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12-0866 (BLCK)P.O. BOX 1504 VOICE (760) 777-7012 • 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 8/03/12 Application Number: �OO"6 Owner: Property Address: NIDA VELASCO . JOE ARBIAS APN: 774-251-027-4 -000000- 54269 AVENIDA VF Ste" Application description: WALL/FENCE LA QUINTA, CA 9 3 Property Zoning:„ COVE RESIDENTIAL Application valuation: 2941 2Q9'Z Contractor: ` �J 0 , + Applicant:. Architect or Engineer: ART OF MASONRY,y T CITY A6 LA QUINTA 44515-CASSIA DRIVE FINfiN_PT INDIO, CA 92201 (760)391-7575 Lic. No.. 918714 r ---------------------- - - -- -- _ LICENSED CONTRACTOR'S DECLARATION • WORKER'S' COMPENSATION DECLARATION. I hereby affirm under penalty of perjury that I arr 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:- C29 License No.: 918714 for by Section 3700 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 • . , Code, for the performance of the work for which this permit is issued. My workers' compensation b OWNER-BUILDER DECLARATION insurance carrier and policy number are: hereby affirm under penalty of perjury that 1 am exempt from the Contractor's State License Law for the Carrier EXEMPT Policy Number EXEMPT, - following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to Xertify 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 7000) of Division'3 of the Business and Professions Code) or _ 00 of the Labor Code, 1 s 11 fort ith comply with those provisions. ' that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031 .5by y e 'any applicant for a permit subjects the applicant to a civil penalty of not more,than five hundred dollars ($500)•: ate: (J v L plicant: + ` (_) 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 WARNING: FAILURE TO SECU RK S' 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 PENALTIESAND 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 ($1,00,000).' 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. • ' 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.). - APPLICANT ACKNOWT- LEDGEMEN - 1�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 r 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 contractors) 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, 1 1 I am exempt under Sec. &P.C. for this-reason - , ' 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 r - performed under or following issuance of this permit. - - I d • /Date; ner: t 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 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 • - _ _ oft ' cou ty to enter upon the above-mentioned property for 'Aspecti purposes. - - - Lender's Name: 9 ate-nature (Applicant or Agent): Lender's Address: , LQPERi11IT - - - - Application Number 12-00000866 Permit WALL/FENCE PERMIT Additional desc . " Permit Fee . . . . 54.00 Plan Check Fee .00 Issue Date . . . . Valuation 2941 Expiration Date 1/30/13 Qty Unit Charge- Per Extension BASE FEE 45.00 • 1.00 9.0000 THOU. BLDG 2,001-25,000 9.0,0 --- ------ :Special Notes' and Comments -80L.F. COMBO WALL, 3.' RETAINING, 6' GARDEN, (3) 12" X 12" COLUMNS, - 20 L.F. COMBO WALL 3' RETAINING, 2' GARDEN AT SIDE P/L AND -20 L.F. 5' FRONT,COURTYARD WALL, ALL CITY STANDARD. 2010 CODES. ------------------- _------------------ - - - --- - Other Fees BLDG-STDS ADMIN (SB1473) 1.00 Fee summary. Charged Paid Credited Due Permit Fee Total 54..00 .00 .00 54.00 Plan Check Total .00. .00 I.00 .00 Other Fee Total. 1.00" .00 .00 1.00• Grand Total 55.00 .•00 00 55.00 IV WWI P.O. Box 1504 LA QUINTA, CALIFORNIA 92247-1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT PROPERTY OWNER'S PACKAGE (760) 777-7012 FAX (760) 777-7011 Disclosures & Forms for Owner -Builders Applying for Construction Permits IWQRIMP NOTICE TO >PRQPERTX OWNER Dear Property Owner - An. application for a building permit has been submitted in your name listing yourself as the builder of the .property improvements specified at E1 y6 I �y�y/O� �(.,,fJCo Leo Gt�i./Tdr �q 9 zZf3 We are.providing you with an Owner -Builder Acknowledgment -and- Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this.permit.issued in your name as:the Owner -Builder. We will not issue a building. permit until yow4ave read, initialed your understanding, of each: provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute "-..-notice unless you, the property owner, obtain the prior approval of the permitting authority. Read and initial each: statement-betow—to signify you utid`eestand or verify this information. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder" u ding perinit 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. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers on my. property- A2- I understand building permits are not required to be signed by property owners unless they are responsible for the . onstruction and are not hiring a licensed Contractor to assume this responsibility- . 3. I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect yself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. 4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on p and contracts. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value my construction is at least five hundred dollars ($500), including labor and materials, I maybe considered an "employer" under state and federal law. I understand if I am considered an "employee' under state and federal law, I must register with the state and federal rnment, withhold payroll taxes, provide workers' 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. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential tures 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. �i 8. 1 understand as an Owner-13uilder if I sell the property for which this pern►it is issued, I may be held liable for any ,odWa—ncial or personal. injuries sustained by any subsequent owner(s) that result from any latent construction defects in the wo anship or materials. r L9. I understand I may obtain more information regarding my obligations as an "employer" from the Inteal Revenue , 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 (CSLIN) at 1- 800-121 -CSLB (2752) or www.csib.ca.gov for more information about licensed contractors. ,Jd10. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the legally and financially responsible for proposed construction activity at the following address: �7,� g AvE3✓� o I�EZ�r i n - /,.�- ,� v,( .✓ i C',4- 92Z -J-3 1. I agree that, as the party legally and financially responsible for this proposed construction activity,.! will abide by all able liws and requirements that govern Owner -Builders as well as employers. 12.1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I ve 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 assisf you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in'civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while worlang on your property; you may be held liable 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 issniug.dw.permit. Note: A copy of the property owner's dclver'sHcensej form notar•*ation•, or other verification acceptable to the agency is required to be presented when the peemit is issued to verify the property owner's signature. Signature of property owner Date: 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 exmgtion of which I understand is my personal responsibility, I hereby authorize the following person(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): 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, form notarization, or other verification acceptable to the agency is requiredto be presented when the permit is issued to verify the property.owner's signature. Property Owner's Signature: Date: s►!r.# :. City. Of La Quinta Building or Safety Division P.O. Box 1504,78-495 Calle Tampico La.Quinta, CA 92253 -:(760) 777-7012 Permit Application -and Tracking Sheet Permit # ' n . 6Building ProjectAddress: 6'� �ili�JV/O� j/EfSLo ✓� `� Owner's Name:. A P. Number. Address: 5 -69 P�Fz10br;,,d Legal Description: City, ST, Zip: `%/ Q(//iV 7,4 Contractor. 77,4-c %1 /2T D F ^4A7-s'A/t " Telephone: / 3S4 — 726 % Address: 4g,-/,� G S�i� 'OIL Project Description: corf-fe�c,T, o; / t�F I oo RF •mac G City, ST, Zip: /. Al D (O Gq ZZo l 'n' c✓� cy , 8� P,iSlo�J c3c�cK Aye 20 �SCur.a 5"rr,� Telephone r- z . r✓Au u,�c r1E !2 i—/�o/s t?itEii State Lic. # : "" City Lic. M. Arch., Engr., Designer. Fins'r ' 10 OF . -4v e w/4- 6Gr S A-7&-,2 r4 %r ,f IONST/LlJG'T.o.� vp' ¢6 � i�/LOL� W/'PL /N iL ✓fiP Address: SYd N e a 1 rnk City, ST, Zip: 4-,P Telephone: State Lic. #: Name of Contact Person: Construction Type:. Ocxupancy: Project We (circle one): New Add'n Alter Repair Demo Sq. Ft.: #Stories: # Unity Telephone # of Contact Person: /� 3 ��. 7 2 D7" Estitnated-Value of Project: APPLICANT: DO NOT WRITE BELOW THIS UNE # Submittal Req•d ' Rec•d TRACMG PERMIT FEES P142 Sets Plan Check sabmlt' O 'Ltem Amount Structural Cates Reviewed, ready for corrections " Plan Check Deposit. . Truss Cala. IC alled Contac Person Plan Check Balance Me M-Calcs Pians picked up Construction Flood plain plan Pians resubmitted, " Mechanical Grading plan V Rtvlew,"ready for correctionsfissue Electrical Subcontattor List Called Contsit Person Plumbing Grant Deed Plans picked up S M.L H.O.A. Approval Plans resubmitted Grading EN HOUSE:. '"' Review; ready for correctionsfissae Developer Impact Fee Planning Approval Called Contact Person Pub. Wks. Appr - _ Date of permit issue . School Fees Total Permit Fees 5129cl AVE-WID.A VEL,4S-C,O*) 4`09-,cr CITY c BUILD N( AP FO 3( DATE ROLE I � , L� ;ejtA-,O,(2s ve-D P20 ros�ed t -ft -L- ' P1t�Gt Stogy/ 13 LOCK. NEIcrNT 6 I'VSIDC- #0400&ltl� A,112 -CF, Ao MEMO= 4 0 P/Zo POSE IJAU SLUMP SZo NiE 06 K - A . ojp--/ AVE -N I DA VELA!5,C,,C)