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12-0569 (BLCK)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 112-00000569~. . Property Address: 53025 AVENIDA NAVARRO APN: 774-064-025-2 --000000- Application description: WALL/FENCE Property Zoning: COVE RESIDENTIAL Appliratinn imlimtinn• '1.4 T`ht 4 4 Q" BUILDING & SAFETY DEPARTMENT BUILDING PERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Owner: HALL GRADY STANTON 53025 AVENIDA NAVARRO LA QUINTA, CA 92253 --------------------------------- Date: 5/22/12 Contractor: Applicant: Architect or Engineer: Owner D a ------------------------- - ---MAY 22 P� 2012 . CITY OF LA QUIN FINANCE. DEPT. 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 (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 applicant 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 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.). (_ 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. , BAP.C. for this reason caner: - 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 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. 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 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 /7! 3700 of the Labor Code, �,Ishall forth 'itthhcomply with those provisions. te.aV& A scam: 7 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 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, andherebyauthorize representatives s co of thiy to enter upon the above-mentioned propee5*n/ nectior ur/ es. D Sig re (Applicant or Agent): ' Application Number . . . . . 12-00000569 Permit . . . WALL/FENCE PERMIT Additional desc . Permit Fee . . . . 15.00 Plan Check Fee .00 Issue Date . . . Valuation . . . . 192 Expiration Date 11/18/12 Qty Unit Charge Per Extension BASE FEE 15.00 ---------------------------------------------------------------------------- Special. Notes and rnmmPntc 25 L.F. 5' WROUGHT IRON FENCE AT FRONT YARD, PER PLANNING APPROVAL (JW). ---------------------------------------------------------------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary ----------------- Charged Paid Credited ------------------------------ Due Permit Fee Total ---------- 15.00 .00 .00 15.00 Plan Check Total .00 .00 .00 .00 Other Fee Total 1.00 .00 .00 1.00 Grand Total 16.00 .00 .00 16.00 LQPERMIT CITY OF LA QUINTA BUILDING & SAFETY DEPT. APPROVED FOR CONSTRUCTION DATE✓" 22 -(- BY J -A f 1A)7b V n.; -,p APPA Q SY PL.ANNING 0 AR HENT BY _®ATE S r EXHIBIT CASE NO. to, m- ffo— ree m r# P.... w, P.O. BOX 1504 LA QUINTA, CALIFORNIA 92247-1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT PROPER'1' OMER'S FACKAGE. (760) 777-7012 FAX (760) 777-7011 Disclosures & Forms for Owner-BuRders ApplybW for Construction Pets DW Pcomity OyonW An. application for a building permit has been. su6mittod ffiyour nameyouaelf as the builder of The property mWWv+ements specified at g ZS' D4' �t//9VIX, O !/� We are pmViding you Vith an Owner -Builder Ackao easpQW*ilitios and p�ble w t Iafvtimatiea Vexit&Eatien forrla m nm� you aweatm of yaw Owaes-Builder. we OU msy int ur by lurv%'ttdspemit-is=ed in your earns as .tile wO not Isaac a btdidtu&.permit until yam -have read, initiated your. an . act @ of euackpma Viden, and wined this form tv us at Our official address indicated. An agent of the owner cast execute this notice unless You. the Property owner, obtain the prior approval of the permitting authority. LWML' z0Ja Read aaitimt eackstatmwlt bd*W'10 signify you mtdnrstmW or verb, dtu k4brma" . 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 stud material pemnally.1, 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 wodidag on my property. My homeowner's insurance may not provide coverage for those injuries. I am wailfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to wodmn on my property. A2. I understand building permits are not required to be signed by ptnpetV owners unless they are rwponsibk for th eonstrucbon and are not ham& a hconsed Contractor to nasties flus W.Vd4. 3. I unde•,ratand as an "(w cr-Builder" I am die responstlsk party of revord on the permit I undentand Ow I may prole myself from potential financial risk by hiring a licensed Contactor and haying the permit filed in his or hex name instead of a own - 4 i0- 1 understand Contractors are required by law to be licensed and bonded in California and to list their licew numbers permits and contracts. 1 A(5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total va Of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employ under state and federal taw. AZ6. I understand if I am considered an "employee, under state and &dere i taw, I must regww with the state and fel government, withhold payrotl taxes, provide wort rs' compensation disability insurance, and contribute to unemployr compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious f m risk. understand under California Contractors' State Incense Law, an Owner -Builder who builds single-family eesid, structures cannot legally build them with the intent to offer them for sale, unless all work is performed by tia subcontrexceedtors and the number of structures does not exceed four within any calendar year, or all of the work is perfc under contract with a licensed general building Contractor. Gd�8• I understand as an Owner -Builder if I sell the property for which this permit is issued,.l may be held liable for any financial or personal, it{juries tustained by any subsequent owner(s) that result from any latent eonsttuction defects in the workmanship. or tnateziais.- 9.. I understand I may obtain.more information regarding my obligations as an "employee" trona the Intetnai 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 (CMZ) at 1- 8000-321-CSLB (2752) or www.csrb.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 l- ally and Willy responsible for proposed construction activity at the following address: C t, A n iJ wr.t �Ar1Ai7 i� WA ' Mian �'.- .. ori- i agree that, as the party legally and fina=ially responsible for this proposed construction activity, l will abide by all applicable laws and requirements that govern Owner-Buulders as well as employers. G�(CI t 2.1 agree to notify the issuer of this form immediately of any additions; ddetiom or obese= tunny Of the isfotinaion I have provided on this form.. Licensed contractors are regulated by laws designed to protect the public. If your contract with someone who door not have a, he==, are contractors, State Lioease Boatel may be unable to assist you with any Bnanaial. loss You may sustain as a result of a complaint Your only remedy against ualioensed Contractors may be fiQ'ui'►il eotut: It is also ituportaid for you ft understand do if an twliceem d 0ou"ctor aw eaVloyee of time iudividnal of fkm is io*cd While wig on Your ProPWY. You Way be held H" for damagm If you obtain a pemait as Owner -Budder and wWb 10 idly Conftti+stors, you will be resDousMo for vedryiug why or not those Car rmtorm are properly Homed and the ststA of tbW worktas' oompensadon iasuaamc oovcrago. Before: a bullring permit can be kmed, &is form must be completed and signed by the property owner and returned to the aVsCY her ORdble for U9094 So VermIL Notes A copy of d wp owsw's t*reo's Ei f0m Win► Of other verTkadon aacep"k to tete Wnq is taguhed to lir prweated raheuh &V psi is Lumd so ss dge propen Signaiiro of property owner Date: ' 2 Note: The following Authorization Form is riequired to be completed by the property owner only when designatin. an agent of the property owner to apply for a construction permit for the Owner -Builder. Au' 9RWAU0M OF AGF. T TO ACT ON PROPERTY QW- 's Excluding.the Notice to Property Owner, the exawfiou of which i understand. is my pemomal rrspousibhlicY, I hereby authori the following person(t) to act as my Wats) to apply for, sight, and file the dommems ammaty tri obtain an OwQW-Budde Permit for my project Scope of Construction Project (or Description of Work): Project Location or Address: Name of Autboriaod Agent: Address of Authorized Agent: Tel No I declare under petty of perjury that I am the property owner for the address listed above and I personAlly filled out the information and certify its accuracy. Note: A copy of the owner's driver's license. form notarization, or other ver} fheatioi aoceptable to the agency is required to be presented when ere permit is issued to verify the property owner's signature.. Property Owner's Signature: - - Date: Bin.# Oty Of Q[1(t1td Bulldby a Safety Division P.O. Box 1504, *78-495 Calle Tampko 1.a.Qulnta, CA 92253 -:(760) 777-7012 Building Permit -Application'and Tracking Sheet Permit # Project Address: j/,iI✓%I% /l//� 1/1,��f/!� Owner's Name:. A. P. Number. Address: e Legal Description: City, ST, Zip: ��,4 64 %R�Y Contractor. / Telephone: Address: Project Description: I'Anle City, sr, zip: Telephone: State Lia N: City Lie'. M /V/)j/'�� Arch., Engr., Designer. Address: City, Sr, Zip: Telephone: State Lia #: ,c. : Construction T e . yp YW/wOOccttpaacy: Project type (Circle one): New dd' Auer Repair Demo Name of Contact Person ��`% / Sq, Ft.. /� # Stories: A4�t #Units: Telephone # of Contact Person: 760 Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS UNE d Submittal Req'd Recd TRACRING PERMIT FEES Plgn Sets Plan Check submitted Item Amount Structural Calca. Reviewed, ready for corrections Pian Check Deposit. . Truss C21cs• Called Contact Person Plan Check Salaa:e. Mde 24 Calci. Plans picked up Construction Flood plain plan Pians resubmitted.. Mecharacal Giading plan 2`! Review, ready for correctionsfissue Electrical Subeoutoctor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.L H.O.A. Approval Plans resubmitted Grading IN ROUSE-, ''' Review; ready for cormetionsAssae Developer Impar Fee Planning Approval Called Contact Person A.LP.P. Pub. Wks. Appr " Date of permit issue School Fees Total Permit Fees