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BWFE2016-015478-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT INSI BUILDING PERMIT Application Number: BWFE2016-0154 Owner: Property Address: 52040 AVENIDA VALLEJO JOHN CAREY APN: 773223002 52040 AVENIDA VALLEJO Application Description: CAREY / 80 LF 6' COMBOWALL ON SOUTH PL LA QUINTA, CA 92253 Property Zoning: Application Valuation: $4,200.00 Applicant: JOHN CAREY 52040 AVENIDA VALLEJO LA QUINTA, CA 92253 --------------------------------------------- LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 {commencing with Section 70001 of Division 3 of the Business and Professions Code, and my License is in full force and effect. License Class: License No.::CONV:140528101254126490 Contra 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 Am 0).::0) as owner of the property, or my employees with wages as their solepensation,'will do the work, and the structure isnot 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 In or she did not build or improve for the purpose of sale.). 7 as owner of the property, am exclusively contracting with licensed contractors (� Cstruct 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 t-Ilie Contractors' State License Law.). m exempt under Sec. B.&P.C. for this reason Date: / r W Owner: 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 Add Contractor: JOHN CAREY 52040 AVENIDA VALLEJO LA QUINTA, CA 92253 VOICE (760) 777-7125 FAX (760) 777-7011 �Qgfe: c_7/11/20 r -T I o �^+ c p M 2 CEJ i rn LIc. No.::CONV:140528101254126490 - 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: Car r• Policy Number: ertify that in the performance of the work for which this peimit is issued; I s II not employ any person in any manner so as to become subject to the workers' 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. nn/ Date: i. • � G Applicant: WARNING: FAILURE TO SECURE WORKERS' 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 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 correct. 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. Date: 7, /I , r & Signature (Applicant or Agent): C �n1C��.�f'v.:.vC' �df5 �.yr?, u §\. >t�x ;:,s ��' �'.�^�,:'y c ,.} ::.a`,, �'. ta, G! DESCRIPTION4�� ° QTY AMOUNTS StlP�AID` DATE R, x �ACCO{UNT ¢� . PAIU * BSAS SB1473 FEE• ( 101-0000-20306 0 $1.00 $1:00 7/11/16., ° `PAIDBY� X�' METHOD RECEIPT #ti� CHECKS# �C TD BY y r,. t JOHN CAREY ..CASH, - •• R16958 w SKH . .. Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 $1.00 s,,:""a� a QTY "' '? "?� Crtz, t.„.; si..`"`,r'�• AMOUNTrPA'ID `'` ' ,t" K' 'Y .YF "; ...,yt^:'ry. PAID DATE h DESCRIPTIONACCOIJNT kw ^� COMBINATION GARDEN/RETAINING WALL -, 101-0000-42404 0 .$95.72 $95.72 7/11/16 FIRST 10OLF A16-ByE."t'�s' M� HOD 'RECEIRl '#, p �'CLTD B,msY �SNr f" udt' -#n u0:K .`3S• i,'r ' `tz5'Yi. s: JOHN CAREY ` CASH ' R16958 ' -SKH . i l q r SCR:,ac.�# ."_�'�:`�.`.• . h M`u.' COU~ '�"��,+.� "m", C 3 'A.r�AI'DA�.T"IPYON .�•,s�..�� .teDa.E �«s#s .�'�'�A�C.; � V,E.•yY. COMBINATION GARDEN/RETAINING WALL - 101-0000-42600 0. $60.91 _. $60.91 7/11/16" FIRST 100LF PC - v PAIDrBY � i,i+- � - fiMETI10D --.-XIh.�}..h,�:� RECEIPT# CHECK# 4, a ter a.•..�� w�._� x ., ,r,<. �CITDBY JOHN CAREY .CASH �V R16958 SKH { Total Paid for COMBINATION GARDEN/RETAINING WALL: $156.63 '$156.63 ' • Description: CAREY / 80 LF 6' COMBOWALL ON SOUTH PL Type: WALL/FENCE Subtype: CITY STANDARD/PRE- Status: ISSUED Applied: 7/11/2016 SKH APPROVED Approved: 7/11/2016 SKH Parcel No: 773223002 Site Address: 52040 AVENIDA VALLEJO LA QUINTA,CA 92253 Subdivision: SANTA CARMELITA VALE LA QUINTA Block: 76 Lot: 21 Issued: 7/11/2016 SKH UNIT 10 Lot Sq Ft: 0 Building Sq Ft:.O _ Zoning: - Finaled: Valuation: $4,200.00 Occupancy Type: Construction Type: Expired: 1/7/2017 SKH No. Buildings: 0 ' No. Stories: 0 No. Unites: 0 Details: *80 LF 6' COMBOWALL ON SOUTH Pl. [CITY SPECIFICATIONS) PRECISION CONCRETE BLOCK SHALL BE COVERED WITH STUCCO, PAINT, OR TEXTURED COATING WHERE VISIBLE FROM OUTSIDE THE PROPERTY. 2013 CALIFORNIA BUILDING CODES. . . ,, K U .. ;. FINANCIAL INFORMATION Printed: Monday, July 11, 2016 11:08:18 AM 1 of 2 SYSTEMS . INSPECTION§ . ..... .. -PAR91NITTROJECr Printed: Monday, July 11, 2016 11:08:18 AM 2 of 2 lYSZEMS 'AMOUNT 'PAID = D'ESCRIPTION• "`ACCOUNT QTY PAID PAID DATE RECEIPT #" CHECK # METHOD BY BY BSAS SB1473 FEE 101=0000-20306 0 $1.00 $1.00 7/11/16 R16958 CASH JOHN CAREY SKH Total Paid for BUILDING STANDARDS ADMINISTRATION• $1,00 $1.00 BSA: COMBINATION GARDEN/RETAINING 101-0000-42404 0 $95.72 $95.72 7/11/16 R16958 CASH JOHN CAREY SKH WALL - FIRST 1001-F COMBINATION GARDEN/RETAINING 101-000042600 0- $60.91 $60.91 7/11/16 R16958 CASH JOHN CAREY SKH WALL - FIRST 10OLF PC Total Paid for COMBINATION GARDEN/RETAINING WALL: $156.63 $156.63 TOTALS: $157.63 $IS7.63 INSPECTION§ . ..... .. -PAR91NITTROJECr Printed: Monday, July 11, 2016 11:08:18 AM 2 of 2 lYSZEMS Bin # . y _ V t City of, b -Quill to Building & Safety Division' 78-495 Calle Tampico, La Quinta, CA 92253 - (760) 777-7012 i :Building Permit Application and'Tracking Sheet!-.'. Permit # " •, Project Address: Q �.52 kfb ��(� Cl;�q �� d Owner's Name: JOP)✓LL;Ca✓/e A. P. Number:Address: a2 • �� Legal Description: City, ST, Zip: -,M? 53 . Contractor: Telehone: P �6 7 l Address: Project Description: CaIeYrQ'J' of,6 %(, t,) h " l City, ST, Zip: TelePhone: _`- s ll CO f Td State Lic. #,: City Lic. Arch., Engr., Designer: 4' L Address: ^ City,^ST, Zip: i '• M r hone: C1ele r on tructi onTY Pe: O ccu PaneY Lic. # s o.ProJe t type (circle ne • New Add'n AlterStato Repair Demo, Name of Contact Person: Sq. Ft.: _ #Stories: # Units: Telephone # of Contact Person: r P ,i Estimated Value of Project: B� - APPLICANT: DO NOT WRITE BELOW THIS LINE,-,. ' H Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted r r r Item ,` ; ! Amount Structural Calcs.. Reviewed, ready for,corrections Plan Check Deposit T Truss Cates. Called 'Contact Person Plari 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 correetionsrssuc Developer Impact Fee Planning Approval Called Contact Person - A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees, ' ti Total Permit Fees P.D. BOX 1504 _ 'LA QUINTA, CALIFORNIA 922.47-1504 BUILDING & SAFETY DEPARTMENT 78-495 CALLS TAMPICo (760) 77.7=7012 LA.QUINTA, CALIFORNIA 922,53 ' FAX (760) 777-7011 - .PROPERTY OWNER'S PACK -AGE'- Disclosures & Forms for Owner -Builders Applying for Construction Permits IMPORTANT. NOTICE TO PROPERTY OWNER Dear Property Owner:. - An application for a' building peimit _has beenubrr'itted in our name listin yourself as the builder of theproperty. improvements -specified at 6�6 We are providing you with an Owner -Builder Acknowl gme nA Information Verification Form to make you aware of your responsibilities and possible risk you may incur byhaving 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 propeity owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION.. �_• DIRECTIONS: Read and initial each statement below to signifyyou understand or verify this information.. . . Py I understand a frequent practice' of unlicensed persons .is to have the property owner obtain an "Owner -Builder" bu ilding permit that erroneously implies that the roe owner is providing his p p rty p g or her own labor and material personally. I, as . an Owner -Builder, may be held'hable 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. 1. understand building permits are not required to be signed by property owners unless they are. responsible for the ' ci/ ontrucion and are not hiring a licensed Contractor to assume this responsibility. #-e-3- • . I understand as an "Owner -Builder I amthere nsible spo partyof record on the permit. I understand that Iinay protect self from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my wn. • , 4 I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. 5f I understand 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-frnancial risky . wI understand under California. Contractors' State License Law, an Owner -Builder -who builds single-family residential tures 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. I understand as an Owner -Builder i= I sell the property for which this permit is issued, I may be held liable for any inancial or personal injuries sustained by -any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. 0I understand I may obtain more information regarding my'obligations as an "employer" from the Internal Revenue eice, 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 party legally,: and financ ially ,responsible ' for 1. 1�proposFd construction ' activity at the following address: n,� v v I agree that, as the party legally and financially responsible for this proposed construction.activity, I will abide by all 47 laws and requirements that govern Owner -Builders as.well as employers. 12. I 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 in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or fum. is injured while 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 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 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. Signature of property owner Date: 7. 110b LIT 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 understand is my personal responsibility, 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: 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 thepermit is issued to verb theproperty owners signature. Property Owner's Signature: Date: d. TbfO •z �,: JOHN A CAA�9 .y,�rfi��i • ! '_ r• •� 4/i Y" ' 4' .. � _ ,lu�.'�•IR, 1— IN'GTS-y � . , � �n1,.��_.-•� ��g\��{2o�Ys�ao T�851b ' �'BRN • MEN :. - r - � _ f ` J� r ot_;S039E�•�� % ./s s,t:N.`.CASTRO:�,.. .f,�.—�.�}^`�,� z,''i ^ • s Fb5 PRISCILLA IJ ! 1'- lA QUINTA CA: 92263 ,•-. _ -- _ • • r � i::- � ` '><.ie08128M'948 �` T,R CURR;LENS,:-?' =_ .;;;..`.:,=_:;t_�;' i= , :'-:08?_ 51. 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