13-1507 (BLCK)P.O. BOX 1504
78-495 CAL:LE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 13-00001507
Property Address: 79660 CORTEZ IN
APN: 649-063-004-72 -2180 -
Application description: WALL/FENCE
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 1250
v, M
Applicant: Architect or Engineer:
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
I hereby affirm under penalty of perjury that I'sm licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business. and Professionals Code„and my Lioenj, i 'n full force and effect.
Cicerise,Cl • s 5 License No.: Slit'
�.
Date '� / Contractor vV
OWNER -BUILDER DECLARATION
I -hereby affirm under penalty of perjury that) am exemptfrom the Contractor's state License Law for the
following resson.(Sec. 7031.5„Business and Professions°Code: Any city or county that requires a permitao
construct, alter, improve, demolish, or repair any structure, prior to its Issuance,:alsorequires 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
LlcenseLaw (Chapter9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that,he or she is exempt:therefrom andthe basis for the alleged exemption. Any violation of Section 7031.5 by
any applicant for a,permitsubjects the,applicant:to a civil penalty of not more than five.hundred dollars (9500).:
(_) 1, 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; Businssaand Professions Code: The
Contractors' State License Law does not apply 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
Ole 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.).
l _) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Coded The Contractors' State License Law does not apply to an ownerof
property, who builds or Improves thereon, and who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors: State License Law.).
(_) 1 am exempt under Sec. , B.&P.C. for this reason
Date: Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is ,.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
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/26/13
Owner:
VALDEZ ROGELIO & MICHELLE
79660 CORTEZ LANE
LA QUINTA, CA 92253
(
Contractor: , 26 2013
Owner
OF LA
------------------------------------------------
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 selfaneure 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 whiehthis permh'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, 1 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 shoal atoneZsubl to the workers' compensation provisions of Section
3700 of theL or Cod eh I focomply. with those provisions.
Date:.�� Applica t:
WARNING: FAILURE TO SECURE WORKERS' comPENSATIDN COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS 18100,000). IN ADDITION TO THE.COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
SECTION 3708 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':appiication.
1. Each person upon whose behalf this application Is made, each person at whose request and for
whose benefit work is.performed under or pursuamto 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 Quanta, its officers, agents and employees for any as or omission related to the work being
performed under or following issuanceof 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,permlt, or cessation of work for 180 -days will subject
permit to cancellation.
I certify that I have read this application andstate th the above formation Is torr ..I agree to comply with all
city and county ordinances and state laws relating building truction, and h by -authorize representatives
of this county to enter upontheabove-mentioned roperty for pe ion purpo
Date: ll'/ /f0[/] Signature (Applieentor Age 1:
Application Number . . . . . 13-00001507
PermitWALL/FENCE PERMIT 2013
Additional desc . .
Permit Fee . . . . 47.19 Plan Check Fee
.00
Issue Date . . . Valuation . . .
. 1250
Expiration Date . . 5/25/14
Qty Unit Charge Per
Extension
1.00 47.1900 LS MISC WALL, FIRST 100 LF
47.19
Special Notes and Comments
INSTALL BLOCK WALL ORCO DETAIL TOTAL OF
50 LN FT X .6 FT HT (4) COLUMNS ORCO
DETAIL. ALSO (2)WROUGHT IRON GATES VIEW
OBSCURING.APPROVED PER A.7.
----------------------------------- - -
-----------------. .
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 Qurnta
Bw7ding & Safety DIWIon
P.O. Box 1504, 78-4.95 Calle Tampico
La Qidnta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: -1 q (0 (P � (j� 2 (
Owner's Name:
A. P.Nurnber: .
Address: -101
Legal Description:
City, ST, Zip: w, nht • C1 ?J5 -z;, '
eomp� «us
Contractor: �.W�,p
Telephone:
Address: p 80�r I O
.Project Description: :ru-S4-Al,I
City, ST, Zip: IA.ti�i
Telephone: `� (�� -j "%a '�'� �}'
( •As. LST 6 Of-
0 40 Ae L
Stec Lic. # : g LA I. City Lic..#;
s 1 . L b2 I .IQwptl W
Arch., Engr., Designer:.
g)J dV2 ft iUA4-5 ev► Sdq
414
Address:
("osT sl e. -fn . 9M)e qq . W a W W I w • 6 �-
City, ST, Zip:
Telephone:
State Lic: #:
s ,
&nstruction Type: L Occupancy: 50 LF 6
114 PAILklmik)
Project type (circle one): ew Add'n Alter Repair Demo
Name of Contact Person: P0',( vcZ
Sq. FL:
1# Stories:
# Units:
Telephone#,of Contact. Person: -1(Q 0 - LJ 0 3 '(o -5
Estimated Value of Project: Loo
APPLICANT: DO NOT WRITE BELOW THIS LINE
�!
Submittal
Req'd
Recd
TRACMG
PERMIT FEES.
Plan Seb
Plan Check submitted
item
Amount
Structural Calcs.
Reviewed,•ready for corrections
Plan Check Deposit
Truss Cales.
Called Contact Person
Plan Check Balance •
Tide 24 CAM
Plana picked up
Construction
Flood plain plant
Plans resubmitted
Mechanical
Grading.plan
L
20' Review; ready for correctionsliscue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant.Deed
Pians picked up
SALL
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
Reyiew, ready for correcdonarmue
Developer Impact Fee
Planning Approval
Called Contact Person
AXP.P.
Pub. Wks. Appr
Date of permit issue
Scho ' Fees
Total Permit Fees
, T ��
v�
ORL uw^t-,
a.40.use 1
d
EX*I'ZnNG GRNE
YJAY
1
HOUSE
NIT
Tt
& Atai
VAIDEZ •HOME
79,660 CORTEZIANE.
!W PkOPC15ED BLGK
W Crrr srnNNARS to �
v mo .` /
4/ -
Sock ® V 4K4 -v
P.O.-'.BOX 1504
LA QUINTA; CALIFORNIA 92247-•1504
7$-495 CAtLE TAMPICO
LA Q.UINTA, CALIFORNIA 9.2253
B`UILD.ING & SAFETY DEPARTMENT
PROPERW OWNE-' R'S PACKAGE
(760) 777-7012
FAX (760) 777-7011
Disclosures & Forms for Owacr Bullders Applying for Cosstlruction Permits
J-49MMATI NOVICE TO I'ROPI RTY nVVNFlt .
Dear'Pnpaty Owner
An. motion for ,a building permit has been in your name listing you m f as the builder of the property
impr+civements specified at'1�0 002T1✓2 L^As4 -
Wie are proVW* YOU VA an Owner: Builder Aclmowledgment and Info�n' Verification Form to =aloe y m awave of your
>aesponsibilities,andposarble ri&you may iacmr by having Wspemdt issaad in yow nam as the
Oar -Builder- We wig not :bin a buildiafi.pmnit antdlyaa-lave read, iridd" your- aadaataadin$ of each"provis ion,
signed, and retrained this form to us at our official address indicated. An agent of the owner cannot ereec>tte •this notice
unless you, the property owner, obtain the prior approval of tle permuting authority.
Read and irrWd ew* statement bdow to ngmfYYOU
dQunderstand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder"
l?ermlt that ernoaeously-implies that the pcopertyowner a providing his or her own labor and material pensonally.:I, as
an Owner -Builder, may be held liable and subject to serious financialrisk for any injuries sustained by .an unlicensed person
and his or her employees while woriung on, my property. My homeowner's insurance may not provide coverage for those
injuries. I am widlfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers
'on my. property.
I understand building permits are not required to be signed by property owners unless they are responsible for the
construction andare n0 hiring a.licensed Conttactorto assume Ibis responabdity..
3. I umdersttmd 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.
4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on
permits and contracts.
5.1 understand if I employ or otherwise engage any persons, other 6= California licensed Contractors, and the total value
of my construction is at least five hundred dollars ($500), including labor and materials, 1. may be, considered an "employer"
under state and federal law.
undersfaad if I amconsidered an "employee' under' state and federal law, I moat register with the state and federal
government, withhold payroll taxes,. provide worim. ' 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
AA��7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-faanily 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.
dastard as an Owner -Builder if I sell the property for which this permit is issued, I may be be!d liable for any
financial or personal. 6#suat?ained by any subsequent owner(s) that result from any latent construction defects' in the
workmanship or materials
understand I may, obtain more information regarding my obligations as an "employee" from the B.aIMM
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 Hasid (M-8) at I-
800-32 1 -CSLB
800-321-CSLB (2752) or www.csib.ca.gov for more information about lieerised contractors.
I am aware,of and consent,to an Owner -Budder permit applied for in my name, and'understand that I am the
'party legalli and fimmiaily responsible . for propo®ed construction activity. at, thefollowing address:
agree that.,as.the party legally and fuoaucially:responsibte for this proposed construction activity, I will abide,by all
applicable laws and tequiremitents that govern Owner-Biuldetslas wewas employers.
LA_4-�ag_= to notify theJssuer of this form immediately of any additions, deletions, or changes to say of &Winfonnafml I
have provided on this form. Licensed CMftdorSL are regulated by laws designed to protect the public. l f you contract with
someone who dow sot hm a limenxa,. tLe Comraetors' State License. Board.may be udible to
you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors maybe is civil CMI.. it is also
kVurWnt for ynu to.un&nftnd:thMManuWkensbd Centactor or esnployee of that individual orfum is i*red while workiog
on your properly,you my be: kid liabin_:for demos .'If you obWna peamit"as Owner -Builder and wib to him Canuactors,
YM wdl be reaporrsNo Lfiff verHying .or not those property liccumd'Mil the.ststus of-Anir workers'
uomptosation ian[aace, coverage.
Before a building permit can be issued, litlx form must be completed and signed by the property owner 2" retartted°to
the agency responsible for ixnd tg.dw.Vwr=lt.. hfq ,A; cW of 9k rp vVerV oiwrsr's _ ivar.'s , fes++ s or
carer verifieatiox awgparb%. to tke yoerrc/ Fs grr red xo be >i P .er
the wd is . 11q veto die P
pnd .
owner's Signatui+e.. .
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 fora construction permit for the owner -Builder..
AUTHORIZATION OF AST TO ACTON PROPERTY OWftH'S BBHALF
Excluding the Notice to Property Owner, the.sxeq*on of which I understand is my personal responsibility, I hereby authorize
the foffowing persons) to act as my agents) td applyfor, sign, and file'the docun en nmessary 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, fibim notarization, or other verification
acceptable to Ike agency is required to. be pr es;aded when die permit is issued to verify the property owners signature_
Property Owner's Signature: __ _ _ Date: