13-0826 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
13-00000826
Property Address:
48750 SANTA URSULA ST
APN:
646-130-009- -
Application description:
WALL/FENCE
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
5142
Applicant:. Architect or Engineer:
------------------
LICENSED CONTRACTOR'S DECLARATION
• Qum&
_ VOAX (760) 777-7012
777-7011
BUILDING & SAFETY DEPARTMENTS INSPECTIONS (760) 777-7153
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
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 a scant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500):
lilyI, 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
Dy
ane year of completion, the owner -builder will have the burden of proving that he or she did not build or
��11y I improve for the purpose of sale.).
lA 1I, 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
I/' pursuant to the Contractors' State License Law.).
1
hiUllFy�r� ((( am exempt under Sec. , B.&P.C. for this reason
., n 1
Date: ) Owner: 1 ( /
CONSTRU ION 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 ISec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQPERMIT
Owner:
AUDREY TOMERLIN
48750 SANTA URSULA ST: D
LA QUINTA, CA 92253 r
(
Contractor:
Owner
Date:
LM U 11D
JUL C 3 2013
CITY OF LA QUINTA
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 become subject to the workers' compensation provisions of Section
3700 of the Labor Code, I shall forthwith comply with those provisions.
Date: Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS (5100,000). 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 const r ction, and hereby authorifrwresentatives
of this county tolentte pon the above-mentioned prop p
/e/ri`]v for tion purpo es.
Date: Y"nature (Applicant or Agent):g.�L
TT
v_•r - � ,
Application Number . . . . . 13-00000826
Permit . . . WALL/FENCE PERMIT
2013
Additional desc .
Permit Fee 61.49
Plan Check Fee
.00
Issue Date . .
Valuation . . .
. 5142
Expiration Date 12/30/13
Qty Unit Charge Per
Extension
1.00 47.1900 LS MISC WALL,
FIRST 100 LF
47.19
.1.00 14.3000 EA MISC WALL,
ADDL 50 LF
14.30
----------------------------------------------------------------------------
Special Notes and Comments
BLOCK WALL - INSTALL 132 L.F.. OF 5 FT.
HIGH BLOCK WALL WITH WROUGHT IRON GATE
AT FRONT OF HOUSE PER APPROVED ORCO
BLOCK WALL DETAIL. 2010 CALIFORNIA
BUILDING CODES.
Fee summary Charged Paid
----------
Credited
Due
-----------------
Permit Fee Total 61.49
.00 .00
61.49
Plan Check Total .00
.00 .00
.00
Grand Total 61.49
.00 .00
61.49
•LQPERMIT `
Bin #
Permit # 1zk
13
Project Address:
A. P. Number:
Legal Description:
Contractor: 14'd
Address:
City, ST, Zip:
Telephone:
State Lic. #
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
City of La Quinta
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
Owner's Name: —R r- 'D,, o M. e (Z L I V1
�+ t V 1 /l C3✓ F C Address:
City, ST, Zip: U1 �'.
P —
f .
Telephone: '
i'e% — 46 11 l d t-,<, Project Description:
L �✓�ywl cvVC
Name of Contact Person:7"I(-N `
Telephone # of Contact Person:15:
' °
a Submittal Req%
Plan Sets
Structural Caics.
Truss Cates.
Tide 24 Cales.
Flood plain plan
Grading plan
Subcontactor List
Grant Deed
H.O.A. Approval
IN HOUSE: -
Planning Approval
School Fees
Lic.#: /32
4/ocl— Cl)
\ I'r aj rc�%'
Total Permit Fees
t ra
La Quinta Golf Estates -
Community Association
Architectural Committee
P.O. Box 553 s. • ,
La Quinta, CA 92247 _
(760) 564-0136
jimandjMew(awerizon.net
r 5 ..l
June 24, 2013 .
Mr. Beltran
48-750 Santa Ursula Street y `
_ -.La Quinta, CA 92253
r _
Dear Mr. Beltran:
The Architectural Committee for the La Quinta Golf Estates Community Association has
reviewed your request for permission to construct a block wall at 48-750 Santa Ursula
Street as shown in the enclosed sketch that you;have`subinitted and we have approved
your request. a,
The approval is only for the wall as shown in the sketch and any changes will have to be
resubmitted for approval. You have indicated that you will be enclosing a more complete
sketch to the City of La Quinta. When you have that sketch ready if you bring it to me,' I
will stamp it with our official stamp and sign it.. '
Yours truly,
. /(`\ Com° • . N' ..
k
. Woods, Architectural Committee
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) 777-7012
FAX (760) 777-7011
Disclosures & Forms for Owner -Builders Applying for Construction Permits
VkWORT'ANTt NOTICE TO PROPERTX 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— µ g -1 SO Sly-tl:-i9 (4 p s4 n
We are providing you with an Owner -Budder Acknowledgment and Information Verification Form to make you awain 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 yourunderstanding 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.
OAR'S AC1Q40WLEJ)GAVM AND VE)(tIFLCATION OF N
���(DfREt✓TIONS: Read and initial each statement below to signify you understand or verify this information.
"Q%1. 1 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 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 my property -
092)z -f understand building permits are not required tobe signed by property owners unless they are responsible for the
construction and are not hiring a licensed Contractor to assume this responsibility-
r,4,L A. 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
own.
ad; I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on
permits and contracts.
040-5-t 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.
(� 1 understand if I am considered an "employee' 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.
��l 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.
LA -1 understand as an Owner -Builder if I sell the property for which this permit is issued, I may be he'd '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.
49 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-
800-321-CSLB (2752) or www.csib.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:
�/n ��_�
Ly Zw. I agree that, as the party legally and financially responsible for this proposed construction activity, 1 will abide by all
applicable laws and requirements that govern Owner -Builders as well as employers.
I agree to notify the issuer of this form immediately of any additions; deletions, or changes to any of the i OTmation 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 tounderstand that if an unlicensed Contractor or employee of that individual or firm is injured while vmrldng
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 respowible for verifying whether or not those Contractors are property 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. Ow permit. Nota: A copy of the property owner's driver'slioensef form notar. ns or
other verification acceptable to the agency is required to be presented when the permit is issued to verify the property
owner's signature. '
a& .
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 persons) 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 1 am the property owner for the address listed above and I personally fulled 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:
CITY OF LA QUINTA-
BUILDING & SAFETY DEPT.
APPROVED--%
FOR CONSTRUCTION'
7&o
772 - _�3 �S_ "vc-,
ORCO STANDARD 6' TO 8' CMU SITE WALLS
OPTIONAL RAT CAP
DESIGN CRITERIA PER THE 2010 C8C
1. ALLOWABLE SOIL 864RLW PRESSURE = 1500 PSF
Z ALLOWABLELATERAL PASSTVFPRESSURE = 150 PCF
3, GROUT STR6NGM - 2000 PSI p 28 DA YS
4. RETVFVRCVWSTEEL : GRADE 60.
S LS00 PST MASONRY 070PRESSION STRENGTH.
6816, 6616, OR 6618OW
GPZUTMOKY@ MT
STEEL
NOTER
(�T
1. CONKRM BLOCK WALL CONFORM TO ASTM C 90.
L CONCRETE R71R R)OTDW SHALL BE 1 PART CENENT TO 2-1/2
7' DROP-IN 1N QAR
PARIS SAND TO 3-112 HARTS GRAVEL WITH A MAXIMUM OF 1-W
rs Zo.
r-0'
GALLONS OF WATER PER SACC PORTLAND C04ENT SHALL CONFORM
TO ASTM C 150 TYPEJ7/V. FC e 2500 PSI
16 STD JCIINT
3. Rt7AfV RCIAG SrM 9ULL BE OV7i7RMED AND CONFORM TO
RENfORCEIfEAff @ 24' C111C
ASTMA 6IS GRADE 60. PROVIDE 48 OM DL LKETER LAP.
PLACES -. PLACES T
a ID.
ID.
4. REM V AL L BE CFNTERW JN THE CONCRETE BLOCK CEL IN
RJR ST-lAHP BLOCK
MRSLULB�LOCK
VWOL7fITsLOCA7LO.
AOM AWME /4 DOOOR A
5 CONCRETE BLOCKSHALL BE LAYER IN A RIA WV G BOND
/4 OROPBN BAR AT E4af
PATTERN WITH VERTICAL COM7Afm OF Tw CELLS CAVO.
570EOF OCINTROL JOIMS;.
&ADS OF WAILSAND p WALL
;NEIGHTCFRANGES
6. ALL BLOCK CELLS CONTAINING VER71CAL REBAR SHALL BE SOLID
-GROUTED.— -
7. LOSE TYPES MORTAR PROPORTIOLNLD USING ASTM C270 PART
LFfENT TO 1/2 PART LIME TO 4-42 PARTS DAW, -LOCISESMfD.
T DOWEL. @ CENTER OF
a4U.
B. GROUT FOR CONCRETE BLOCK PER ASTM C 476 TO BE 7 PART
aNBVT TO 3 HARTS SAND (GROUT MAYCONTAIN 2 PARTS Xr
PEA GRAVEL IF WEATHER COMMONS AREFAWRABLEAND BLOCK
LU'voasTRLACTED CELL ST2FLS SUA-TCIENT TO ALLOW GOOD GROUT
FIDW). WATER MALL BEADDED TO PRODUCE GOOD GROUT ROW
WITHOU7*SEGWGATION OF THECONSmA91RS
9. BEOCKSTEN MAYBE-WtTSET 1-AM-INM THEPOOTING MOLE
SE°CHART
THE CONCRETE JS PLASTIC BLOCK STEN MAY BE PLACED TO
EITHER BXE OF THE TRS CH TYPE ROOTING
10. F007M MIST BE POMM ON OR INTO GNDWMIED
SOILOR ar LOMWACTED F7LL W7THAMIWMLN4
I—AL4TLR4L
2
COPIFAC/lON OIF90 %.
, ,,,,,,L
11. FIRSTRV-91ECTION TO BEAPTER FOOTING 7REVCfESARE
READY RM CONCIRETEAND ALL REIN M SIEiL IS TIED IN PLACE
SECOND RMECTION TO BE WHEN THE RWWRED VERTTCILL IS IN
RACE AND THE BLOCC WALL 1S READY TO GROUT.
12. A14MI IN CONTROL JOINT SPAam 40' OX 20' O/C FOR
14 HORZ. CONT.
WALLS TO BE MORTAR WAWED OR snAc CO COATED.
5-7DL11YLIGHT
8*
MIN. FOOTING DEPTH EOR
WALL O WALL 0
(�T
SLOW TOP 1 Fr. SETBACK
SEE CHART FOR REQUIRED REQAR
AND FOOTING DIMENSIONS.
rs Zo.
r-0'
DAYLIGHT
WALL p
2 FT. SETBACK
CITY OF LA QUINT, j
CITYOF LAQU1W 'SOV ®PT.
FOR PONSTRUCTION
er���e_,e
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TRENCH
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X' DOWEL
'Y' BAR
SPEED
HEIGHT
DEPTH
#4@ 40' 0/C
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6'-0"
21'0*
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V U
36'. 0/C - 19' CMU
36' OIC - le' CMU
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to W
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36.OIC - If* CMU
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CITY OF LA QUINTA
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