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14-0469 (BLCK)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number. Property Address: ' APN: Application description Property Zoning: Application valuation: Applicant: 14-00000469 52625 AVENIDA VALLEJO 773-292-017-5 -000000- WALL/FENCE COVE RESIDENTIAL 1400 Architect or Engineer: LICENSED CONTRACTOR'S DECLARATION 4 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT - I hereby affirm under penalty of perjury that I a$$$�'''t�� liceqsed u der provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business ^and\protk ion Code, and my License is in full force and effect. License Class: �t ` \� VVVV 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, 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..,, Mle or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by pplicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: ( ) 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 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 he or she did not build or improve for the purpose of sale.). _ ) I, 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 pursuant to the Contractors' State License Law.). I am exempt under Sec. , B.&P.C. for this reason a i IA Oate: - 1- - 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 Name: _ Lender's Address: \po LQPERMIT Owner: LINDA SHIELDS 52625 AVENIDA.VALLEJO LA QUINTA, CA 92253 (909)591-4076 U Contractor: Owner VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 4/21/14 C17 y op �'�►�,Vis�� UNVTq ----------------------------------------------- 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 s Pi, 1d b�rcome subjet• the workers' compensation provisions of Section 37`00 of the Labor e, 1 I1 fohwi omply , th ose provisions. Date: ��`-1 Applicant: WARNING: FAILURE TO SECURE WORK RS' 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 c rect. I agr to comply with all city and county ordinances and state laws relating to build' co struction, an reby auth ize representatives of this county to enter upon the, above-mentioned grope r ' ection pur Date�� (qty Signature (Applicant or Agent): Application Number . . . . . 14-00000469• Permit . . . WALL/FENCE PERMIT 2013 Additional desc . Permit Fee . . . . 47.19 Plan Check Fee .00 Issue Date . . . Valuation 1400• Expiration Date " 10/18/14 Qty Unit Charge Per Extension 1.00 '47.1900 LS MISC WALL, FIRST 100 LF 47.19 ---------------------------------------------------------------------------- Special Notes and Comments 64LF OF 6' GARDEN W/2' RETAINING AND (1)PILASTER AT NORTH, AND SOUTH PROPERTY LINES [ORCO SPECIFICATIONS] PRECISION CONCRETE BLOCK SHALL BE COVERED WITH STUCCO,•PAINT, OR TEXTURED COATING WHERE .VISIBLE FROM OUTSIDE'THE PROPERTY. 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 Iain #• City of La Quinta Building U Safety Division Permit # P.O. Box 1504, 78-495'Calle Tampico /�La Quinta, CA 92253 - (760) 777-7012 4* Building Permit Application and Tracking Sheet Project Address: (o�S jt9UjtOA V9& 0 Owner's Name: ,0�£ A. P. Number: Address: ✓ N f! Legal Description: City, ST, Zip: q 7/e) Contractor Telephone:gQ or/ Y9 Address: Project Description: (O a,4U- (),,J T1(��[-fl t. City, ST, Zip: O one• Telephone: P State Lie. # : City Lie. #: Arch., Engr., Designer. Address: City., ST, Zip: . Telephone: ::•:::>::.:::..:..,..:....:::.....:.::::.. Construe to YP t) f Occupancy ' State Lie. #: New Add'n Alter Repairai Project type(circle one) r Demo Name of Contact Person: Sq. Ft.:S� 5 #Stories: # Units: Telephone # of Contact Person:Estimated Value of Project: lq6 Q 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 Deposit Truss Calcs. Called Contact Person Plan Check Balance. Title 24 Calcs. Pians 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 Decd Plans picked up S.M.I. H.O.A. Approval Plans resubmitted r Grading IN HOUSE:- 3" Review, ready for correctionsCssue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees . 1 a P.O. Box 1504 LA QUINTA, CALIFORNIA 92247-1504 7$-495 CALLE TAMPlco. LA QUINTA., CALIFORNIA 92253 e BUILDING &'SAFETY DEPARTMENT (760J 777-7.012 FAX (760) 777-7011 (PROPERTY OWNER'S PACKAGE Disclosures & Forins for Owvner-Builders A'pi "I' g for Construction, POM " , d'ITNT/ 1�IQ�CE TQ P)Gt�PERTY OWNER Dear'Property Owner Aa. application,4or :a `building permit has. been submitted in your name listing+ yourself gas •the builder —of—.the.:—property improvcnicnts specified at -5-14P45" AA)4 11DA in We are pr+oviiiing you with an Owner -Builder Acknowledgment and Info matioii`Vetifieadw-F(itin to make you aware of your responsibilities and possible risk you may incur by baivuig dd&permit isst a itv.' r aerie"ss ttie t Owner -Builder. •We%wiff:notissue?at buil • tali -until ou=bave rea tnctuled otti' AdErstAnd..' oteaickl ""Vision, ding Ret y d, - y mg= pro n, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute=tbis.riotice Unless you, the property owner, obtain the prior approval of the permitting authority. a:S t rte. aauar eacrr.statement betow to signify yoit understand or verify Ms rlrfOn7nafton. 1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder" wilding 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- I 4oniction I understand building permits are not required to be signed by property owners .unless they are responsible for the and are.not hiring a licensed Contractor to assume this responsibility..: GL3. I understand as an "Owner-l3utldet" I am the responsible party. of.record,on the,pe*t. I+understand that 1,"y protect . if from Potential financial Y Po risk by hiring a licensed Contractor and having the permit filed in his or her name Instead of my own. 54. I understand Contractors are required by law to be licensed and bonded in California and to list their license' numbers on ermits and contracts. P. 55.1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value sof my construction is at least five hundred dollars ($500), including labor and materials I may. Pto ez" under state and federal law. 6. 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. C47. 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 offe rur 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.generat building Contractor. Ainan 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 cial or personal. irjaries sustained by any subsequent owner(s) that result from' any latent construction defects in' the worlamanship or materials. 9. I understand I may obtain more information regarding my obligations as an "employer' from the IntI Revenue ervice, 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- at 1- 800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. 0. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the le ally and financi y ible or p posed construction activity at the following address: ,95 bio g L4- _ 467-W _ JL 11. I agthat, as the party legally and financially responsible for this proposed construction activity, I will abide by all pplicablree e laws and requirements that govem Owner -Builders as well at employers. 12. lag= to notify the issuer of this form immediately of any additions; deletions, or changes to any of the information I L provided on this form Licensed contractors arc regulated by laws designed to protect the public. If you contract with someone who does. not have a licensc, the Contractors' State License Board Panay be unable to assist'any W. loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be iwavil court It is also important for you tounderstand that if an urnik sod Contractor or employee 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 -Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors -are properly licensed and the status of.thcir workers' compensation insurance coverage. Before it building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuiagAke.persait. Notes A copy of the property owner's driver's ReeKay farm "04kOOM or other verirwadon acceptable to the agtrtcy is 'required to be praaented ".n the permit is issued to verify the owner's signature. Signature of properly owner 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 understand. is my personal responsibility, I hereby authorize -the follow ng persons) 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) -Cock AJAL_ f p,✓ Project Location or Address: S� (o _-� S Name of Authorized Agent:Fla e, Tel No �nq mac/ 7 - s6LS Address of Authorized Agent: ffQ(7a s AyrSIILL %__e� 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 resented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: ` h • fi, ' t P's, marc 1 1 -f 0 LN FN vLIND �Z�jr`y'r` MS' END<QNE 7 ` y r "49501RVING CONIO�CA'91710 CS EORRLENS — - MOMM- R i / SEX -F aIAGOM R' MEe •i , r,� �;: DRI` R :i t j 9 iISHfEL>DS wFgI�tPNILLIP�CORY '._"�`� i r 4950,IRVING • CHINO CT. CA ;91710 ;::: � • 3 s `""' �i ' Q, f06� 0615la? • J� \ ::.� �'� —�_ ,`J� :•U� 20]26x_ 32{gCBFD/16. ES BL•U • r