2010 COC
1. ALLOWABLE SOIL 8FARI1W PRESSURE =1500 PSF
2. ALLOWABLE LATERAL PASSIVE PRESSURE - ISO PCF
3. G7ROUTSTR&4GTH - 2000 PSI O 28 LAYS
4. REWRVaNGSTEEL : GRADE 60.
S ISM PSI M4SWY COAVREMON STRE YGM.
Je r TU DAYLIGHT
c—' MIN. "
t�7VVT. SLOPE
2 iD I
SEE CkART FOR REQUIRED REQAR J Tn I
AND FOOTING DIMENSIONS.
NOTES•
1. CYJNCRETE BLOCK SHALL CONFORM TO ASTM C 90.
2. CONCRETE fOR fi7 TM SHALL BEI PART CEWff TO 2-112
PARTSS4N0'TO3-112PAR75GR4VFIWITNAM XMIMOF1-W
GALLONS OF WATER PER SACK POMAND CBIPNT SHALL CXMIMtxm
TO ASTM C ISO TYPEmv. k - 2500 PSI
3. RERWr aW STEEL SMALL BE 0SM4ED AND CONFORM TO
ASTM A 615 GRADE 60. PROVIDE 48 BAR DIAMETER LAP.
4. REBAR SHALL BE CENTERED IN THE CONCRETE BLOCK CEL IN
WHICHl IT IS LOC47M.
S. CONCRETE BLOCKSHALL BE IAYED IN A RLNV OW BOND
PA77E tN WITH VHRTICAL COIMNL4TYCF THFCELLS UNO.
4 ALL BLOCK CELLS C ONTAIAM VERTICAL RE84R SHALL BE SOLID
GROUTED.
7. U5E TYPES MORTAR PROPORTIONED I WC ASTM C 270 PART
CEMENT TO 112 PART LINE TO+42 PARTS CAMP, LOOSE SAND.
8. GROUT FOR CONCRETE BLOCK PER A5774 C 476 TO BE 1 PART
CEMENT TO 3 PARTS SAND (GROUTMAYCONTAIN 2 PARTS 318'
PEA GRAVEL IF WEATHER Ci7NDIIJONSARE A00tABLEAND BLOCK
L0000SS7RWrED CELL SIZE IS SUFFIafw TO ALLOW GOOD GROUT
PLOW!. WATER SHALL MADDED TO PRODUCE GOOD GRCTUTFLOW
W7TH0UTSSGREG4T70N OF THE CGWSITLENTS
I BLOCK STEM ANY BE WET -SET 1 -112 -INTO THE POOTTMG WHILE
THE CO NCTREM I5 PLASWC DOCK STEM MAYBE PLACED TO
EITHER EDGE OF TIE TRENCH TYPE POOTDN(i.
1a fWTTNG MUST BE POURED ON OR INTO UNDISTURBED
NATURAL SOIL OR ON C O MACTE9 PILL W77H A MINIMUM
UM
COWALTION OF 9016.
I.I. F7R5TbWEMO N TO BE AFTER F0077NG TREMOiESARE
READY FOR CONN ETEANDALL RmLam STEEL is TIED IN RACE
SECOND INSPECTION.TO BE WHEV THE REQUIRED VERTICAL IS IN
PlACEAND THF BLOCK WALL 5 READY TO GROUT
12. MAXIMUM CONTROL JOINT SPACING: 40' OX 20' OK FOR
WALLS TO BE MORTAR WASHED OR STUOOO COATED.
)TING DEPM FOR F TO DAYUGN
WALL O WALL O WALL O
TOP I FT: SFTR40C 2 FT. SET84CK
2'-- 2'-0-
2'-r — —
CITY OF" QUINTA
E
N �v
a: ~ CSL928. UI a
,k Ex►. it-aazou
lF OF CP,,4OP
CHART FOR 6' TO 8' SITE WALL W/ TRENCH FOOTING
WIND
MAX.
�
DESIGN
WALL
TRENCH
FOOTING
'X' DOWEL
'Y' BAR
SPEED
HEIGHT
DEPTH
6'-0'
2'4'
#40 40' 0/C ID+I'-9-
#4 Q 40' 0/C
36' 0/C - 18' CMU
W
M x
W
6'-80
2'-2'
#4@40' 0/C ID+I'-9"
#4 0 40" 0/C
ZQ
_ W
36' 0/C - 18' CMU
36' O/C - le' CMU
3w
a-
mN
7'-4`
2'-4'
#400 32' 0/C ID+I'-9-
#4 0 32" 0/C
n-• I••—
N
27. 0/C - 18' CMU
L)' OIC - IC CMU
LA
co
8'-0'
2'-6'
#40 24' 0/C I D+I'-9'
#4 0 24' 0/C
18. Olc - 18' CMU
36. 0IC - le' CMU
MR =tYARO AMMV WALLS W9W
AUMWS*4Lf O=A= A W BLOCK
MOLMOVIOSWALiMAM My=
N DOOR AND /i ARCVVN OR ON EACA
SIDE Of PC 42 BLOCK ORAOY - AS
SHOW
O FACAS►OE OF
T W/ N CROP -LY 9V
rovr
CITY of La QUINTA
&=mu w m�aaia
m oem"
MIQY'. fRL I bAi�lp/Im
I�m4XIR WMDIIIYOMT
aut�a
m W�rae
XIL
FOOTING STEP DETAIL
/PPpFEss 10
y �O
u
W A
~ C31925
*
Exp. 12-31-2012
s�4r C I v
F OF CA1 �fp
�y °� .�L�Krtla1a
P.O. Box 1504
LA QUINTA, CALIFORNIA 92247-1504 BUILDING & SnFETY DEPARTMENT
78-495 CALLS TAMPICO (760) 777-7012
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011
PROPERTY OWNER'S PACKAGE
Disclosures'& Forms for Owner -Builders Applying for Construction Permits
IMPORTANT! NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application -for. a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified at •k8— G //�l3 (0<, 4 1> iaCa Qv'j nY'w
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
Owner -Builder. We will not issue a building permit until you have read, initialed your understanc.ing of each provision,
signed, and returned this form to us at our official address.indicated. An agent of the owner carrot execute this notice
unless you, the property owner, obtain the prior approval of the permitting authority.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
DIRECTIONS: Read and initial each statement below to signs you understand or verify this informations;
1. 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 material personally. I, as
an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained Eby 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 2. I understand building permits are not required to be signed by property owners unless the} are responsible for the
construction and are not hiring a licensed Contractor to assume this responsibility.
�Y�. I understand as an "Owner-Builder".I am the responsible party of record on the permit. I undListand 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
own.
�i!/4. I understand Contractois are required by law to be licensed and bonded in California and to lis- their license numbers on
permits and contracts.
'�y5. I undeistand 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.
oo'
�r� �• 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.
P='.' 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 .s 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.
1
4
�8. 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 injuries sustained by any subsequent owner(s) that result from any latent construction defects in the
workmanship or materials.
21,,"'9. I understand I 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-
8�00-3�21-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors.
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:
L11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all
applicable laws and requirements that govern Owner -Builders as well as employers.
Z1 2. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I
ve 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 Contractors are properly licensed and the status of their workers'
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 issuing the permit. Note A copy of the property 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. 1�
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 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: