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11-0146 (BLCK)r g3 d*!t 44 P.O. B(?X 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: ' 2/11/11. Application Number: 'C=1.1'6.0000 Owner: Property"Address: 51140 AVENIDA VALLEJO., CHITWOOD WILLIAM APN: 773-063-006-17 -000000- 51140 AVENIDA VALLEJO Application description: WALL/FENCE LA QUINTA, CA 92253 Property Zoning: COVE. RESIDENTIAL (760) 887-8888 Application valuation: 292 Contractor: Applicant: Architect or Engineer: Owner ---------------------------------------------------------------------------'------------------- --- _ 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 U _ 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: 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 b come bje�et 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 nd agree that, if I should bec a ubi ct the-wo ensation provisions of Section License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 700 of the Labor C d I f rtt!i th comply with those Prov s. tha r e or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by applicant for a permit subjects the applicant to a civil penalty of not more than,five hundred dollars ($5001: t yDate: •Applicant. --1 ( 1 1, 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 WARNI F (LURE TO SECURE WORKERS' COMPENSATION COVERAG �S 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 himselforherself 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. 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 withlicensed 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'4hereon, 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.&P.C. for this reon 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. Dater-' "" , Owner:. 2. Any permit issued as a result of this application becomes null and void if work is not commenced �,r.., f f y- `_ within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject - 1----'� CONSTRU N LENDING G CY permit to cancellation. I hereby affirm under penalty of perjury that there is a constructiomlerf ing agency for the performance of the I certify tFia I hav read this appli ation and st to the above information is correct. I agree to comply with all work for which this permit is issued (Sec. 3097, Civ. C.I.,i� city and co my dinances and st e I ws la g it n and hereby authorize representatives of this counter upon the a ve me io p6Vty- r inspe io urpose . Lender's Name: ` Date: - - Signature IAp Ii or ge 1 Lender's Address: •��,Y. - LQPERMIT " Application Number 11-00000146 " Permit, . ' . . WALL/FENCE PERMIT _ Additional desc Permit Fee- 15.00 Plan'Check Fee .00 Issue Date Valuation 292 Expiration Date 8/10/11 Qty Urii"t Charge Per Extension BASE FEE 15.00 ----------------------------------------------------------------------------- Special Notes and Comments 10 LN FT X'5 FT HT GARDEN WALL PER CITY STANDARDS .AND (3) - 618" PILLARS PER APPROVED PLANS. APPROVED PLANNING E.C. & BUI LD ING - A . J.. Other Fees . . BLDG STDS.ADMIN (SB1473) 1.00 Fee summary Charged Paid" Credited Due Permit Fee Total- 15.00, .00 .00 15.00 Plan Check Total .00 .00 .00 .00 Other -Fee Total 1.00 .00 .00 1:0'0 Grand Total 16.00 .00- .00 16.00 LQPERMIT - YIS 3 + i 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 IMMUNE NOTICE TO PRQPERTY 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 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. O%WWS ACIQgOWLEDGMENT AND VERWWATION OF U4FORMIWN �/jDfR�ECTIONS: Read and initial each statement below to signify you understand or verify this information. v1. I 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. 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. 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. 0nderstand Contractors are required by law to be licensed and bonded in California and to list their license numbers on Tuperrruts and contracts. Iunderstand 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. �. I 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 me to serious financial risk. 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 financial or personal. iujnries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. 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.csib.ca.gov for more information about licensed contractors. 0* 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: l 1. I agree that, as the party legally and futancially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner -Builders as well as employers. VVagree 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 ticmw, 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 in civic court_ It is also important for you to: understand that if an unlicensed Contractor or employee of that individual or firm is injured white working 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 property 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 issuing the permit. Now A copy of the property owner's driver's t ; form notarization-, or other verification acceptable to thee cy a Abe presented when the permit is issued to verify the property owner's signature. / j / Signature of property howner 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 execution of which I understandis my personal responsibility, I hereby authorize the following person(s) 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): 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 required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: Bin # City of LQ Quint,Q -Building 8r Safety Division P.O. Box 1504,•78-495 Calle Tampico La Quints, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # .— Project Address: q'U %w -e �ig- J owner's Name:All r,¢ �,,� C / � pV 0 A. P. Number: Addies"s° �',%�0 Legal Description: City, ST, Zip: Iq IN /,.y- Of 2.r 3 'Cor ntrac o : /r Telephone: O �i %^ Address: Project Description C City, ST, Zip: 3 " to /� /11,4 Rs Telephone: ?:':><`s•:'s rf:�3t<ris`>'<< / _ State Lie. # : City Lie. #: Arch., Engr.; Designer: Address: City., ST, Zip: Telephone: :;:}}'rr{•}}:v:;F':v4:;Ji: : :;;: ,� •:;�:..:<:.•?:�s {_s?v : i ;<stls,rc c<: 'Construction Type: Occupancy: Project type circle one New Add'n' 'Alter Repair Demo State Lie. #: Name of Contact Person: Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'd TRACKING " PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposii Truss Calcs. Called Contact Person Plan Check Balance 1 Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 21" Review, ready for correctionsfissue Electrical ' Subcontactor Iast Called Contact Person Plumbing, Grant Deed Plans picked up e S.M.I. H.O.A. Approval Plans resubmitted, Grading IN HOUSE: 'id Review, ready for correctionsfissue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees , 0