Loading...
11-0115 (BLCK)• Applicant: Architect or E� Idle&: �F lw4�rw BUILDING & SAFETY DEPARTMENT BUILDING PERMIT LICENSED CONTRACTOR'S DECLARATION I 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: "'' 1 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, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended nr nffPrnd for sale (Sec. 704,1, Bucinocc and Profc3sionn 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 1, 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. forfhis r4ason Date: TNSTROCTION LENDING AGENCY I hereby affirm under penalty of perjury tha here is a construction lending agency for the performance of the work for which this permit is issued (Sec. 097• Civ. C.). Lender's Name: Lender's Address: LQPERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 2/01/11 Owner: JONES JODY / CHRISTINE --------------------------------- - Contractor: Owner ------------------------- f - - - 022011 C'OF. fA Frf-p�t�, QWNTA �'�RT WORKER'S COMPENSATION DECLARATION 1 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 P ' y Number I certify that, in the performanc the ork for which this permit is issued, I shall not employ any person in any manner so a o beco subject to the workers' compensation laws of California, and agree that, if I sho am s ject to the workers' compensation provisions of Section 3700 of the Labor , I hall fo h ' h comply with those provisions. Date: Applicant: WARNING: FAILUHt'1 U SECUR OR S' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO9RIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). INA DITION 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 stat*above tion is correct. I agree to comply with all city and county ordinances and state laws relatinon, and hereby authorize representatives of this court y to enter upon the above-mentioned purposes. Date: Signature (Applicant or Age Application Number . . . . . 11-00000115 Permit . . .. WALL/FENCE PERMIT Additional desc . . Permit Fee . . . . 108.00 Plan Check Fee .00 Issue Date Valuation . . . . 8875 Expiration Date 7/31/11 Qty Unit Charge Per Extension BASE FEE 45.00 7.00 9.0000 THOU BLDG 2,001-25,000 63.00 ---------------------------------------------------------------------------- Special Notes and Comments 355 LN FT X 6 FT HT BLOCK WALL PER CITY STANDARDS & APPROVED PLANS PER K.K. ---------------------------------------------------------------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged Paid Credited ---------------------------------------- Due ----------------- Permit Fee Total 108.00 .00 .00 108.00 Plan Check Total .00 .00 .00 .00 Other Fee Total 1.00 .00 .00 1.00 Grand Total 109.00 .00 .00 109.00 LQPERMIT _ Bin # City Of La Quinta Building 8i Safety Division P.O. Box 1504, 78-495 Calle Tampico . La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # Project Address: 7 / Owner's Name: 7" Demos A. P. Number: 0 _ S-. .00S Address: 4 062 7 fl Legal Description: City, ST, Zip: t�i4 9u�a Contractor: �OA 1 Telephone: i'g Address: Project Description: �lp �rqq City, ST, Zip: Telephone: iF :'.Si'i7,Ew{. •:"'.:::'':..:•�:a'a • wi i i� E�:,:iii:;k: ?tl�y�;�'%��v:�:sr<:�'sz; %?`:<%•<3: :i:j� ...y..1;S vi:>.'i•iir.'.'O�Z:: ii::yiy.T Alan State Lic. # : City Lic. #: Arch., Engr., Designer: ALO 60 Address: City., ST, Zip: Telephone: r.• ;.:,:; ,: <;: >> J:i 5••i:?;: :. P State Lic. #: ?"t :;s;:rlf; Name of Contact Person:s Construction Typa. Occupancy: Project type (circle one) New Add'n Alter Repair Demo Sq. Ft.: # Stories: # Units: Telephone R. cf Contact Person: $ q' 3 / (o Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING 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 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan V Review, ready for corrections/issue Electrical Subcoutactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- ''d Review, ready for correctionstissue 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 78-495 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 4VPQR-TAATt NOTICE TQ 1'ROPERTy OWNER Dear Property Owner. :An application for a buildinM7M-__ been submitted in your name i'stmg yourself as the builder of the property improvements specified at '416r, 6 Weare providing you with an Owner -Builder Acknowledgment and information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We wilt not issue a building permit until you have read, initialed yourunderstanding of each prevision, 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. OVMER'S AC1Q40WLEDGMNT AND VERIFICATION OF MOPMAMN DFRECTIONS. Read and initial each statement below to signify you understand or verify this information. 1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder' ding 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 Party 2. I understand building permits are not required to be signed by property owners unless they are responsible for the truction and are not hiring a licensed Contractor to assume this responsibility. #11 understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect MWlf from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. . I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on �e4s itand contracts. 5. 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 be considered an "employer" o 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 Y� emment, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment c mpensatioh for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. I 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 licensee subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performe< under contract with a licensed general building Contractor. F8. I understand as an Owner-Builder if 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. M9. I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue e cv , 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.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 am the arty legally and financially responsible for proposed construction activity at the following address: 4911. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all cable laws and requirements that govern Owner -Builders 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. 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 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 bice 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 Rcense; form notaV=dVn; or other verification acceptable to the agen . required to be presented %*en the permit is issued to verify the property owner's signature. Signature of property 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 understandis 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 the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: 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 rnancial or personal. byucies sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. 9. I understand I may obtain more information regarding my obligations as an "employee" from the laternal 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 -LB) at 1- 800-321-CSLB (2752) or www.cs(b.ca-gov for more information about licensed contractors. 10. 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the arty legally and financially responsible for proposed construction activity at the following address: agree that, as the party legally and financially responsible for this proposed construction activity, 1 will abide by all lir-able laws and requirements that govern Owner -Builders 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 1 have provided on this form- Licensed contractors are regulated by laws designed to protecf 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 firm is injured while woriang on your property; you may be held tiable 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 eoverage. 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. am permit Note: A copy of dw property owner's Mver's Reense, farm xotarnadi ; or otker verification acceptable to die • requiri( to be presented when dw permit is immW to verify the property owner's signature. � - Signature of property 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 following person(s) to act as my agent(s) to apply for, sign, and file the documentsnecessary to obtain an Owner -Builder Permit for my project: Scope of Construction Project (or Description of Work): Project Location or Address: Name of ?kuthorized 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 abov 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 the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: - ^r .4 ' 7 t M-EN04MARK fTUH 100.08) I (N 00'05'57 W) .� CA'LLE RONDO. (101) EXISTING SIDEWALK + Fo -'(101 ` (108.51') (N 00'05'5(1 W) FG 101.5 A6 EX PP --0.5x--- 0.5R - •0 - EXISTING � I ) HP FG 102.5 _ _______ __ __ BUILDING SETBACK UNE (TYP) 11 sr _ 1 102.0 \ dls _ F5 102: I I FS 102.14 r� •.. ( \/ _-27[ OC 102.2 5 �•'J F 102.5 1 ( - \I /. 7 SPA I 102.97. 104 ;} 1 LOIS' 137 ' 1 FF 103 k7 PE 1Oro.00 4 POOL 3.00 i 'dam • (TAH I .53) -91'34.3(" K _ p 1 ;.)7•.'. FS 102.58 R-20.00 I /`,7J( ; FS'10E.9 L-31.97 ..• FF 1 • T-20.58) IST � ..) ',N. ' •50t.. FOR SIGNr _. '.. �p II � g, O o I TC $ .. TGW 1 O I ! I 1 I _ i O'+/ 101. c o I TF ,01.00 0~ TF 101. 0 . =� I I • B7L I • FS 102. 6J'. 101.89 • x I FF 17 i FS 103.13 FS 1 17 _ _ _ FF 10 17 FS 103. 3 TOPOF SLOPE ............ e 2 Z 101.18 EXISTING SEWER UNE . . . . . . . . . . .. 1 ImL - 10 M 1101 8, I � FS 101.20 i LEGALL/G �T.TIIr 1 MN °1 .m �. •: r f p {'. . • v I POOL EQUIPMENT �. INFECTION FS 101.32 LOT COYRIAGE: IOTA LUT NEA- 12.I H 1.19 B' t9rAL BULLDIts ARE(CDVM PATIO AID WWa On=) . 4,289 ST LOT WKRAff (POICENTALE) - 0-2'28'4- is R-1839.20 I L-79.55 ((I •�•�r-r11 T-39.78) I TGW 108. m r� P 101.41 (N 00'05'57 W) .� CA'LLE RONDO. (101) EXISTING SIDEWALK + Fo -'(101 ` (108.51') (N 00'05'5(1 W) FG 101.5 A6 EX PP --0.5x--- 0.5R - •0 - EXISTING � I ) HP FG 102.5 _ _______ __ __ BUILDING SETBACK UNE (TYP) 11 sr _ 1 102.0 \ dls _ F5 102: I I FS 102.14 r� •.. ( \/ _-27[ OC 102.2 5 �•'J F 102.5 1 ( - \I /. 7 SPA I 102.97. 104 ;} 1 LOIS' 137 ' 1 FF 103 k7 PE 1Oro.00 4 POOL 3.00 i I 'dam • Io 90 ii5,}J K _ p 1 ;.)7•.'. FS 102.58 1 I c1� � .. a •{ ; FS'10E.9 m•. 104.99 ..• FF 1 • � 1 � ..) ',N. ' •50t.. FOR 'a: '��.�r _. '.. �p II � g, O o FL 101.54 TC I .. .� I ! I 1 I _ i O'+/ 101. T� I: 10•+ - TF ,01.00 0~ TF 101. 0 . =� 1 I • B7L I • FS 102. 6J'. 101.89 • x I FF 17 i FS 103.13 FS 1 17 _ _ _ FF 10 17 FS 103. 3 TOPOF SLOPE ............ e 2 103.17 EXISTING SEWER UNE . . . . . . . . . . .. 1 ImL - 10 M 1101 8, ':{ It• 03.00 i LEGALL/G �T.TIIr 1 MN °1 .m �. •: r f p MfASDE COUITY, STATE OF CAIJUF t I I u v I POOL EQUIPMENT �. I 'dam • 1 ( wE FF 1 C E WALK _ p 1 ;.)7•.'. FS 102.58 =0.050 TGW 108.00 T. 108.50 N TCW 108.50 TOP OF GARDEN WALL ....... : ..... TRW 103.00 20.1 B' EW FINISHED FLOOR ELEVATION........... 1 MR ONE BL 02.0 1 FOR I M- TF 102.00 (124.70')-. TOP OF CURB ............... o FL 101.54 INV 10 r I FG TCW 100.50 TRW 10,.50 I ! I 1 e _ i O'+/ 101. T� 1 I 10•+ - TF ,01.00 0~ TF 101. 0 . =� VM SEWER LATERAL.......... GRAPHIC SCALE PUBLIC LMLITY EASE)AENT. . . . . . . . . . . . SETBACK UNE ................. _ _ _ FLOW GRADE ................... TOPOF SLOPE ............ TOE OF SLOPE ...... EXISTING SEWER UNE . . . . . . . . . . .. 1 ImL - 10 M i . . W GARDEN WAIL ............ ..... r i LEGALL/G �T.TIIr 1 MN L(07 138 (RESIDENCE) UO1T T 39 (RESIDENCE) LECOM TOP OF RETAINING WALL . . . . . . . .. . O.SIG FINISHED SURFACE ............... =E E WALK N -UNE (N 0005'57_W - --.RET 1'.MAX-- -- - - - =0.050 TGW 108.00 T. 108.50 N TCW 108.50 TOP OF GARDEN WALL ....... : ..... TRW 103.00 TRW 103.00 TRW 103.00 FINISHED FLOOR ELEVATION........... 1 0 0 PROPERTY UNE ................. TF 101.50 TF 102.00 TF 102.00 TOP OF CURB ............... LO4 136 TOP OF FOOTING .. ...........TT: 103 FG TOP OF GRATE ..................TG e r ())OUO()......................EXIST. ELEV. L(07 138 (RESIDENCE) UO1T T 39 (RESIDENCE) LECOM TOP OF RETAINING WALL . . . . . . . .. . . ..TRW FINISHED SURFACE ............... FS HIGH POINT . . . . . . . . . . . . . . . . . . . HP LOW POINT ...................LP GRADE BREAK . . . . . . . . . . . . .. . . .. GB INVERT . .. .. . . . .. . . . . . . . . . . .DN TOP OF GARDEN WALL ....... : ..... TOW PAD ELEVATION ................. PE FINISHED FLOOR ELEVATION........... FF FLON'UNE . . . .. . . . . . . . . .. . . .. . FL PROPERTY UNE ................. - PL - CLEAN OUT .................... C.O. TOP OF CURB ............... TC TOP OF FOOTING .. ...........TT: FINISHED GRADE ................. . FG TOP OF GRATE ..................TG END OF PAVEMENT . . . . . . . . . . . .. . . EP ())OUO()......................EXIST. ELEV. RIGHT OF WAY .. . . . . . . . . .. .. . . . . R/M' PLANTER AREA .................. PA WATER METER .................. VM SEWER LATERAL.......... . SL PUBLIC LMLITY EASE)AENT. . . . . . . . . . . . SETBACK UNE ................. _ _ _ FLOW GRADE ................... TOPOF SLOPE ............ TOE OF SLOPE ...... EXISTING SEWER UNE . . . . . . . . . . .. . . .S EXISTING WATER UNE . . . . . . . . . .. . . W GARDEN WAIL ............ ..... . ' REFAINING WALLLL.............. .... LEGALL/G �T.TIIr 1 MN LOT 132 OF DOW CLUB TRACT LOU NO. 5. AS %M N NAP BOON 21. PAGES 01, OFFICIAL RECORDS OF MfASDE COUITY, STATE OF CAIJUF t OUW7AY APPROACH RMXIII S A SEPARATE PEAIIT AND INFECTION FRMI CITY IF LA ODNTA FU LIC Ip95 DEPARIIEIR LOT COYRIAGE: IOTA LUT NEA- 12.I H 1.19 B' t9rAL BULLDIts ARE(CDVM PATIO AID WWa On=) . 4,289 ST LOT WKRAff (POICENTALE) - 33.9 i OWNER/DENT My NO O1DSruc .A6 4"V VISTA TIERM (M))72�2-LI'49 ALTA VISTA WJI TING ! DESIGN 943 EAST I00E1TMO ST. A 8N81RA, CA 93103 905)W3I99 ENQINEER ESL EICINO IN 79-M CCU AYI9D, STE 102 lA )771A, G 97757 (790)721-0993 + �Y. PA TYPICAL WALL 8ECTION Arc