12-0883 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: '�12=000i0'0.88.3%
Property Address: 51100 CALLE- OBISPO
APN: � 770-142-002-92 -000000- .
Application description: WALL/FENCE
Property Zoning: LOW DENSITY RESIDENTIAL.
Application valuation: 498
Applliic�anntt:� Architect or Engineer,
l
c . &t!t 4 Xi& Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
TORRES DANIEL
51100 CALLE OBISPO
LA QUINTA, CA 92253
(760)567-0133
Contractor:
Owner
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/07/12
�D AA
!I AH. 0 7 2012 ;�
CITY OF I:AOWNTA '
1 .: FWAP CE M—PT
J.
:•41r _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ — _ — _ _ _ — _ _ _ — _ _ _ _ _ I — _ _ _ _ _ _ _ _ — _ — — _ _ _ _ _ _ _ _ c_ _ _ `_ _ — — — _ — _ _
Hyl" LICENSED CONTRACTOR'S DECLARATION - WORKER'S COMPENSATION DECLARATION
I hereb affirm under penalty of perjury that I am licensed under provisions of Chapter 9.Icommencing with I hereby affirm under penalty of perjury one of the following declarations:
x '
Sectiont7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. S_ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided ,
License :Class: License No.: - for by Section 3706 of the Labor Code, for the performance of the work for which this permit is
t• _ issued.
Date:. '. - Contractor: I have and will maintain workers'. compensation insurance, -as required, by Section 3700 of the Labor
• f
• 9WNER-BUILDER DECLARATION
Ihe'rebyraffirm under penalty of perjury that 1- C
am exempt from the.ontractor's State License Law for the-
following�reason .(Sec. 7031.5, Business'and Professions Code: Any city or county that, requires a, permit to
consiructj: alter, improve, demolish, or repair, any structure, prior to its issuance, also requires the applicant for the
peimii'.fo-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 o the Business and Professions Code) or
that he &*i he is exempt therefrom and.the basis for the alleged exemption. Any violation of'Section,7031-.5.by
anyappliant for a permit subjects the applicant'to a civil penaltyofnot more than five hundred dollars ($500).:
(_ 1 f,_cas•owner of the property, or my employees with wages•as their sole compensation will doahe 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 .doIes 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.).,
(_ 1 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.).
( ) I am exempt under Sec. , B.&P.C. for this reason
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:
OPERMIT
Code, for the performance of the work for which this permit is issued.. My, workers compensation
insurance carrier and policy number. are:
Carrier-----r-----'----=.-=----Policy Number
I.certify that, in the performance'of the work'foi which this permit -is issued,.) 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 �co—m%� wit/s� pi/oy�'sions.
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 ($100,000). IN ADDITION TO;THE COST OF COMPENSATION', DAMAGES ASPROVIDED 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 underorrpursuant 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,,age'nts and employees for any actor 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 constructi�oPn, and hereby authorize representatives
of this county to enter upon the above-mentioned property for inspec '6n purposes.
D _r�/�S gnature (Appl ca,.1nr =Agent): /✓ii�^
LQPERMIT
Application Number . . . . . 12-00000883
Permit ... . WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 15.00 Plan Check Fee
.00
Issue Date . . . . Valuation . . .
. 498
Expiration Date 2/03/13
Qty. Unit Charge Per
Extension
BASE FEE
15.00
-------=--------------------------------------------------------------------
Special Notes and.Comments
23 LN , FT BLOCK WALL . X - 5.. FEET_ ,,HT„W,ITH` (2 )
COLUMNS. PER CITY -.STANDARDS a APPROVED
PLANS. .2010--,CODES' ...
-----------=----------------------- ----------------------
Other 'Fees � ' `. .. BLDG:STDS ADMIN (SB1473)
-------
r1 0 0
Fee summary Charged Paid Credited
Due
Permit=:Fee Total 15.00 .00 .00
15.00
.Plan Check..--Total 0,0. 00 .00
00•
Other 'Fee,7otal 1.'00 .00 .00
1.00
Grand Total 16.00 00 .00
16.00
'Fc
d
LQPERMIT
.t;
I
P.OBox 1.504
LA QUINTA, CALIFORNIA"92247-1504 BUILDING & SAFETY DEPARTMENT
7e-495 CALL'F TnMPlco ,: (760) 777-7012
LA QUINTA, CALIFORNIA.92153 FAX (760) 777-7011
PROPERTY OWNER'S PACKAGE
Disclosures '& Forms for Owner=Rudders Ap:�lying for Construction .Permits
4WipR1 NOTICE)� O PRQPERTY OWNER,
Dear Property Owner
,An. application .for a building.,Permit :has . btnitted in Your name
impnovements:specified at 1'o Lstinf a
g yoursels. te builder of the .property
h
We are providing you with an Owner- Budder Ackncrwled hand•Inforaiatien Veri ationForm to make you aware:of your
responsibilities:and possible risk you:imy tncurwby having ihispernghissued.in your as`the
Owe -Builder. We win not,issue a building.permit uotil'you_•�have read;,inrtzslediyetir understabding of each`provision,
signed, and returned this form to us at ottr official address indicated. -An agent of the owner cannot execute this notice
unless you, the property owner, obtain the piior.approval of the permitting authority.
DIRECTf411IS: Read aril enitiaFeaz :3 ;hent ; rb signify you, aiulersiand or vercfy this information.
� -I - I understand a frequent practice of unlicensed- persons is to have the property owner obtain an "Owner-Buildee'
building permit that erroneously implie's.that the property* is providing his or her.own labor and material pessonalfy. 1, as
an Owner -Builder, may .lie held liable and subject to serious` financial risk for anyJgJuhes sustained by an unlicensed person
and his or her employees while working:`
on my property - My insurance may not provide coverage for those
injuries. I am willfully acting as an Owner -Builder and am aware
Z2.
of the limits of my insurance:coverage for injuries to workers
P�rh'- 1 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. 1 understand as an "O'wner Builder"' 1 am tlte''responsible party of record';on the permit. I understand that I may protect
myselffrom 'potential financial risk by htrmg a licensed :Contractor and having the permit filed in his or her name instead of my
o
' 4. I understand Contractors are required by law to be,Gceased and bonded in California and to list their license numbers on
pe is and.contracts.
5.1 understand if 1 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, 1may be considered an "employer"
undeystate and federal'law.
6. I understand if I am consideced' in "employer'.' under state and federal, law,:.L in register with the state and federal
go ernmeni, withhold payroll 'taxes, provide workers' compensation, disability insurance, and contribute to unemployment
compensation for each "employee_" I also understand 'my failure to abide `by ihese laws may subject me to serious financial
risk. / - .
L�L7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential
structures cannot .Legally"build therit with the 'intent oto 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.
r- 8. I understand as an Owner -Builder if I sell the property for which this perm it is issued, I may be held liable for any
financial or personal. injuries Awtained by any subsequent owner(s). that result from any latent construction defects in the
workm 'hip or materials.
understand I may obtain more information regarding my obligations as an "employee' from the benl 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 (MR) at 1-
800-32�1-CSLB.(2752) or www_csib.ca.gov for more information about licensed contractors.
LI O. 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:
j/(_ 11. Vagree that, as the party legally and financially responsible for this proposed construction activity,.) will abide by all
V-1
Ie lisws and requirements that govern Owner -Builders as well as employers.
. 1 agree to notify the issuer of this form immediately of any additions; deletions, or changes to any of the information 1
have 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'aivd court: It is also
important for you to. uutderstand that if an unlicensed Contractor or employee of that individual or firm is injured while wonting
on your property; you may be held tiable 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 issajag,the.permAt. Now A copy of the property owner's diiver,,s h'censr, form riots athrn; or
other verification acceptable to the agency is required to be presented when the permit is issued to verify the,preperty
owner's signature.
Signature of property owner " Date: Z_ _
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,) hereby authorize .
the following. person(s) to act as my agents) 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 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 ' esented when t perm' is is ued to verify the property owner's signature.
Property Owner's Signature' Date: ���
cin.#;Quint
BulWlrlg 8t Safety Division"
P.O. Box (504, 78 41,95 Calle Tamplco
La.Quinta,.CA 92253-,:(76Q)'-77 7-7612
Building: PermitApplication and, Tracking Sheet.
Permit #
'�-
Project Address:,
i
Owner'sName:. J
or
A P. Number.
Address: d:�—
Legal Description:City;
Contactor.-
ST, Zip: �Y
.� '" •.``� ati?.<'�:�s;; '<
Telephode: — O J _ a
Address:
• Projeet'Descciption:
City, ST, Zip:
/
Telephone:
M.
State Lic. ft: City•
Arch., Engr., Designer.
Address:
City, ST, Zip:
Telephone:
State Lic. #:
.%u
Name of Contact Person:
Construction Type: Occupancy:
pJo ecf circle one New Add'n Alter Repair Demo
.1 type. ( )
#'Stories:
#Univ:
Telephone # of Contact Person:
Estimated VaNe.of Project: / ^` • d "
APPLICANT: DO -NOT WRITE BELOW THIS UNE
N
Submittal
Req'd
'Reed
j TRACMG
PERMIT FEES
Plan Sets
Plan Cheek submitted
Item
Amount
Structural Calm
Reviewed, ready foe corrections, '
Plan Check Deposit_ .
Truss Calcs.
°•Called Contact Person
Plan Check Bal ante.
Title 24 Cake.
Plans picked.up
Construction
Flood plain plan
Plans resubmitted n..
Mechanical
Grading plan
2a° Review, ready for•.correcGonskssue
Electrical
Subeontaetor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S M.L
H.O A Approval
Plans resubmitted
Grading
IN HOUSE:-
'^' Review; ready for correctionslissue
' Developer Impact Fee
Planning Appal
`Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
' I AREA
1493 SF
O TBA
A (E) COI/EREDL
Q)1
PATIO 172 SF I ` � • . o� , a���`�'-���,x'`
11I
77 .. (E) GARAGE
AREA 432 SF ' Covee •� < F,e '
•
--------------
I , ,
COCIeTY.veD �
W OCTA_
1�
®F QUpEpT. - - - GATE '
�!
BU & SAF ® _ amici PLf1/VT6e w :c
t� DOVEWA. ® p' I
App CTJON w
RTREE
NSTRU
0. a:? ZBY o
n/Ew DA
BLOCKWALL TO ,
Q lEl
m 0. �o GR&i b
Q
REPLACE OLD WALL, p , `� C COVER .
PLANI&P '' e
\/ GATE
fig-
�.
OGH .GATE I RADIUS:RAISH PER OW
AfitR
MIN
COVER 9/cc
AEW
7 A S
(E) DOVEWAY ' GROi.WD COVER
MAILBOX AUG 0 7 2012 � cove? I
R '
(E) CURB -t ::GUTTER
SITE PLAN AND DEMO PLAN
• j�
scs�E : iie•�=r-o-- -
THE ABOVE DRAWING SPECIFICATIONS, CONCEPTS AND DESIGN ARE AND SHALL REMAIN. THE PROPERTY OF
DUAL DESIGN AND NO PART THEREOF SHALL BE..COPIED- DISCLOSED TO OTHERS OR TTS+ DIMENSIONS ON THESE DRAWING HAVE PRECF�ENca OVER SCALED DIMEN�tp q
9E�'.IN `CONNECTION VERIFY. AND'BE RESPONSIBLE FOR ALL DIKENSIONS 'AND CGNDIitONS OF THE PR ECT. `ANb ;COKTRA
WITH ANY WORK' THAN THE SPECIFIC PROJECT FOR WHICH THEY HAVE BEEN DEV&,OpED.
WITHOUT ( E.
THE WRITTEN CONSENT OF DUAL DESIGN. VISUAL CONTACT WITH THESE DRAWINGS OR 9p ft3FICATIOHB DUAL DE9IsN OF ANY VARIATION FROM THE DIME"ONS• AND' CONDITIONS SHOWN �Y :THESE DRAt r"
SHALL CONSTITUTE CONCLUSIVE EVIDENCE OF THESE RESTRICTIONS. MUST, BE SUBMITTED BY THE CONTRACTORS FOR004M Pmocm!dm NOW ``APPROVAL
f11
- - ' - '.• r- - ._ u ... ..q. - .:�. ....- ., .. .�r:�i�'��Cm.--e+ _�ysg. .E .C,��� .: r. �� '�, i .d. :n �"�.F"�'o �•2d D.°� .iV �S��A