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12-1441 (BLCK)P.O. BOX 1504 78-495 CALLE TAMPICO ,w LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: r Application description: Property Zoning: Application valuation: } i Applicant: I~ 12-00001441, 53240 AVENIDA VELASCO 774-055-011-12 -000000- WALL/FENCE- COVE RESIDENTIAL 1516 Architect or Engineer: 4�.^ VOICE (760) 777-7012 FAX (760) 777-7011 BUILDING & SAFETY DEPARTMENT . L�INSPECTIONS (760) 777-7153 • BUILDING PERMIT �� Owner: CAROLINE ANIER 84024 LOVELY SAGE PLACE THERMAL, CA 92274 (951)000-0694 Contractor: Owner 4 Date: 12/18/12 =- -----------------------------------------------— ----------------------------------------------- ' 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 issued. Date: - Contractor: - _ 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 - OWNER -BUILDER DECLARATION insurance carrier and policy number are: • I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier - - - - - - - --- - - - - - - - - - - - - - -Policy Number following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to I certify that, in the performance of the work for which this permit is issued, I shall not employ any construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner so as to become subject to the workers' compensation laws of California, permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I should become subject to the workers' compensation provisions of Section License Law (Chapter 9 (commencing with Section 70001 of Division 3 of the Business and Professions Code) or 3700 of the Labor Code, I shat mply with those provisions. 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 or my employees with wages as their sole compensation, will do the work, and te: P`plicant: -_ property, the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The WARNING: FAILURE TO SECURE ERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO.ONE HUNDRED THOUSAND ' and who does the work himself or herself through his or her own employees, provided that the DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED -FOR IN improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. r - - one year of completion, the owner -builder will have the burden of proving that he or she did not build or - . improve for IN purpose of sale.). APPLICANT ACKNOWLEDGEMENT - (_ 1 I, as owner' of the property, am exclusively contracting with licensed contractors to construct the project (Sec- IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the 7044, Business and Professions'Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application. property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed 1. Each person upon whose behalf this application is made, each person at whose request and for • pursuant to the Contractors' State License Law.). - whose benefit work is performed under or pursuant to any permit issued as a result of this application, . I am exempt under Sec. , B.&P.C. for this reason the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City ' of La Ouinta, its officers, agents and employees for any act or omission related to the work being ate: 0/4 �ner: performed under or following issuance of this permit. 2. Any permit issued is 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 ONSTRUCTION LENDING AGENCY permit to cancellation. ' I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify that I have read this application and state that the above information is correct. I agree to comply with all work for which this permit is issued (Sec. 3097, Civ. C.). city and county ordinances and state laws relating to building construction, and hereby authorize representatives . of this ounty to enter up o he above-mentioned property for inspec ' ses. ` Lender's Name: ate: la ignature (Applicant or Agent): Lender's Address: LQPERMIT Application Number . . . . . 12-00001441 Permit . . . WALL/FENCE PERMIT Additional desc . Permit Fee 37.00 Plan Check Fee .00 Issue Date Valuation 1516 Expiration Date 6/16/13 Qty Unit Charge Per Extension BASE FEE 15.00 11.00 2.0000 HND BLDG 501-2,000 22.00 ------------------------------------ ---------------------------------------- Special Notes and Comments 70 L.F. 5' GARDEN WALL WITH ORNAMENTAL GATE ON CORNER LOT, CITY STANDARD.2010 . CODES. - ---------.------------- ------.-------------------- . Other Fees . . BLDG STDS ADMIN.(SB1473) 1.00 Fee summary Charged Paid Credited ---------- -- Due ----------------- Permit Fee Total 37.00 .00 .00 37.00 Plan Check Total .00 .00 00 .00 Other Fee.Total 1.00 00 .00 1.00 Grand Total 38.00 .00 .00 38.00 - en. # City Of % Quih to Building a Safety Division P.O. Box 1504,78-495 Calle Tampico 1.a.Quinta, CA 92253 -:(760) 777-7012 Building Permit Application and Tracking Sheet Permit #� i a' Project Address: v Owner's.Niune: r-� �` A. P. Number.RL.Ozit o— Legal Description: Cii ty; 3T,_Zip: ' Contractor. WOf2.-- M K +QST iTeleph6ng .s Address: g -Z3� G ��4- Project Description: City, ST, ZiP I:A3.(71 b ' tLT* Telephone: —7 60 GO e4 6 7; s 3 � lv 4�PA 1V T' N State Lie # : 1 $'p Z City Lie'. #; 1 Arch., Engr., Designer. Address: City., ST, Zip: • a Telephone: State Lie. #: ... �/. .." » Construction Type: Occupancy: Project type (circle one): New Add'n Alter Repan Demo Sq. Ft.: # Stories: #Units: Name of Contact Person: pgF— l z Telephone # of Contact Person: '7&0.`G.01' 'e f, 7 Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS UNE # Submittal Req'd Rec'd TRACIMG PERMIT FEES Pian Sets Plan Check submitted item Amount Structural Coles Reviewed, ready for corrections Plan Cheek Deposit. . Tross Coles• Called Contact Person Plan Check Balance, Title 24 Cities. Plans picked up Construction Flood plain plan Plans resubruitted.. Mechanical Grading plan 2" Review, readyfor correcGons/usue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Pians picked up S3LL H.O.A. Approval Plans resubmitted Grading IN HOUSE-, 7i° Review; ready for correctionvlssue Developer Impact Fee Planning Approval Called Contact Person A f P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees V n 3 N o 9 l' V n X P.O. BOX 1504 LA QUINTA, CALIFORNIA 92247-1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT PROPERTY O'WNER'S PACKAGE (760) 777-7012 FAX (760) 777-7011 Disclosures & Forms for Owner-Ballders Applying for Construction Permits 1 NOTICE T5:11ri 1:110 I�TY ORR Dear Property Owner: An. appiieatioa for specified at burbling perms has been >a�raittod inr;mpt+o"your name Listing yourself as the builder of the property �ents We am prgovidmg you I an Owner -Budder Aclaw wledg�ment and Information Vctifieation Foran to make you aware of your mpmbililms and possible risk you may incur by having thispermit-imed in your tame as the Ownee-Buitder. We will net issue a building permit until have read i nidakd your understanding of eack signed, and returned this form to us at our Official address indicated. An agent of the ownercasmW execute this notice R unless you, the Property owner, obtain the prior approval of the permitting authority. r r r -., i a I W1,Jr ..aa l� 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- 1 an w"lhWy acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. C4_27I'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. L! -r3: Ij understand as an "Owner -Builder" I am ilio 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. Ca 4� 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. CA? -_t understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total valur of my construction is at least five hundred dollars (5500), including labor and materials, I may be considered an "employer' under state and federal law. r6'11 understand if I am considered an "employer" under state and federal Law, I must register with the state and feden government, withhold payroll taxes, provide workers' compensation disability ins�, and contribute to unemploymei compensation for each "empl risk. oyee." I also understand my failure to abide by these laws may subject me to serious fkumi Cftf7Z!.-,undefstand under California Contractors' State License Law, an Owner -Builder who builds single-family resident structures cannot legally build them with the intent to offer them for sale, unless all work is performed by keens subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is perform under contract with a licensed general building Contractor. t CA8. (',understand as an Owner -Builder if I sell the property for wbicb this permit is issued, l may be held liable for any financialJor personal. itouries susUked by any subsequent owner(s) that result from any latent construction defects. in the workmanship or materials. J9. I�urederstand I may obtain more information regarding my obligations as an "employer" from the Intessat 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 tnay contact the California Contractors' State License Board (cstA at 1 800-321-CSLB (2752) or www.cslb.ea.gov for more information about licensed contractors. 1-9- -[]am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that t am the ply legally and financially responsible for proposed construction activity at the following address: agree that, as the party legally and funanccially responsible for this proposed construction activity. [will abide by all applicable laws and requirements that govern Owner -Builders as well as employers. J?. I agree to notify the issuer of this form immediately of any additions; doietieas, of donees to troy of ehe information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with som000e who does not have a liee , the Contractors' State License Board may be unable to assist YOU with nay 6naaeW loss You may sustain as a result of a complaint Your only remedy against unlicensed Contractors may bei is civil Caul- It is also important for you to. understand that if an u nhoousod Contractor or employee of that individual or fim is iBkdmd while vrotldng on your property, you may be held tiabk for dawages. If you obtain a perimt as Owner -Budder and widl to Este Coors, you wdl be respon9*6 for verifjamg whist m or not those Contractors arcpttapedy heensed and the status of dim workers' comp tion insurance oovesaga. Before a building permit can be issaed, this form must be completed and signed by the property Owner and returned to the agency respoaaNe for issuh%.&4.permlt. Nota: A copy of the p vperV ownff's Mrac's s fs' n"a40"6m � other verification accgn 5le to bre icy is req' uh d to be presented when bloc pMnk is iUUCJ to vv* Ehe property owner's signature. Lswwtum of pmpeaty owner Dale Note: Tire 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 OWNTR'S BRHAI Excluding the Notice to Property Owner, the extwtion of which I understand is my persomal rmpoms-iulity, I hereby authorize the following pemon(s) 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): no,, n4in J— Project Location or Address: 5 3 – :I HQ Ane to i ci SVP (QS c (- Name of Authorized Agent: Wo rid`� �"' azk n -TeiNo(771001O Address of Authorized Agent: �l ^ ,aaC Gan ea k C'Ildlb Cot 9 1-- I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the ab4 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 requi d to be presented when the permit is issued to verify the property owner's signature. ;Property Ownec's'Signa Date: