Loading...
12-0506 (BLCK)Ti4fP.O. BOX 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: 5/08/12 Application Number: ,12-00000506 _` r Owner: Property Address: 52885 AVENIDA VALLEJO ROBERT T MILLER APN: 773-323-020-7 -000000- 52,885 AVENIDA VALLEJO Application description: WALL/FENCE LA QUINTA, - CA 92253 Property Zoning: COVE RESIDENTIAL ----------------=--`-=----------- Application valuation: 2750 - Contractor: D d w Applicant: Architect or.Engineer. Owner ' - = MAY 08 ------------ -- 2 J 011 fk CITY O '� 1 FINANCE DEP.rTA . ---------------------------------------------------=----------------------------------------------- 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 oftheLabor Code, for the performance of the work for which this permit is issued. ' • Date: Contractor: _ I have and will maintain workers' compensation insurance, as requiredbySection 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 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 become subject 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 and agree that, if I should become subject to the workers' compensation provisions of Section License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or - 3700 of the Labor CI de, I shall fo tw• h c ply with those provisions. ' that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by a(��pplicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars IS5001.: te: 0 S"OU_ 11 A nt: 11 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and IIID— the structure is not intended -or offered for sale (Sec. 7044, Business and Professions Code: The • WARNING: FAIL EURE WORKERS' COMPENSA ION COVERAGE IS 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 orofferedfor 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 - t - improve for the purpose of sale.). F - APPLICANT ACKNOWLEDGEMENT = (_ 1 I, as owner of the property, am exclusively contracting with licensed 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 restrictionsp et forth on this application. property who builds or improves 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 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 reason the owner, and the applicant, each agrees to, andshalldefend, indemnify and hold harmless the City 101 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. ate: 0'5 - Q — I2 • wne - 2. Any permit issued as a result of this application becomes. null and void if work isnot commenced • within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject CONSTRUCTI N 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 above information is correct. I agree to comply with all work for which this permit is issued (Sec. 3097, Civ. C.). city and county ordinances and state laws relating to b '(ding construction, and hereby authorize representatives of this county to enter upon th •above-mentioned prope y for (npec •di�yrp _ Lender's Name: . ate: � Si tura (Applicant or Agent(. Lender's Address: - \ LQPERMIT 1 Application Number 12-00000506 ~ ` Permit WALL/FENCE PERMIT ` Additional desc . Permit Fee . . . . 54:00 Plan Check Fee .00 Issue Date Valuation 2750 Expiration Date 11/04/12 Qty Unit Charge Per' Extension BASE FEE 45.00 1.00 9.0000 THOU BLDG 2,001.25,000 9.00 ------------------------------------------------------------_----------------- Special Notes and Comments 110 L.F. 6' BLOCK WALL AT REAR P/L & SOUTH P/L, CITY STANDARD. 2010 CODES. Fee summary 'Charged Paid Credited Due ----------------- --------- Permit Fee Total 54:00 .00 .00' 54.00 t . Plan -Check Total .00 .00 .00. .00 Grand Total 54.00 .00 .00 54.00 v + LQPERMIT eDoSow'edit Exl$tufrt 'woad f mee.. .� ...�:- mwnvu:�,..:s ... q'r�".uq�r.«u.vn„ r. f�ti+.es r•.:w.. "._ �e��•:c+%. �...� _ ... ,_ J,* 1%14 WA -11 loov *em ce or 4.t-; • � 6�'r the 5 •�, . ' � . � . mac'` 'brwe WIN \/ f CITY OF LA QUIIVTA BUILDING & SAFETY DEPT. ,APPROVE® FOR CONSTRUCTION DATE '1.8' 17, BY IL6� �� , .52iaia5 Akin.. L� Cl% -12253' r _F& ! -Af - w-?A_A_A,1 l� ®. a / I P.O. BOX 1504 LA QUINTA, CALIFORNIA 92247-1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT PROPERTY OWNEWS PACKAGE (7'60) 777-70.12 FAX (760) 777-7011 Disclosures & Pornis for Owner-B.411ders Applying for Construction Permits 1ARM-TANT1 MORCE TO >PQTR Dear Property owner. Aim. application .for a building permit has been submitted in your name listing youesel€ as the builder of the .property improvements specified at We are providing you with an Owner -builder A€lnlowledgment and Information Verification Form -to male you awn of your rospensibilities and Possible risk you may incur by hawing this permit•issuo in your name as .the Owner -Budder. We will not issue a building. permit until yo;u�have read, initialed your understanding of each.#mvislon, 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. Read and Mkial emit: statwrentbebow to signify you orver¢fythis Mforrnation. 1. 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 I, as p �. P��- an Owner -Builder, may be held liable and subject to serious. financial risk forany 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 Q.onm y property- 2- arty2. 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. . 3. I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potentialfinancial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. V) 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. n5. 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. .6- I .understand if I am considered an "employee' 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 Q� 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. 4-8. 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. i'r tides sustained by any subsequent owner(s) that result from any latent construction defects in the wortmnanship or materials. R 4J 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 (CMB) at 1- 800-321-CSLB (2752) or www.csib.ca.gov for more information about licensed contractors. U� 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: 11. I agree that, as the party. legally. and li"ocially responsible for this proposed construction activity, .1 will abide by all plicable laws and requirements that govern Ovifter-lluilders as well as employers. 12.1 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. U you contract with someone who does not have a license,. tare Contractors' State License Board may be unable to asst you with any finaaeial. loss YOU may sustain as a result of a complaint Your only remedy against unlicensed Contractors may be inleivit court- It is also important for you to understand that if an unlicens6d Contractor or employee of that individual or firm is injured while working on your property; you may be held liable fbr damages. If you obtain a permit as Owner -Builder and wish to him Conbutors, You will be Mponsibto for verdi ire vAtedter or not those Cortractors are propcdy lieensed and the status of'!'city workers' compensation irrsirrarrcre ooven ge. 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 issuitrg Um-pprmit Now A copy, of tke propel owner's Mver.'sl hoed ferns nwt nc or other verification aecept4le to the agency is Eequh-ed to be presented whentine pcvmit is issrW to ver(O the pmpen), owner's signature. Signature of property owner �I \�� Date: Note: The following Authorization Form is ceguired 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 OWNERS BEEF Excluding the Notice to Property Owner, the ex-owtion of which I understand is my persomal responsibility, I h¢reliy authorize the following persons} to act as my agents) to apply for, sign, and file the documents necessa fy to obtain "Owner -Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address - Name of Authorized Agent: I t4, 5 Tel No Address of Authorized Agent: I 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 presomed when the permit is issued to verify the property owner's signature. Property Owner's Signature:. Date: I . • F -� y r r' .. ara l� , .. - �• iaj t •� '� •.••T _ ,• _• • - - �. .. ,.. � moi►. ' - � , - � + .{ , - ., �. •, - � , �.. r • � 1�0��� C ^,I�`/`� J �: 1. ., _ obi,,„ �•: �._ � ^ �� �.� j ��,�, . � •.. w.�.t{_ ;j ` All, � - .• is • _ .{ F .. � t, �! �� - � r Bin.# Cf/ of La Qurnta Bulkiing 8t Safety Ahu6n P.O. Box 1504,78-495 Calle Tampico La.Qulnta, C4,92253 -:(760) 777-7012 Building Permit Application and Tracking Sheet Permit #! O \�` . J ProjectAddress: Owner's Name:. Q . �I L A. P. Number. n \ ' Address: 2 V Kt l e 0 - Legal Description: Contractor. ik,Telephone City, ST, Zip: i'A k f C` • 2 7 S u Address: X E 61 to D'Project Description: 11 c� L fT City, ST, Zip: b LoC VC tk) i4 t � ' . l� C k Q Telephone — ���— 0Z 3c}1' sr 4�% Llh-� SDtrt►�. 2 + State Lic. # : City Lic. Arch., Engr., Designer Address: City., ST, Zip: Telephone: "° • :. ., -Construction Type:. Occupancy: Project type (cu+cle one): New . Add'n Alter Repair Demo yy7 State Lic. #: �� Name of Contact Person: Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: Estimated Valine of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd 'Reed TRACIONG PERMIT FEES Plan Sets Plan Check submitted Item • Amount Structural Cates Reviewed, ready for corrections Plan Check Deposit. . Truss Calcs• Called Contact Person ' Plan Check Balance Title 24 Calci. Pians picked up Construction Flood plain plan Plans resubmitted. _ Mechanical Gi-ading plan 2' Review, ready for correctionstissue Electrical p . Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up H.Q-A. Approval Plans resubmitted Gradiag 61 HOUSE:- 7n° Review; ready for correctionsAss6c Developer Impact Fee Planning Approval Called Contact Person A.LP.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees - 0