BWFE2017-014878-495 CALLE TAMPICO V Cl/
LA QUINTA, CALIFORNIA 92253 DESIGN &DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BWFE2017-0148
Property Address: 77141 CALLE SONORA
APN: 773241002 '•
Application Description: FERREIRA / 80LF GARDEN WALLS AT FRONT COURTYARD
Property Zoning:
Application Valuation: $4,000.00
Applicant:
JUSTIN FERREIRA
77141 CALLE SONORA
LA QUINTA, CA 92253
VOICE (760) 77:-7125.
FAX (760) 77:-7011 '
INSPECTIONS (760) 777=7153
Owner:
JUSTIN FERREIRA
77141 CALLE SONORA
LA QUINTA, CA 92253
Contractor:
AUG 0 2 2017 OWNER BUILDER
CITY OF LA-QUINTA
DESIGN AND DEVELOPMENT DEPARTMENT
LIc. No.:
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury thatl am licensed under provisions of Chapter 9
(commencing with Section 7000).of Division 3 of the Business and Professions 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)::
V-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.).
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
_CQntractors' State License Law.).
-I-am exempt under Sec. . B.&P.C. for this reason
C
ate-^c�(IL Z
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
Lender's
Date: 8/2/2017
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 whicWthis permit is issued.
I have and will maintain workers' compensation insurance, as required -JV
Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued, My workers' compensation insurance carrier and polity number are:
Carrier: —Policy Number:
j�_
e I certify that in the performance of the work for which this permit is issued, I
shaWFot employ any person in any manner so as to become subject to the worker'
compensation laws of California, and agree that, if I should become subject to the
workers' compensation provisions of Section 3700 of the. Labor Code, I shall forthwith
comply with those provisions.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAMFUL,
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 Building Official 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 cor •ect.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter upon the above-
mentioned property for inspection purposes. n
• Date: 8/212017
Application Number: BWFE2017-0148 Owner:
Property Address: 77141 CALLE SONORA JUSTIN FERREIRA. .
APW 773241002 77141 CALLE'SONORA
Application Description: FERREIRA / 801-F GARDEN WALLS AT FRONT COURTYARD LA QUINTA, CA 92253 .
Property Zoning:
Application Valuation: $4,000.00 5
Applicant: Contractor:
JUSTIN FERREIRA OWNER BUILDER
77141 CALL'E SONORA
LA QUINTA, CA 92253
Llc. No.:
Detail: 801-F OF 5' GARDEN WALL AT NORTH AND EAST FRONT COURTYARD PROPERTY LINES W/ (2)PILASTERS FOR GATE [CITY SPECIFICATIONS]
PRECISION CONCRETE BLOCK SHALL BE COVERED WITH STUCCO, PAINT, OR TEXTURED COATING WHERE VISIBLE FROM OUTSIDE THE PROPERTY. THE
AREA BETWEEN THE.BACK OF CURB AND ANY FENCING SHALL BE LANDSCAPED, HAVE A SUITABLE PERMANENT IRRIGATION SYSTEM, AND BE
CONTINUOUSLY MAINTAINED BY THE PROPERTY OWNER. 2016 CALIFORNIA BUILDING CODES.
r
DESCRIPTION.,
INFORMATION
ACCOUNT . y QTY
AMOUNT
WALL/FENCE - FIRST 100 LF
101-0000-42404 0
$50.67
DESCRIPTION
ACCOUNT QTY
AMOUNT
WALL/FENCE - FIRST 100 LF PC
101-0000-42600 0'
$63.33
Total Paid for BLOCK WALL:
$114.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
BSAS SB1473 FEE
101-0000-20306
0
$1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA:
$1.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
Credit Card Fee
101-0000-43505
0
$2.16
Total Paid for Credit Card Fee:
$2.16
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE:
$5.00
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Bin #
.: City of La Qulnta
Building &r Safety Division,
78-495 Calle Tampico ,
La Quinta, CA 92253.- (760)-777-7012.
y o Building Permit Application and Tracking Sheet
..Permit # -
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.-APPLICANT: DO NOT WRITE BELOW THIS LINE
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Submittal
Req'd
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TRACKING
PERMIT FEES '
Plan Sets.
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed; ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Calcs. `
Plans picked up
Construction "
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2'4 Review, readyfor corrections/issue
Electrical ,
Subcontactor List
Called Contact Person
Plumbing .
Grant Deed
Plans picked up
S.M.I.
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H.O.A: Approval
Plans resubmitted
Grading
INHOUSE:-
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'"' Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub."Wks. Appr
Date of permit issue
School Fees
.
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Total Permit Fees
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TWyl 4 4Qwh -a
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
IMPORTANT! NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application for a building e t s en submitted in your name listing yourself_as_the_builder of the property
improvements specified at('
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 you have 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 this notice
unless you, the property, owner, obtain the prior approval of the permitting authority.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
DIRECTIONS: Read and initial each statement below to sign you understand or verify this information.
f I. A 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. 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 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.
2 �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.
I— — 3) I understand 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.
er
t 4r understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on
permits and contracts.
.' 'r 5 unI derstand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value
of my construction is at least five hundred dollars ($500), including labor and materials, I may. be. considered an "employer"
under state and federal law.
C%;6 understand if I am considered an "employer" under state and federal law, I must register with the state and federal
government, 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
risk. me to.serious financial
7? I understand under California Contractors' State License Law, an Owner -Builder who builds single-family 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. .
8. I understand as an Owner -Builder if I sell the property for which this permit is issued, I^may be held liable for any ~r
financial or, personal, injuries 'sustained by any subsequent owner(s) that result from any latent construction defects' in the
workmanship or materials.' -
I understand I may obtain more information regarding my -obligations as an ."employer" from the Internal 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 (CSLB) at 1-'
800-321-CSLB (2752)'or ,�vww.cslb.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 legally, and financially ' responsible for proposed construction • activity ' at 'the- '.following address:
�.--`771-►-rR�l���� - .:
� TMA. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all
applicable laws and requirements that govern Owner -Builders as.well as employers:. _
12I agree to notify the issuer of this form immediately of any`additions, deletions, or changes to any of the information I
have 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 assist you with any financial loss
you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be iii 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 working, 4
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 thoseContractors 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 r
the agency responsible for issuing the permit. Note:, A copy of the property owner's driver's license, form notarization, or
other verification acceptable to the agency is required to' be presented when the permit is issued to verify the property
owner's signature. t
Signature -of -property, owner _ - Dater l� `
I
.R � ._ � . _ , - ,r Zf a .•
Note: The following Authorization Form is required to be completed by the propertyowner 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`BkICT]F
Excluding the Notice to Property Owner, the execution of which I understand is m— y p onal'respon ibility, 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: `-- Tel No
Y
Address of Authorized Agent: ,
i I declare under penalty of perjury that I am theroe y '
p p rty owner for the address listed above and Lpersoiially filled out the above
information and certify its accuracy. Note: A copy of the.owner's driver's license, form notarization, or other,verifrcation
acceptable to the agency is required to be presented when the permit is issued to verify the property owner s sign`afure.
s.
Property Owner's Signature: r '
Date: s�