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12-0070 (BLCK)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: x`12 -00000070>> - Property Address: 77811 CALLE -SINALOA APN: 773 -181 -001 -24 -000000 - Application description: WALL/FENCE Property Zoning: COVE RESIDENTIAL Application valuation: 3118 Applicant: Architect or Engineer: 4'4 Quza BUILDING & SAFETY DEPARTMENT BUILDING PERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date:. 1/25/12 Owner: D ' SIYOUNG SONG 1109 SIMPLICITY IRVINE, CA 92620 JAJ ------------------------------- JAIJ,) Owner I� ------=-------------------------- 4J� ------------------- LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION 1 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 forwhich 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 Iuld 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 3700 of the Labor o e I. shall forthwith comply 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 ($5001•: e: v plicant: ( =-r 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: 7040 Business'and'Professions Code: The ,WARNING: FAILURE TO SECURE W KERS' 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 CRIMIN .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 theDOLLARS 1$100,0001. IN ADDITION 0 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 ACKNOWLEDGEMENT (_ 1 1, 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, (_ 1 I am exempt under Sec:' , B. 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 �f performed under or following issuance of this permit. Date: r. v caner: 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 COTRUCTION LENDING AGENCY permit to cancellation. I hereby affirm under penalty of perjury that there construction lending agency for the performance of the I certify that I have read this application. and state that the Iabove information is correct. I agree to comply with all work for which this permit is issued (Sec. 3097, C C.). city and county ordinances and state laws relating to building construction, and hereby authorize representatives - of this jounti to enter upon the above-mentioned pro y fA inspection purposes. ' Lender's Name: '/ te: I ✓ Sign re (Applicant or Agent): Lender's Address: LQPERMIT Application Number- _ 12-00000070 Permit . . . WALL/FENCE PERMIT Additional desc . Permit Fee 63.00 Plan Check Fee .00. Issue Date Valuation 3118 Expiration.Date 7/23/12 Qty Unit Charge Per Extension BASE 'FEE 45.00 •2.00 .9:0000 THOU BLDG 2,001-25,000 18.00 ------- -----Special Notes and Comments 144 L.F. 5' GARDEN WALL AT FRONT YARD,_ CITY STANDARD. 2010 CODES.. --------------------------------------- ------------------.-- Other Fees . . . . .BLDG STDS ADMIN (SB1473) 1_00 Fee -summary• Charged Paid Credited Due Permit Fee Total 63:00 .00 .00 63..00 Plan"Check Total 00 .00 .00 .00 Other Fee Total -1.00 .00 00 1.00 Grand Total. 64.00• .00 ..00 64.00 P.O: Box 1504 LA QUINTA, CALIFORNIA 92247-1504 78-495 CALLE T,AMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT (760) 777-7012 FAX (760) 777-7011 PROPERTY OWNER' S PACKAGE Disclosures .& Forms, for Owner -Builders Applying for Construction Permits NOTICE T(1 MEWITY OMM9 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 We are providing you with an Owner -Builder Acknowledgment -and Information Verification Form to make you aware of your eespensibilities and possible risk you may incur by having tWpermit•issued in your name as .the Ow= -Budder. We will not Issue a building permit until yewhave 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 thisnotice unless you, the property owner, obtain the prior approval of the permitting authority. OWN S ACKNOWLEID AND-YERNWA.TIOPI OF IIOORMAT N Df"CTfONS: head and it dud each: statement iFdow-to signify you undwstand or verify this i rfOrnratcon. 1. 1 understand a frequent practice of unlicensed persons is to have the property owner, obtain an "Owner -Builder" b ding permit that erroneously implies that the property owner is providing his or her own labor and material petsori�. 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. C212. I understand building permits are not required to be signed by property owners unless they are responsible for the cdnstruction 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 m• if from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of in - Own. X1w4. I understand Contractors are required by lato be licensed and bonded in California and to list their license numbers on permits and contracts. qf_5. I understand if I employ or otherwise engage any persons-, other than California licensed Contractors, and the total valde 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. 56. I understand if I am considered an "employer" under state and federal law, I must register with the state and federal oyetnment, 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 7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential s ctures 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. E �_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 fihancial .or personal. 4.uries austained by any subsequent owners) that result from any latent construction defects in the worlananship or materials. '1.9. 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 www.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 arty legally and financially responsible for proposed construction activity at the following address: 11. [ agree tha as the legally and financially responsible for thisproposed construction activity, I will abide by all t, party � Y Y po . applicable laws 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 chw*es to any of the information 1 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, die Contractors' State License Board may be unable to assit;t 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 sed Contractor or employee of that individual or farm is i*red while wonting on your property, you may be held habit for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying v4mther. or not those Contractors are properly licensed and -the status of their wotkers' 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 issufiMr. ft.p'ermtL Note: A copy of the properW owner's &*er'sAt0M6# form rccrtadVatibni or other verification acceptable to the agency is required to be presented when the permit is issued to verify the pt+operty 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. AUTRORIZATION OF AGENT TO ACT ON PROPERTY OWNEWS BEHALF Excluding the Notice to Property Owner, the exception of which I understand is my personal responsibility, I hereby authorize the following persons} to act as my agents) 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): g� O to We- ret; t d o to t_e Project Location or Address: ',C� 1 it ('_ e_12,�nrd o a_ Name of �kuthoriaed Agent: J t.- ( t 0 D0 Gt A oL Q Tel No -160 Address of Authorized Agent: (e "' b &P%,0 rr._VvkA J 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 venfication acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature.. Property Owner's Signatures ��� Date: Bin #.: .. ., cis 0 . i,d Mon., . Building & Safety Division P.O. Box 1504, 78-495 Calle, Tampico La Quanta, CA.92253 - (760) 777-7012 ' Building Permit Application and Tracking Sheet . . Permit # Z10 Project Address: 7 7 Owner's Name: 51 . 1 "611 A. P. Number: 7.7.3 12K loo OF Address:' i Legal Description: 5 , City; $T, Zip: Y �d/N� Z v Tele hone:....:{>a<•t. P. �,>4•tm. Contractor ! J d Address:,q g 600 �/hV Vii^ Project Description: ..- City, ST, Zip: C �Z Z�J Tele hone:'�p0 -2 %Z- SZ f I_ f 4 ►UC/J ek 2 t d d l JA l !4 State Lie. # : City Lie. #: Arch., Engr., Designer: Address: City, ST, Zip: Telephone: r....>.4: - : State Lie. #: {+:xb}iiiiYr};{!v:. �+C.:.A4Y.A\:. • 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 Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Cates. Called Contact Person Plan Check Balance Title 24 Calcs.Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2°" Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE: 3"! Review, ready for correctionsrmue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees . Total Permit Fees