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13-0002 (BLCK)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 13-00000002 Property Address: 53650 AVENIDA DIAZ APN: 774-112-028-20 -000000- Application description: WALL/FENCE Property Zoning: COVE RESIDENTIAL Application valuation: 2500 Applicant: Architect or Engineer: 4 VOICE (760) 777-7012 FAX (760) 777-7011 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 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).: ( 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 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. 9on r Date: � I �/ Owner: CONSTRUCTION LENDIN 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: IV LQPERMIT Owner: TIM MCCLURE 53620 AVENIDA DIAZ LA QUINTA, CA 92253 ----------------------- Contractor: Owner A.- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - — WORKER'S - Date: 1/02/13 ----------------------------------------------- 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 su ject to the workers' compensation laws of California, and agree that, if I shou come je to the workers' compensation provisions of Section , q %3700 oft a L b de, hall w' com ly with those provisions. / J Q r /v " pplica . WARNING: FAILURE TO SE USE WORKERS' COMPE SATION 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 Quima, 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 c ct' d hereby authorize representatives PJ of this county to enter upon the above-mentioned grope r in c ' roses. Place: L zalmature (Applicant or Agent):4V 7 Application Number . . .. 13-00000002 Permit WALL/FENCE PERMIT Additional desc . Permit Fee . . . . 54.00 Plan Check Fee .00 Issue Date . . . . Valuation 2500 Expiration Date 7/01/13 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 100 L.F 6' GARDEN WALL IN (2)SECTIONS TO COMPLETE EXISTING, CITY STANDARD. 2010 CODES. ---------------------------------------------------------------------------- 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 -,t btL%ting B,Icick Wall Add New, & ail :Tkvo fifry fa -at sections 53&% Aven'ita Diaz Triple lat w.ithibouszoin center. P.O. BOX 1504 LA QUINTA, CALIFORNIA 92247=1504 78-495 CALLE TAMPICO LA QUINTA,. CALIFORNIA 92253 e # i J BUILDING & SAFETY DEPARTMENT PROPERTY OWNER'S PACKAGE (760) 777-7012 FAX (760) 777-7011 Disclosures dt Forms for Owner-Buliders Applying for Construction Permits MEMUNT1 CR Tn Puna Effy Dear Pnaperty Owner: Aa. apxtion for a building permit has been m your name Inting yourself as the builder of the pity improvements specified at �, S'O 4-V We are goviding you with an owner -Builder AcimawledMeat-aad labormatien Verification Forua to make ym &vim of Your eespeasrbi hes and possible risk you may incur by having this permit issued in your nameas a the Oeroes-Builder. Wt will not issue a buRding.permlt anti! �-Itave read, init�d year. a�erstanding of Ck--pW 4Aon, signed+ and returned this form to us at our efflcial address indicated. An agent of trhe owner cumot execute dds notice unless YOU, the property owner, obtain the prior approval of the permitting authority. -E0QW_M AND' W- &IMN QF BffgfflAi'WN DTULL'MNS: Read and witoai earls statmav bdow.l b signify you twrda 3vind or very dw arformatron_ L I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Budder" ding permit that erroneously implies that the property owner is providing his or her own labor and material pezvonaky- 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 homoowner's insurance may not provide coverage for those injuries. I am ` dlfullY acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers on Y pr OP�*)' '2. I understand building permits are not required to be signed by property owners unless they are responsible for the co tion and are not hiring a Licensed Contractor to assume this responsibility. Amli I understand as an "Owner-Builder"I am tideresponsible party of record on the permit. I understand that Imay protect from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name 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 permits and contracts. -10+5- I 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" and to and federal law. iI understand if I am considered an "employer" under state and federal law, i must register with the state and federal geov ent, 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 understand under California Contractors' Owner - Builder tors' 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 performer under contract witha licensed general building Contractor. 69. 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 ial Or. personal. i4wits sussained by any subsequent owner(s) that result from any latent construction defmts in the woriananshp or materials. I understand I may obtain more information regarding my obligations as an "employee' from the intro al Revenue 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 MIA at 1- 800- 1-CSLB (2752) or www.cslb.cagov 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 p legally and fiaiancially responsible for proposed construction activity at the following address: aaiee that, as the party legally and financislly responsible for this proposed consuwtion activity, I will abide by all cable laws and roquiren*nts that govern Owner -Builders as well as employers. M642- I agree to notify the issuer of this form immediately of any additions, deletioaan, or cht qp b any of tlw bikirmatim I veJf Provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you venhiw with somooae who door not have :license, than Contractors' State License Board may be unable to =eW you with my fim=W loss You may sustain as a result of a complaint Your only remedy against unlicensed Contractors may be in civil oomt. It is also for You tor• tmdastaud that if an uWkeused Contractor at employee of the w&vidaal at tirm is wjund while worlong on your property; you may be kcid mbk ft damagss. If you obtain a permit as Owwr-BWMa and with to Aire Coobsctors, you will be reapoiiekk boa Mttflft V&dba of not those CoatracWrs are properly licensed and the :lata: of dow WWktrs' oompe=ation i1WAM0e Coverage. Before a building permit eau be neared, this form must be completed and signed by the property owner orad retwmed to the agency respoudbie for kstif.ti,s.parasit, NOW A copy of Ae pr+gp" *wows AirmIsAwasaq farwa mInkaillim or other verykaden accept" to die agency is aegadred to be presaated when ire powde is issued to tw * die property owner's signaAwu. Signature of property owns /Y� Date /T7/Z7 1,072— 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 sigm iture. Property Owner's Signature: Date: Building a Safety Division P.O. Box 1504,78-495 Cafie Tampico La.Quinta, CA 92253 -:(760) 777-7012 Building Permit Application and Tracking Sheet Permit # Project Address: 15 3 6 5 0 Owner's Name:---t/ki i` A P. Number. Address: Legal Description: City, ST, Zip. Contractor. �/ " r�x .s� Address: Project Description: City, ST, Zip: Telephone: State Lic. #: City Lic, it, //��. • 1-A 6. I'V8 T szc. I&, G V G L f h f Arch., E V., Designer _ •� Address: �.�4""4 r!' I City., ST, Zip: Telephone: State Lic. #: Name of Contact Person. M c C L q ✓1- t Construction Type: , Occupancy: Project type (circle one): New Add'n Alter Repair Demo Sq. Ft.: # Stories: #Units: Telephone # of Contact Person: 1 Estimated. Value of Project: APPLICANT: DO NOT WRITE BELOW THIS UNE p Submittal Req'd Seed TRACKING PERMIT FEES Plan Sets Plan Check submittedItem Amount Structural Calor. Reviewed, ready for corrections Pfau Check Deposit. . '[cuss Cala. Called Contact Pcrsou Plan Check Balance Title 24 Cales. Plans picked cep Construction Flood plain plan Pians resubmitted MCCharikal Grading pian 2'4 Review, ready for corrections/issue Electrical Subeostaetor List Called Contact Person Plambing Grant Deed Pians picked up S.M.I. ' H.O A. Approval Plans resubmitted Grading IN HOUSE:- 7id Review; ready for corrations/issue Developer Impact Fee Planning Approval Called Contact Person A.LP.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees