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12-0343 (BLCK)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 -4 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 4/02/12 Application Number: , 12-00000343 Owner: Property Address: 52414 AVENIDA VELASCO BRAD HOFFMAN APN: 773-265=008-8 -000000- 52414 AVENIDA VELASCO Application description: WALL/FENCE LA' QUINTA; CA 92253 ri /�1 Property Zoning: COVE RESIDENTIAL -------------------------- -----&A Application valuation: 175 • Contractor: � °r`i?�� 02 2012F Applicant: Architect or Engineer: Owner e CITY OF LA C;,,i,IINT'A 1 - -------------------------------- LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations: Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided License Class: License No.: for by Section 3700 of the Labor Code, for the performance of the work for which this permit is 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 applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: () 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. , B.&P.C. for this re� n Owner: - - CONSTRUCTION DING 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 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 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 be ome su) ject to the workers' compensation provisions of Section 3700 of the.Labor C941 4fiall fo h ith comply with those provisions. te: �TOSCEa,URE t: _ WARNING: FAIL 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 constru tion, and hereby authorize representatives of this unty to enter upon the above-mentioned pr y for i pZon pur oses. te: #'C - LL ature (Applicant or Agen Application Number . . . . . 12-00000343 Permit WALL/FENCE PERMIT Additional desc . Permit•Fee 15.00 Plan Check Fee.. .00 Issue Date . . . . Valuation . . . . 175 Expiration Date 9/29/12 Qty. Unit Charge Per Extension BASE FEE 15.00 Special Notes and Comments ADD (3) 12" X 16" PILASTERS, ORCO' SYSTEM, PER S. TRAXEL. 2010 CODES. -------------------------------------------------- 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 P.O' BOX 1.504 LA QUINTA, CALIFORNIA 92247-1504. 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 e BUILDING & SAFETY DEPARTMENT PROPERTY OWNER'S PACKAGE (760) 777-7012 FAX (760) 777-7011 Disclosures & Forms for Owner -Builders Applying for Construction Permits 1 1!iQ€C1 Dear Property Owner: An -application fora building pmt has beep A submitted irr YOut Aam listing yourself as the hnilde€ of the property r+"ements specified at Z� (�{ V ).1 f)A Uk9A5&0 We am providing you with an Owner -Builder A€ mwiedgment�andInformation Veri€eatien Fords to matte you awats.o€ your WSPOW"ities and Possible risk -you may incur by having W&permit.issaed. in your nam as the atarne"Vilder. We will 00issue a building -permit until 3w' have read,'inittaletl your. Understanding of eadt'ptFoviston, signed, and rehrrned this form tous at our oflieial address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. DfiUWMNS. Read and irritiai each statPmer[t�e�biv signify you rr dw3twW or vla* this i bmt adon. tI. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder" .ing.pertrdtht that erroneously implies at 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 inj.urtes. 1 am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers 'en my property. f42. I 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. WL3 I understand as an "Owner -Builder" I am.tlie responsibleparty 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 b law to belicense �► Y licensed and bonded to CaliforniaCahforma and to list thea copse numbers on permits and contracts. Afm I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. . I understand if.I am considered an "employer" under state and federal taw, I must register with the state and federal government, withhold payroll taxes, provide workers, compensation disability insurance, and contribute .to unemploymen, compensation for each "employee." I also'understand 'myfailure to abide by these laws may subject me to serious financia 7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residentii ctures cannot legally build them with the. intent to offer them for sale unless all worts is performed by license subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performe under contract with a licensed general building Contractor. i3in.# CI / O: b Quth Building a5afety Division .' P.O. Box 1504,78-49S Calle Tampico. La..Quinta, CA 92253 • (760) 777-7012 Building Permit Application' and Tracking Sheet Perinit # � % Project Addrrss:.. Owner's Name:. A P. Number Address: Z L CU Legal Description:. S Contractor. O(A)K—Nowt City, ST, Zip: ZZ Telephone: p Address: Project Description: City, ST, Zip: Telephone: .?,. ,� ;' :% State Lic. # : City Lie. #; ' 7-K- J S Q UA &EES Arch., Engr., Designer Address: City., ST, Zip: Telephone:v �. State Lic. #: w jay-� Name of Contact Person: Construction Type:. Occupancy: Project type (circle one): New Add'n Alter Repair Demo Sq. Ft.: #Stories: #Units: Telephone # of Contact Person: Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS UNE # Submittal Req'd Reed'. TRACIOPIG PERMIT FEES Plan Sets Plan Cheep submitted Item Amount Structural Calm Reviewed, ready for corrections Plan Check Deposit... Truss C21cs• Called Contact Person Plan Check Balance Title 24 Calci. Plans picked up Construction Flood plain plan Plans resubmitted.. Mechanical Grading plan 21t Review, ready for corrections/issue Electrical Subcoutactor List Called Contact Person Plumbing Grant Deed F Plans picked up S.M.L H.O.A. Approval Plans resubmitted Grading IN HOUSE:- 3" Review; ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A:LP.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees