Loading...
13-0099 (BLCK)P.O. BOX 1504 TA 4 VOICE (160) 777-70 12 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALI . FORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153, BUILDING PERMIT Date: 1/31/13 Application Number: 13700000049 Owner: Property Address: .51420 AVENIDA VALLEJO COOK KARIE,L APN: 773-084�-009-16 -000000- 51420 AVENIDA VALLEJO Application description: WALL/FENCE LA QUINTA, CA 92253 Property Zoning: COVE RESIDENTIAL- (760)464-1739 - Application valuation: 1200 Contractor: Owner Applicant: Architect or..Engineer: FP3 2013 5e� C1 F QUI lyce - -------------- ----------------------- 7 ---------- -------------------------------------------- - LICENSED CONTRACTOR'S DECLARATION WORKEWS COMANSATION DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (c6mmencing with I hereby affirm under penalty of perjury one of the following clecla I rations: 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 thb 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 for which 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 requirei-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 io the workers' compensation laws of California, permit to file a signed statement that he. or she is licensed pursuant to the'provisio�s of the Contractor's State and agree that, if I should become subject to the workers' compensation provisions of Section License Law (Chapter s (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3700 of the LaborCode, I sh�ll forthwith compl wit i that he or'she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5. by Applit:Zn plicant for a permit subjects the.applicant to a civil penalty of not more than five hundred dollars ($500).: Date 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 (See. 7044, Business and Professions Code: The WARNING: FAILURE TO SEC�� �SCOMPE�NSATION COVERAGE'lS 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' I and who does the work'himself or herself 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 FEiS., one year of completion, the owrier-builder will have the burden of proving that he or she did not build or I prove forthe purpose of sale.). APPLICANT ACKNOWLEDGEMENT IMPORTANT, Application is hereby made to the Director of Building and Safety for a permit subject to the as owner of the property, am.exclusively contracting with licensed contractors to construct the project (Sec. 7044, Bu;iness 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 improve . i 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 Contra ' ctors' State License Law.). whose benefit work is performed under or pursuant to any permit issued as a result of this application, am exempt under Sec. the ov�ner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City B.&P.C. for this reason 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. Dat .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 CONSTRUCTION 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 ab ove information is correct. I agree to comply with all work for which.this permit is issuedlSec. 309 Civ. C.). city and c6unty ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter upon the above-mentioned prope for inspec ion purposes. Lender's Name: I I (Date:'Sh 1 1-:; Signature (Applieantor Agent):, Lender's Address: LQPERMIT Application, Number 13-00.000099, Perii1it . . . . . . WALL/FENCE PERMIT, Additional desc Permit -Fee 29..1.6:0 Plan check Fee Issue Date -Valuation . . . . 1200 Expiration Date 7/30/13 Qty Unit Charge Per Extension BASE FEE, 15-00 7'-0 0 - 2.0000.HND BLDG 501-2,000 14. 00., ------------------------------ -------------------------------- ------ ------ Special Notes and Comments. 48 IN FT'X�6FT HT ORCO STANDARDVALL PER APPROVED PLAN. �20101 CODES.' - - - - - - - - - - - - - - - - - - - - - - - - - - �-7 - - - - - - - - - - - - - - - - - - - - - - - - - 7 Other Fees . . . . .... . . BLDG STDS ADMIN (S91473) - - - - - - - - - - - - - - - - 1_u'* 0 0 Fee summary charged, Paid Credited - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Permit Fee Total' 2 5.� 0'0 0 0. ..00 29.00 �Plan Check Total .00 .00 .00 .00 Other Fee Total - 1.00 .00 .00 1.00 Grand Total 30.00 .00 .00 30.00 LQPERMIT Bin.# Permit # 0 utnta P.O. Box 1504,78-495 Calle Tampico 14.Quinta, CA 92253 -.-(760) 777-7012 Building Permit Application, and Tracking Sheet OwneresNamc:. 's k P. Number. 7dd . j-. r=. Add rcss: 2-0 A ve, Vc Ile- 1�1 Legal Description: Contractor. City. ST, Zip: Lk 9 2Z65 a0w0m 0a 65. Telephone: 7�0 q 10L4 1 -1 Z9 ; . Address: PrOJ�,A Description: Wod Qn City, ST. Zip: f Telephow. M-4. M State Lic. # . rcity Lir_ 11, Arch, Eag, Designtr, Address. City. ST. Zip: Teliphone: State Lie. 9: Name of Contact Person: A Construction Type: Occupancy: Project type (circle a Add'n ne) Alter Repair Demo Sq. FL. I # Units: - Telephone 0 of contact Person: Ca" O� -4c57-- nt,,S Estimated Val4c of Project .0 Submittal d plan Sets A UCANT: DO NOT WRITE BELOW THIS LINE RecId TRACMG PERMITFEES- Plan Check submitted h1cm Amount' "o -un, Struduftl Cales. Reviewed, ready for corrections Plan Check' Deposit. Tross CsIcs. Called Contact Person Plan Check Balance. Mile 24 Calci� Plans pickid up Construction Flood pwu plan Plans resubtal . fted.w. Mech2ldC&l Ginding plan 2"Reviciv,'ready f0orcorr"tiousrmue Electrical Subcontactor List A Called Contact Person Pla.mbing. Grant Deed :�- Plans picked up S.NLL ILO.A- Approval Plans resubmitted Gradlug IN HOUSE, Reylew, ready for corrcctio . nsrwoc Dev,cloper Im I pactFee FigunlagApproval. Called Contact Person A.I.P.P. Pub. %Yks. Appr - Date of permit Issue School Fees Total Permit Fees Ai P.O. Box 1504 LA QUINTA*1 CALIFORNIA 92247-1504 BUILDING & SAFETY DEPARTMENT 78-495 CALLE TAMPICO (760) 777-7012 _U_Q_G­iNTA , CAL I FO RN IA 9 225 3 FAX (7 60) 77 7-70 11 PROPERTY OWNER'S PACKAGE Disclosures & Forms for Owner-BuRders Applying for Construction Permits kw -m WERn " . Dow Pnpcny Ownw 0 An - Molication for a building pa= has bma su in your YQUE-self as the builder of Ute prop" spftified at ve, LQ hs� st q,20 7ma ,a U Vt. 'n We am P""dwg You Wft as Oaver-Duilde, Adcnow.kAbnezit-wid. InEbtumaou'Venfieutim Fonn to make you av= of your MWOUStbilities and possible YOu may W= by hAvft dus permit-isated w yew na� as &e Olmclr'�- We WDA " issue a buildi"ptrmH Until y4M-haVe read, initialml your 04 sack Provision, "gned� and returned this form tq us At our Official address indicated. An agent of the owner cumot tRecuft Ibis notice unle'ss You, the Property owner, obtain the pnof approval of the permitting audxxity- MD YAMCAMN OF VW DfftffCr[Ma.Rwdaftd MON M 319nify you waw3umd or vo* dus hiformewort. 1 understand a fir-quent pmctice of unlicensed persons is tO have the property owner obtain an "Owner -Builder" Wildmg permit that enumeously implies that the property -w— is providing his or her own labor and material penmnaft. 1, as an Owner -Builder, may be held liable a�d subjec A to serious financial risk for any injuries sustained by an unlicensed person and his OF bl" cMPJOY= while working on my property. my lomcowDff's inisurance. may not provide coverage for dwse injuries. I am w'JUMY actLR as an Ownef-Builder and am aware of the limits of my insurance coverage for injuries to workers on may property- HLC, 2- 1 understand building permits are not re"ired to be signed by property owners unless they are responsible for the construction and am not hiring a Licensed C .ontrwwr to assume this responu-bility. MLC, 11 understand as an"Owner-Builder" I am d* otec FtWODS161t party Ofrecord on die pa -mit. I UDdaMAW that I may pr I myself from potential financial risk by hiring a licensed Cont-&Ctor and haying the permit filed in his or her name insteadof my own- LC- 4. 1 understand Contractors are required by law to be licensed and bonded in California and to list thm license numbers on penauts and contracts. 5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total valu. Of MY construction 'is at least five hundred dollars (S500), including tabor and materials� I may be considered an "employer under state and federal law. �k 6- 1 understand if I am considered an -employee' under . state and federal taw, I must mgisw with the state and feder government,. withhold payroll taxes, provide workers' compensation disability insuraum. and contribute to uaemployme compensation for each "employee-- I also understand my failure to abide by the3e taws may subject me to serious financ�. risk. gU- 7. 1 understand under California Contractors' State License Law, an Owner -Builder who builds single-family residew structure� cannot legally build them with the intent'to offer them for sale, unless all work is performed by tictu subcOatmctors and the number of structures does not exceed four within any calendar year. or all of the work is perion: under contract with a licensed general building Contractor. �6tf&kiaW fa, any 8. 1 understand a3 an Owner -Builder if I sdl the property for which th�is penaut is issued, I may be . financial or persoW, inouies VagUhmd by.any Subsequent owner(s) that result from any latent Construction defmts in the workmanship or materiak 9- 1 understand I may obtain wort information regarding my obligations as an -employet" fMM th� UftMA TLOWnut MU and tl�t C." rRi Swvicc� the Unitod States SmAH Business Administration, the Catifornia. Department of Benefit PaYm - 0 & Division of 1�dustriai Accidents. I also uriderstaDd I Way contact the Califomia Contractors' State Uct= Board (CM -B) at I 800-321 -CSLB (2752) or www.cs1b.ca.gov for more information about licensed contractors. W,10- I am aware of and consent to an Own er-Builder building permit applied for in my name, and understand "I I am the party legally and fin�%iap msponFA& fo conStroction W-tiVity at the following addressi r) M A � &a 6- I L I " that, as the party legally and finuicially responable for " proposed cqnstrwAion activity, I will abiode by all applicable laws and M"ireutents that govern Owtier-Builders as well at employem. AU-- 12- 1 agree to Do* the issuerof h this form immediately of any additiors, or danges to WY Of the infO"natim I have pr0VidW on this form- Licensed contractors art regulated by laws designed to protect the public. If YM c9aftactwith Mnoone who dom not have a fimm, &t coaftowts, State Licwse Boord may be UMablC to =gist you with my 888DOW low You May Mstain as a result of a complaint Your only remedy agaiiist unlicensed Contractors may ba in-Givit COWL It is also imPMtW for YOU to M&rstud that if an atfficowd Contractor " camployce Of 1W io&vi&w or firm is ij� wbile wMiring On Your Prop"; you may be held H" %r damaws If you obtain. a permitt as . owner -Builder and wist to but COQUft6m, you wdl be reVomib6 for vu#YM v&dbw or W dww Coa=tors am pmpcdy fiecand wd Vue S"M Of &M W"kM' . I — . Were a budding perndt can be imed, Uds form mug be completed and signed by the prop" owner mid returned to the Ageu" reqmndMe for kswift Gw-FenukL Now A copy of dw pvpsrqr *wngr's dWrw'xAWMW% J'wm n0t"4061M Of odser venTwation awAps4k so *e dWency is req'uira tv be prCSCAIC4 when d" permit is in%" so "rify the propcM owner's signature. S*naUUtQfprop0tyoWMrjZ9W2- D&W. Note: Aefollowing Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apptyfor a construction pennitfor the Owner -Builder. AMORIZATION OF AGRff TO ACT ON PROPERTY 0"MUS �B�F Excluding the Notice to Property Owum, the txtwtion of which I undwentmd is my pwmg vtWOMibilitY, I 11'11�y authorize &C f0l6will# Penwo(s) to act as my ageaqs) to apply for, siM and file the documents racessmy to obtain an 'Owu"-Buikkr Painit for my project. P Scope of Construction Project (or Description of Work): Cit1jedc �1"w all bQJ< sde,- rof)ljo C , q2.Zg, PrOject "tion or Address: 61'42-0 Ave, V121hoif-') 11n, ') � & Name of �kuthorizcd Agent: C=L:T-Zp�,S,, �<, pA,,ji�, Tel No L—J[,O nj Addressof Authorized Agent: GiL)ZO AVE -\)riLL-FY0 L-pq 00.r.�j� I declare under penalty of perjury that I am the propetty owner for the address listed above mA I PeMUAllY filled out the al inf"InatiOn and certify its wxuracy. Note: A copy ofthe owner *s driver's tkense. form notarization, or other voftcation awWable to the agency is required to be p i ed th ed 10 ver* the property o wner 's signature. 'Propeny Owner's Signatum: Date: 'is CLA�S- 37 P I OUISE '�'S 0 14 0 AVENITA VAI Lrib"- LA UINTA C �,-SEX-Fj L-HAIR:BRN-; ts -HZ HT -5-01 WT 220 fh� D 0 B'" - 5� 4 0. 6a 141!r 01. -DONM V-V.04/'Z.O-/'2010'ijS-RB'-'FD/lS r