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10-1376 (BLCK)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 10-00001376 Property Address: 52390 AVENIDA DIAZ APN: 773-252-024-17 -000000- Application description: WALL/FENCE Property Zoning: COVE RESIDENTIAL Application valuation: 2165 Applicant: Architect jor, Engineer: 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: 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).: () 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 Cont!!!!.Sta license Law.). 1 _ 1 1 am exempt under Sec. .C. for this reasom,^!>., A - Date: Owner: CpNSTRUCTION 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: LQPERAIIT Owner: STOKER JASON 52390 AVENIDA DIAZ LA QUINTA, CA 92253 ( VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 12/17/10 Contractor: Eijt;t�j Owner �-. F r.'" "�ja,1� tlF A ----------------------------------------------— 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 ' `I ,3,700 of the Labor Code, [I►ssha11 forthwith ply with those provisions. Date: 1 Applicant: �Asii TO 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 th t above informati 's corre t. I agree to comply with all city and county ordinances and state laws relating to buil g construction, n re authorize representatives of this coun y to enter upon the above-mentioned pr erty or inspection p Date: 119 Signature (Applicant or Agent): Application Number . . . . . 10-00001376 Permit . . . WALL/FENCE PERMIT Additional desc . Permit Fee . . . . 54.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 2165 Expiration Date 6/15/11 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 100LN FT X 5 FT HT BLOCK WALL.& 8 COLUMNS 5FT HT PER SITY STANDARDS AND APPROVED PLANS PER A.J. ---------------------------------------------------------------------------- Other Fees . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary ----------------- Charged Paid -------------------- Credited -------------------- Due Permit Fee Total 54.00 .00 .00 54.00 Plan Check Total .00 .00 .00 .00 Other Fee Total 1.00 .00 .00 1.00' Grand Total 55.00 .00 .00 55.00 LQPERMIT me -40- Raff, rii_ , P.O. Box 1504 LA QUINTA; CALIFORNIA 92247-1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT PROPERTY, OMNEW S PACKAGE (760) 777-7012 FAX (760) 777-7011 Disclosures & Forms for Owner-B.uIIders Ap�Tng for Canstructian Permits TANTI go (IUM � 1q ..Dm Preperty Owner .Ari. application for a building permit has been submined in your name listing yourself as the builder of the property -impmM menta specified at We ase providing you MA an Owner -Builder Adm&Wl ent and- In&imation Verifreation Form to make You Maw Of your ' mVenstbilities and po"ible ristr-yoir may incur by having thispermrit-ice in your nun as the Owwx-Budder. We Will not issue a building -permit tines you have gid, Initiated your und+exstaudfng of each PVaVblon, signed, and returned this form to its at our otIleial address indicated. An agent of the owner cannot er ante (bisnotice unless you, the property owner, obtain the prior approval of the permitting authority. DfitFX, t7NS- Riead md i+&kd each stawnw betsvw tisigmfy you widwstandervW0 dais k0r adon. 71. 1 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 materia# petson&ft— 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 caverWge 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 y property - I understand building permits are not required to be signed by property owners unless they are respo=ible for the (T3 ction and are not hiring a Licensed Contractor to, assume this responsibility. I understand as an `°Owner -Builder" I am the responsible: party of record on the permit. I understand that I may protect from potential financial risk by hiring_& licensed Contracto�nd_havingAke_petmit f led in his or her nam instead of my own. 4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on rm its and contracts. 5. I 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 "employee' under state and federal law. 6. l .understand if I am considered an "employee, under state and federal law, I must register with the state and federal ernment, vs�["ald payroll taxes, provide workers' compensation disability insurance, and contribute: to unetnPloyment• compensation for each "employee." I also understand my faihrre to abide by these laws may subject me to serious financial 7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential s ictures 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. r'. 8. 1 understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any ancial or personal. houdes tamed by any subsequent owners) that result from any latent construction defects is the workmanship or materials. Qk19. I understand I may obtain more information regarding my obligations as an `employer" from. the > I� l Oeenua Service, the United States Small Business Administration, the California Department of Benefit Paymetzt t' and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (C-R) at I- -321-CSLB (2752) or www.esib.ca.gov for more information about licensed contractors. 10. [ am aware' and consent to an.Owner-Builder building permit applied for in my name, and understand that I am the party legally and fimcially responsible . for proposed construction activity at the following address: AD -1 L I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all Nk licable laws and requireiuehts that govern Owner -Builders as well aS employers. 412.1 agree to notify the issuer of this form immediately of any additions, &cloth M,'of cigirgee totay of the iddranfich I veprovided on this form. Licensed contractors are regulated by laws designed to protect the public. If you o.oatract with someone who downot have a heense, the Contractors' State Liogrse Board may be unable to. asma`you with any flnandtd loss . . You may sustain as a result of a complaint. Your only remedy against urilicensW Contractors may be 'civil court- It is also importaat for you tounderstand "if antrabicansed Contractor at employee of that individed of firm is injured while on your property, you may be hW lie for damages. If you obtain a permit as Owner-BuiWU and wish to hire C08U"tors, you will be .respousiMoi for ve&jirtg vkahw or not those Contractors are property &eased mad dm stems of tbsir walkers' Coon iW� voverage. 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 Invft. #w-Vw=tL NoW A cop} of tker properW owra's diivaft i fam n"a*Oh"4 or other verification aeceplabk to the agansy is r'ulred to be presented when the Pew is sawi tomi3' the pvp" owner's signature. . Signature of property owQer Date `Z Y) Note: The following Authorization Form is required to be completed by the property owrur only when designating an agent of the property owner to apply for a construction pet7nit for the Owner -Builder. Excluding.the Notice to Property Owner, .the execlrtion of which I understand is my personal tesponsibility, 113areliy authorize the following persons} to act as my agents) to apply for, sign, and file the documents necewarY. to obtain an Owner -Builder _ Permit. for my nro* _ — 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 eer* its accuracy. Note: A copy of the owner's driver's Hcense,form hotariaation, or other verification acceptableto the agency is required to be presented when the permit is issued to verify the property owner s signature - Property Property Owner's Signature: Date: AVENIDA DIAZ Bin # City of La Quinta Building 8T 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:. 5 v ewi DA 17 I k} -e— Owner's Name: 2—a S o --� �K�L A. P. Number: '773- 2,5Z ' 0 7 L — Address: q2 g A✓ e , D t A --�-- Legal Description: City, ST, Zip: .-A 61.11 nTa Co , �'j22� 3 Contractor: �, �j , Telephone: . Address: ProjectDescription:: 100 •, S 9ir.0CV— City. ST,. Zip: _R�,O 44Z- ( Telephone: City Lic. #; �U, Y 5.1 State Lic. # : e vLV ,,r n S Arch., Engr., Designer. Address: City, ST, Zip: Telephone: Construction Type: Occupancy: State Lic. #: Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person: ;A Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: '"' Estimated Value of Project: p "— APPLICANT: DO NOT WRITE BELOW THIS UNE a Submittal Plan Sets Req'd Reed TRACKING PERMIT FEES Plan Cheep submitted Item Amount Structural Cates. Reviewed, ready for corrections Plan Check Deposit Truss Cala. Called Contact Person Plan Check Baku". Tide 24 Cala. Plans picked up Construction Flood plain plan . Plans resubmitted Mechanical Grading plan V Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.L H.O.A. Approval Plans resubmitted Grading IN HOUSE:- 3" Review, ready for correctionaftsue Developer Impact Fee Planning Approval Called Contact Person A.LP.P. Pub. Wks. Appr Date of permit Issue School Fees Total Permit Fees