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14-0579 (BLCK)P.O. BOX 1504 78-495 CALLE TAMPICO t LA QUINTA, CALIFORNIA 92253 Application Number: 14-00000579 Property Address: 52605 AVENIDA VALLEJO APN: 7.73-292-016-4 _=000000 - Application description: WALL/FENCE Property Zoning: COVE RESIDENTIAL Application valuation: 2700 Tit(t 4'.4-4amt BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Applicant: Architect or Engineer: LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that l 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: Contracior: 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 at 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 (S500).: (_) 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. 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 wn 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 he or she did not build or L improve 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 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 ursu 'nt to the Contractors' State License Law.). 1 _) 'am e�xre-mp�under Sec. / &P.C. for this reason Date: 'J � /'Y 0 ner: t _ 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 Name: Lender's Address: LQPERMIT Owner: PARTIDA JOSE LUIS & GUADALUPE 52605 AVENIDA VALLEJO LA QUINTA, CA 92253 (760)972-6401 Contractor: Owner VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 5/05/14 . *. r - 7 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 should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date: 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 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 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 to laws relating to building construction, and hereby authorize representatives of this my to enter upo eabove-mentioned property for inspection purposes. Date: _ y'% , Signature (Applicant or Agentl i Application Number . . . . . 14-00000579 Permit . . . WALL/FENCE PERMIT 2013 Additional desc . Permit Fee .. . . . 47.19 Plan. Check Fee .00 Issue Date . . . . Valuation . . . . 2700 Expiration Date 11/01/14 Qty Unit Charge Per Extension 1.00 47.1900 LS MISC WALL, FIRST 100 LF 47.19 ---------------------------------------------------------------------------- Special Notes and Comments BLOCK WALL - 50 L.F. OF 6 -FT. HIGH BLOCK WALL [INSIDE PROPERTY LINE) PER ATTACHED APPROVED PLAN AND ORCO BLOCK DETAIL., 2013 CALIFORNIA BUILDING CODES. -----------------=---------------------------------------------------------- Other Fees . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 PLAN CHECK, WALLS 60.06 Fee summary Charged Paid Credited ------------------------------ Due --------------------------- Permit Fee Total 47.19 .00 .00 47;.19 Plan Check Total .00. .00 .00 .00 Other Fee Total 61.06 .00 .00 61.06 Grand Total 108.25 .00 .00 108.25 LQPERMIT Bin # Qty Of b Quinta Building &r SafetyDivision P.O. Box, 1504, 78-495 Calle Tampico�� La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permif Project Address: e.' Owner's Name: �p_ k4,s7;7 'b-,4-- A. P. Number: L L Z5 3 Address: 5 2(965 �eA l j' veal Legal Description: Contractor: Oki) Ale,Fp�— L. City, ST, Zip: t QtAM4.a ZS Telephone: '7 Ip.O - 7 Tz – (p (e'pl Address: Project Description: L City, ST, Zip: IVY- SEN c.6. 5D FT Telephone: O State Lic. # : CityLic. #: Arch., Engr., Designer: ;W� F'T Address: City., ST, Zip: Telephone: <`•;: r ........................................ Construction Type: Occupancy: State Lic. #: Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person: Sq. Ft.: # S ries: #Units Telephone # of Contact Person: Estimated Value of Project t�Q APPLICANT: DO NOT WRITE BELOW THIS LINE N Submittal X Reil'd Recd TRACKING PERMIT FEES Plan Sets . Plan Check submitted 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 2qd 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 correctionsrssue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees P.O. Box 1504 'LA QUINTA,* CALIFORNIA 92247-1504 .78-4.95 CkLLE TAMPICO. LA QUINTA, CALIFORNIA 92253 �NA BUILDING &SAFETY DEPA': RTM-E'NT 7 0 -7 .77-7,0 12 FAX (760) 777-70.11 PROPERTY `0VMVR'S'PACKAGE Disclosura & Foimi 's for "' W-­n-'ic;!4uft& G." isApply 'm49. W CE )CarpliverlYowner: kiii.. -in- -lis�l.".y,*umif.,as,�die.,buitd6r---of�,tbe.,.' pernutr your Ila= veapedy mqwoyements spocifi eos We Are-pmviding' wmitli. 10 an Owner Budder Ackmowtodgmexit aril Information'Verificatiba'Fi6tift. to M*,e--You-iLwa126-.of your tspensi -and., le risk. �you may -ijacurby-hi Viis-peirmit-issue'dfit islth-e )wner-Buib der. ig-ned, and returned this form to us at our official address indicated. An agent of mess you, the property owner, obtain the - r approval of the rity- pno permitting authority. you 1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder" uilding , permit that erroneously implies that the property owner is providing his or her own labor and material P'�"i'�'Y .- i, as a Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person ad his or her employees while working on my,property. My. homeowner's insurance may -not.provide coverage -for those juries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance -coverage for injuries to workers :1 my, Prop'e'rty - Lf2. 1 understand building permits are not required . to . be signed by property I owners .unless they are responsible for the Yristruction and are not Conti-actorto.assume this responsibility - 3': I;uirderstand as an,.­9wric -Buildee, i, am the ire.9*y.. protect responsible r�qo�4,.qR.*.pen L.1 undcrsia`n.d'that1'.- V ic party of Yself &OM Potential finariciat risk by'hifi . rig a licensed Contractor and having the permit . filed M hii0r. fii�jiaapr, instead of my .f.4. I understand Contractors are required by taw to be licensed and bonded in California and to list their license numbers on -nits and contracts. .V5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value my construction is at least five hundred dollars ($500), including labor and materials, I may. b-,..considercd-an."C mployce, der state and federal law. P.6. *1 understand if I am considered an -employee' under statc,and federal law, 1 must register federal vernment- withhold. payroll .taxes.: provide woi-kers' compensation disability. insurance, and contribute .to -unemployment mpensatio'n for each "employee." I also understand my failure to abide by these laws may subject me to serious financial J,7. 1 understand under California Contractors' StateLicense Law, an Owner -Builder who builds single-family residential 3ctures cannot legally build them with the intent . to offer them for sale, unless all work is performed by licensed wcontractors and the number of structures does not exceed four within any calendar year, or all of the work isrform PC ed 'ler contract with 'a licensed general building Contractor. KI I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be heid liable. for any rnancial or personal." 'uries sustained b an subsequent owner(s) s that'result fromany latent construction defects in the. uy - y.. y �. �i) workmanship or materials. 9. I understand I may obtain more information regardin my obligations as an 'employee' from the e f 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 (CS.LM at 1- 800-321-CSLB (2752) or www.csib.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 aro, the party legally and financially - responsible . for proposed construction activity at the following address: 520205 I agree that, as the party legally and ftnancially responsible for this proposed construction actin ty, I will abide by all applicable laws and requirements that governOvvrier-'Builders as well at employers. 12. I agree to notify the issuer of this form immediately of any additions; deletions, or changes 46 any oftheinfamatioia I have provided on this forrri Licensed contractors are regulated by laws designed to protect the public. If you:contraet with .sorucone who.does. not iuive a Iicense,.6e Contractors' State. License Boand�may be unable to assist5�th�ny—f tai " . . YOU may sustain as a result of a complaint Your only remedy against unlicensed Contractors may be in°avil'couct -it iis:aiso important for you to:undcrstandithat:ifanunlicawd Coutmotoror catployeeof that individual or+fi m is 4ur0d,vAfi e,vtotiang on your property; you may beheld Iiab for daatages. if you .obtain a .permit, as .Owner -Builder and wish: to hirc.Contraietors, you..will-be .respoa iWe for,va*ing v&cdw:oraot tltose Contractors:=property licensed and:thezUtus ofl..d it woike& compectsation insuranoe. 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 issola: A copyof dor.p duty owner's.46-iver's1ke4 a form,nota o�tv«; or other veriTication ace fable to. Lice Sp agexcy is iequff to . e prescreen iaheii the permit is; xuued to retify,lrcc.pt+u erYy owner's signature. Signature of property Date: Note: The following Authorization Form is required to be completed by the property owner only whendesignating 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 folldwiit persou(s) io act as niy age&(i) to apply'for, sign, and file"`tie documents, necessary o 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 ofthe 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: