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14-0915 (BLCK)i P.O. BOX 1504 78-495 CALLE TAMPICO syr LA QUINTA, CALIFORNIA 92253 Application Number: 14-00000915 Property Address: 77450 CALLE TECATE APN: 774-293-025-12 -000000- Application description: WALL/FENCE Property Zoning: COVE RESIDENTIAL Application valuation: 5000 Applicant: Architect or Engineer: ------------------ LICENSED CONTRACTOR'S DECLARATION BUILDING & SAFETY DEPARTMENT BUILDING PERMIT I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals 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, orrepair. 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).: 11I,�s� ner of the property, or my employees with wages as their sole compensation, will do the work, and 4r 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 O %e year of completion, the owner -builder will have the burden of proving that he or she did not build or lnprove for the purpose of sale.). (` as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor$$' State License Law does not apply to an owner of property who builds or improves thereon, and who c?tracts for the projects with a contractor(s) licensed pursuant to the Contractors' State Lim w.l• ( ) I am exempt under Sec. , B. .�6 this red on Date: I CON RUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there ' a construction lending agency for, the performance of the work for which this permit is issued (Sec. 30970 iv. C.). Lender's Name: Lender's Address: LQPERMIT Owner: EDWIN BURGOS 1603 2ND STREET MANHATTAN BEACH, CA 90266 (310)658-0109 Contractor: Owner VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 6/23/14 ----------------------------------- ____________ 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 which this permit is 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 I 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 shouldWh ect to the workers' compensation provisions of Section l�� /x.$700 of the Labor Code,ith comply with those provisions. Date `` JJ Applicant: WARNING: FAILURE TO SECURE WORKE S' 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 omissi o�/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 voy if work is not commenced within 180 days from date of issuance of such permit, or ce/i.'s of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above informatorrect. I agreeto comply with all city and county ordinances and state laws relating to building o str'cti0nereby authorize representatives of this upon ty to nter upon the above-mentioned property f in ct� n urposes. Date: t-� Signature (Applicant or Agentl: Application Number . . . . . 14-00000915 Permit . . . . WALL/FENCE PERMIT 2013 ` Additional desc . Permit Fee 122.98 Plan Check Fee .00. Issue Date Valuation . . . . 5000 Expiration Date 12/20/14 Qty Unit Charge Per.. Extension 1.00 ''47.1900 LS MISC WALL, FIRST 100 LF 47.19'_ 1.00 14.3000 EA MISC WALL, ADDL 50 LF 14.30 1.00 47.1900 LS MI RET WALL <=121, 1ST 100' 47.19 1.00 14.3000 EA. MI RET WALL <=121, ADDL 50' 14.30 -------------------------------------------------------------------------- Special Notes and Comments . ` 110LF.OF 4' GARDEN W/2' RETAINING AT WEST, EAST AND SOUTH SIDE OF PROPERTY (ORCO SPECIFICATIONS] PRECISION CONCRETE BLOCK SHALL BE COVERED WITH STUCCO, PAINT, OR TEXTURED COATING WHERE VISIBLE FROM OUTSIDE THE PROPERTY. 2013 CALIFORNIA BUILDING CODES.BLOCK WALL ---------------------------------------------------------------------------- Other Fees . . . . . BLDG STDS ADMIN (SB1473) 1.00 ,. PLAN CHECK, WALLS 119.64 . Fee summary Charged Paid Credited ---------------------------------------- Due ----------------- Permit,Fee Total 122.98 .00 .00 122.98 Plan Check Total .00 .00 .00 .00 Other Fee Total 120.64 .00 .00 120.64 Grand Total 243.62 .00 .00 243.62 LQPERMIT Pin # City of La Quinta -Building 81: Safety Division P.O. Box 1504, 78-495 Calle Tampico.- La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # 4 °Cl lS Project Address:" gywnE, Nage. A. P. Number: A>ddreS N9 Legal Description: ST, Ztp h' A0• 7TEA� FEACA qO Z,6 Contractor:c-LA)(,C) 6f7--- Telephon D ©1 Q „<i::<::;>.::.:;r.:. •,:.:.,.;: ,x>%< Address: koo 3 Z `\ p�t,ionJ City, ST, Zip: dYl A/J l'�(�k-' I�J�C,(J 62Cre� f4CL. Telephon(-3 1 19 0 J 06t!�%::�,s fir•:•':' a�..:�`ti.:::.,;;:;y:::::;::,:�`:.r:::::r• :.•r:..•;,,...,,..;:{�>:�l> !i:t:i.:?i.� .irn:i:•,:.•:i:?:: it%i:: i;:-.4,•ji'N.,.v.: State Lic. # : City Lie. #: ` Arch., Engr., Designer. Address: 1 City, ST, Zip:Ali Telephone: :•-:'-:;;->:::;,:; ;:-:.;;::5-;::;:-;;: 1, :::1:�;>;: .,:<n:.,; ;:>:;>s•;•ri:;;h:;.v:.>: z<:> . ,;<.>�;>A.,:>:>v:':;>':,;::... :>::::<::<�:;_'«:<�.:;:>• '::�-:'.�•M.:4.:>:> . Construction Type: ()fl,,_-o P,)( FJr-�-0ccupancy: State Lic. #• • Project type (circle one): ew Add'n Alter Repair Demo Name of Contact Person: T2E 0 C=GL Ak oZ Sq. FL:#Stories: #Units: Telephone # of Contact Person '1 r2,> 1 5 0(--a t p p Estimated value of Project: A P P j2 D 5 Ot�c7 APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES. Plan Sets Plan Check submitted o2D 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 god 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:- '"' Review, ready for correctionstissue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees MIT _"6V?.v4ffW M/= / 1 41 TMr" BUILDING & SAFETY DEPARTME T* 78-495 CALLE TAMPICO (760) 777-7012 LA QUINTA, CALIFORNIA 92253 FAX (760) 777-70h1 iMy"• PROPERTY OWNER'S PACKAGE Disclosures & Forms for Owner -Builders Applying for Construction Permits'` 4 aPf�RTANT! N0110E TO EROPERTY OWNER +. Dear Property Owner Ali ' 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 responsibilities and pomble risk you may incur by hewing 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 eack'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. DfR C. 7E71VS Rica dAd'init-_ 11 �•siateMehi below io signifyyou understand or dertfy.dtis ir+iformation. understand,- a Jfrcquept practice of unlicensed persons is to Have the property owner obtain an "Owner-Buildct h ilding liernii.f diat crroncousl lies that the property ' ' ' `'' y imp p perry owner is.provrding his�br•lier own hbor arid. material. finally. I, as. an Owner -Builder, may be held liable and subject to serious financial risk for any itijuries.sustaivied by an unliccused persou 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. �dcrstand building permits are not required to be signed by property owners unless they are responsible for the co tTuction and are not hiring a licensed Contractor to assume this responsibility. A�derstand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect if from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my ipi nderstand Contractors are required by law to be licensed and bonded in California and to list their license numbers on ts and contracts. derstand if I employ or otherwise engage any persons, other than California licensed Contactors, and the total value Cio&cloo�nmstruction is at least five hundred dollars ($500), including labor and materials, I maybe considered an "employer" under state and federal law. understand if I am considered an "employee" under state and federal law, I must register with the state and federal compensation for each "employee." I also understand my failure pt abide by these lawsmay subject me to serious financial risk. ;, i y • 1' �.v. 1 understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential is Nures 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. 4 7lCf understand as an Owner -Builder if I sell the property for which this permit is issued, I may be he'd liable, for any a at or personal 4urics wstaincd by any subsequent owner(s) that result from any latent construction defects in the worktnasrsirip or materials. understand i may obtain more information regarding my obligations'as an "employes' from the intOMI Revcnuc e, 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 die California Contractors' State License Board (C SLB) at 1- 800-321-CSLB (2752) or www.csib_ca_gov for more information about licensed contractors. 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: agree that, as the party legally and financially responsible for this proposed construction activity. I will abide by all applicable laws and requirements that govem Owner -Builders as well as employers. Z004&01ragree to notify the issuer of this form immediately of any additions, deletions, or chOges 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 lieense, fhe 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 iw6vil coati, It is also important for you tounderstand that if an unlicensed Contractor or employce of that individual or firm is injured while working on your property; you may be held liable for damages. If you obtain a Permit as Owner-Duildei ;and wish to hire Conb*etors, you will be responsible for vilifying vAidbier or not those Contractors are properly licensed -and the status of their workers' compensation insurance coverage. Before a building permit can be iasaed, this form must be completed and signed by the property owner and returned to the agency responsible for issuiag,Iker .pperm#- Nota. A copy of ike-property owner's driver'slicwn farm +o ns or other verrfuation aeceptaMe terth /11" An is rcquyl�l to be presented when the permit is is wd to verify the property owner's signature. j Signature of property owner Dater / 1 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 OWN FR'S.BERALF Excluding the Notice to Property Owner, the ekecpdon of which i understand. is my personal responsibility, I hereby authorize the following person(s) to act as my agents) to apply for, sign, and 51e the documents necessary to obtain an Owner -Builder Permit for my project.'t Scope of Construction Project (or Description of Work): 110 CGV%0D PEO L> -)&U_/3_ Project. Location or Address: ') - 5 c.ALL,,--- TE a-A"�s / o _-- Name of Authorized Agent: �j �ll� G k L_VV,04Z,� Tet Nb 7b�) ` cl\ - y Be Address of Authorized Agent: 67S A tlE.)Jt t 4A A LVA (ZA 9a L A (P`" WTA , e.A I declare under penalty of perjury that 1 am the property owner for the address listed above and I personally filled out the above r information and certify its accuracy. N o y of th er's driver s license, form notarization, or other verification acceptable to the agency is require o e ed a he permit is issued to verify the pro erty o er's signature. Property Owner's Signature: _ Date: i � x' ' e - y '�r�"„'--t �i'k.-� �\����i�-.�1. t r �; - • � A v � .' , /•sr<, :•�P�x'r�k�-t j/ .�., �,� v����Nr- �� u, .'i o;�R. w 1 w � f . � b r ���' �� '� � b' ,`"=a;3 '+`c, ---ms`s• _' y ,_ � r �' r�, ADW AS A`NTT��Jf�FBl7RGOS ► . w , RITTAN'BCOGA 902 ' ill��•� t� l�jG J ,• � (� s ���. - r 1\i: \�1�—_,'.'S�<u�,���_(� �iy� \M :w 'a � It/�.�C�'G. ..-'7 ; - , • , _ .acs=.rig:-l_'�'��' ' .4 f � .. • r A -+ • r \ ♦r .. •aft rr � + ' • - LIDO i � Ni n 1�.:�• y-�-yh� i�':i�fi s Ia�DRIV.ER LIC ! � Tc ♦ ,. 7 683 r ' P s'� LGiLMOREC �h�BENJAMIN EDDIEfi— ' .€ h p \u� 54955,AVENIDA gLVARA_DD LA QU „ • fir A .92253== ST 9R c I I 0 CRR L'•ENS Q9201 = ' • '�7��: / " ti, C^� cit Ct?�il•a � �f .*,. —cress. EX M , w ` �� t ) �U.t� x �C6O \ / ��HGT'�5'-0__•g=yyd'�451b� 0106. 59330A FUI75 � y�ano�o= ` _ : 1i , CITY, OF LA QUINTA SVB-CONTRACTOR LIST JOB ADDRESS 77-7 - 456 c.ALLC-- T5S-ArE PERMIT NUMBER — OWNER BUILDER' ClAiiez, Isof L;etz. This form shall be Oosted on the Job with the Building ln"&dtion'Card. at all times in a conspicuous pla . ce. Only persons appearing on this list or their employees . are authorized to wort on this job, Any - changes' to this list 'Must be approved by the Building Division prior to commencement of work. Failure'io comply will result in a stoppage of work and/or the voidanc( of building permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response. .- .. - . . ... i Trade J Classification tract Con 43%, ontractot,.A Lice6 so. Workers C& Pg -sines Company Name Classification License Number Exp. Date (e.g. A, B. C-8) (xxk' xxx) (xx/xx/xx) Carrieer.Name Policy Number (e.g: State Fund, CalCc6p) (Format Varies) Exp. Date License Number (xxjxxlxx) 1xxxx) : [Exp. xDate Exp, Date x xx (x /x / ) (xx/xx/xx) EARTHWORK 1C-12) CONCRETE (C - 1z ctnolckm C.O.G— S S k3 2_1. q [301 -,V�t tbmf- -roj� .7 5G tz 13 3 Gil FRAMING :('C-5) " q(qo95 lb[311 -jq 5-CATC Cof ovo 59 4 H X53 114 STRUGT-. :StOU-(&-t --T- NRY-(C. PLUMBING (C-36)' VIO 9LUM9104,0 P V to�l c>9 76 3-11] 13t77 t 3t VekWIL14.0 AW 00 JZE?V6(.IC- VW ooiqqg. "TW PLASTER (C�=.315) rLE-9 COWUMTE To T�c- N A e MOM 113 1017-d 11 7.A> DRYWALL (C-9) 5. OT&I !,1 J -r tq STA -M, r -V lip -q0?-Lt0-7 513 ?),2 1 Iq 43jC3 31 t HVAC- (C-20)*-: . . (*AT At --q. 2-0 6, 1 Z-7 &$so C, lot-? 10b [Dlkl -3 11-EcTRiCAI-, (C 0). Z 2-2 /I I Iq (C 78 5TA-Te F0 0 9 q0 8 (41.q (05Z 1 1 0714- liq -7s-7 o zq �kb-o :0 0 q `%L(o 5�-5. . •tiv, '713114 FLOORING GLAZING (C-77} N15kT le/EL 177 -z(ZB 14 Tr-)LAIJ P EwILE XA- INSULA -TION' MASC-0 Cav,=Ac- -(L 9- ces C. - z (0 22 -7 wLAcA473za (dV41 SEWAGE: DIS P'i & 0 CAQ PAINTING . G (C '33) ER- ?010-V 5A WIC AS A (3 CERAMIC TILE* (C-54) CABINETS (C-6) SA PA %'Z� A5 ABOVE FENCING IC -13)3) 5A VA S 04 A)sril opiRL— MA(c)(6111 goo 3siq (Of A1l31,/31/1q jz 'LANDSCAPING (CG27) PO`6 L (C-531