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12-1217 (BLCK)P. _ BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 T4ht 4 4 " BUILDING & SAFETY DEPARTMENT BUILDING PERMIT. Application Number: c-`� 12-00001217 Property Address: 43546 PARKWAY ESPLANADE E APN: 609-380-999-74 -293234- Application description: WALL/FENCE Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 1850 Applicant: Architect or Engineer: --- - - - - - --- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm under penalty of perjury that I 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:. 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 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 ($500):: 1 _ 1 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.). 1 _) 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.). (_ 1 I am exempt under Sec. , B.&P.C. for this reason Date: Owner: CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perju at 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 VOICE (760) 77= FAX (760) 7 INSPECTIONS (760) 777-7153 Date: 10/11/12 Owner: PAMELA RODRIGUEZ 43546 PARKWAY ESP LA QUINTA, CA LA QUINTA, CA 922 OCT 111011 Contractor: Owner CITY OF I -A QUINTA ------------------- 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, hall forthwith co pl ith those provisions. Date:. N 21pplicant: WARNING: FAILURE TO SE 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 state laws relating to building construction, and he5by authorize representatives of this county to enter upon the above-mentioned property f inspection pu s . �Datei�to4{gpature (Applicant or Agent Application Number . . . . . 12-00001217 Permit . . . WALL/FENCE PERMIT Additional desc . Permit Fee . . . . 43.00 Plan Check Fee .00 issue Date . . . . Valuation . . . . 1850 Expiration Date 4/09/13 Qty Unit Charge Per Extension BASE FEE 15.00 14.00 2.0000 HND BLDG 501-2,000 28.00 -' ------------------- Special Notes and Co _,_ Comments 33 L.F. 6' GARDEN WALL & 41 L.F. 3' BLOCK WALL WITH 3' ORNAMENTAL IRON ON TOP, 4 12" x 6' COLUMNS.AND GATE FOOTINGS TO BE CITY STANDARD. 2010_ CODES. ---------------------------------------------------------------------------- Other Fees . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged Paid Credited Due Permit Fee Total 43.00 .00 .00 43.00 Plan Check Total .00 .00 .00 .00 Other Fee Total 1.00 .00 .00 1.00 Grand Total 44.00 .00 .00 44.00 LQPERMIT ... 10, P.O. Box 1504 LA QUINTA, CALIFORNIA 92247-1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT PROPERTY OWNER'S PACKAGE (760) 777-7012 FAX (760) 777-7011 Disclosures & Forms for Owner -Builders Applying for Construction Permits QIfT, 1YT! NOTICE UQ )PROPrII,TY OWNER Dear Property Owner An. application for a building permit has been submitted in your name listing yourself as the builder of the .property imp'mvements specified at `fie are providing you with an Owner -Builder Acknowledgment and, Information Verification Form to make you awain:of your respoesibilities and possible risk you may,mcur by having this permit.. issuedin your name as the Owner Builder. We will not issue a building, per until you, have read, iiutialod 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 property owner, obtain the prior approval of the permitting authority_ Read and initial each: statement hielow 1,6 signify you understand or verify this information. I understand' -a -frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder" Tuilding permit that erroneously implies that the property owner is providing his or her own labor and material personalty. 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 co-erage for injuries to workers o y/property. , I understand building permits are not required to be signed by property owners unless the are responsible for the kns uctionand are not hiring a licensed Contractor to assume this responsibility.y. 1 understand as an "Owner -Builder" I am the responsible party ofrecord on the permit_ I anderstandthat I may protect ffrom potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my o 1 understand Contractors are required by law to be licensed and bonded in California and tD list their license numbers on Is and contracts. r 1 understand if 1 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' der 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 overnment, withhold payroll taxes, provide workers' co nsation disability g compensation for each "employee." n ty insurance, and contribute to unemployment mp yee." I also understand 'my failure to abide by these laws may subject me to serious financial 'understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential tructures 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, er all of the work is performed under contract with a licensed general building Contractor. 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. injuries s+>staained by any subsequent owner(s). that result from any latent construction defects in the workmanship or materials. . I understand I may obtain more information regarding my obligations as an "employer" from the Internal 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 (CMD) at I- 0-321-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 party legally and financially responsible for proposed construction activity at the following address: 11. I agree that, as the party legally and financially responsible for this proposed construction activity,.l will abide by all ;.able laws and requirements that govern Owner=Builders as well as employers. I agree to notify the issuer of this form immediately of any additions; deletions, or changes to any of the informatioe l ave 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 lieease, the Contractors' State License Board may be unable to assist you with any finmeial 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 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 property 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 Ow. per miL Note: A copy of the property owner's dsiverIsliken sei farm notar-At 07mm, or other verification acceptame�te-tlt� agency wired to be presented when the permit is issued to verify the property owner's signature" / J w Signature of property Date: Note: The following Authorization Form is required to be compe 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 1 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 Name of Authorized Address of Autho Address: V h / Ca 1 �S3 Agent Tel lo7�p� �1 3 rrzed Agent: D\jf Ci 1�� 1 J t ot 01,?2s? I declare under penalty of perjury that I am the property owner for the address listed above and 1 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 ed Co be pr fed when the permit is issued to verify the prope owner's signature. Property Owner's Signa Date: f © RCJ Bin. # - - C[ LaC! �ill7 tC� City. 0� Q .. Building & Safety Division Permit # P.O. Box 1504,78 495 Calle Tampico La.Quinta, CA 92253 - (760) 777-7012 Building Permit -Application and Tracking Sheet Project Address:wner's Name: A. P. Number. Address: Legal Description: City, ST, Zip: Q JOcr i Contractor. Teleph e."�3sst''`a" Address: Project Description: p City, ST, Zip: j Telephone:I AN State Lic. # : City Lic. #.: jLAZ Arch En gr., Designer. . Address: City., ST, Zip: Telephone: :� �• Construction Type•VTccupancy: State Lic #: Project type (circle on New Add'n Alter Repair Demo Name of Contact Person:Sq. FL: # Stories. I c' #Units: Telephone # of Contact Person: Estimated e oTA 73 R Y1 APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES' Plan Selo Plan Check submitted Item Amount s _ Structural Cafes. Reviewed, ready for corrections Plan Check Deposit Ttuss Cates. Called Contact Person Pian Check Balance. Tide 24 Cates. Plans picked up Construction ' --- Flood'plalu -ion - — _P.laas-resubmitted= ------ -Mechanical — — ---- — Grading plan 2ie Review, ready for correctionstusue Electrical Subeontaetor List Called Contact Person Plumbing Grant Deed Pians picked up S.M.I. H.O A Approval Plans resubmitted Gradiag IN $OUSE:- '^' Review; ready for correetionsfissue Developer Impact Fee Planning Approval.Called Contact Person A.LP.P. Pub. Wks. Appr Date of permit issue School Fees - Total Permit Fees ,.. ps ° ♦ L �i • a ©WIN • .i I WANAl- IMF- F :® s E AKY Zg -C Y e 5 5 �U G All A S/I Q�� - _ ���:s.�J/ ei s h ups - - � - ---"� S 0 �i✓E 'ems 2 2�-" l IIII © Esc- 50K 5 A-_ ir}r; OFLAQIJINTIA o BUILDING & SAFM DEPT. DI PPR®V ® FOR CONSTRUC ON Ay�tib) 53 4 - (o 0 � 4 veA nV�� �Yel�% �n►-E�Y � :i�� 1 I 'e"1 WNWt`iglL {�IQb�JE DATE �� % BY� _ s g'. Ir )D"e"s oyG T SNE ° D -17 31c:-#9