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10-1138 (BLCK)6 P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application description: Property Zoning: Application valuation: Applicant: 10-00001138 54700 AVENIDA DIAZ 774-271-010-15 -000000- WALL/FENCE COVE RESIDENTIAL 352 ce4tit 4 4 Q" BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Architect or VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 10/29/10 Owner: HUBLCHRISTI1,1MNE E oo nv� i-4 Z Contractor: Owner --99-�-LpccIAITA CA Q2153 ------------------------------------------------------------------------------------------------_ 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 of the Labor Code, for the performance of the work for which this permit is issued. Date: Contractor: _ 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 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 C9 hall forthwith comply 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(�y plicant for a permit subjects the applicant to a civil penalty of not more Than five hundred dollars ($500).: Date: G '(U plicant: ( 1Y) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and _ Y\ the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The WARNING: FAILURE TO SECURE WORKERS' COMPENSATION 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 himself or herself through his or her own employees, provided that the DOLLARS ($100,0001. IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN improvements are not intended or offered for 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 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 I am exempt under. Sec. B.&P.C. for this reason CONSTRUCTION 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 ISec. 3097, Civ. C.). - Lender's Name: /� Lender's Address: f LQPERMIT 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 Ouinta, 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 hereby authorize representatives oft county to entee��ure r upon thbove-mentioned proper CC/ 1inspection purposes. ate: `6(Applicant or Agentl: S LQPERMIT Application Number. . . . . . 10-00001138 Permit . . . . WALL/FENCE PERMIT Additional desc . Permit.Fee, 15.00 Plan Check Fee .00 Issue Date . . Valuation 352 Expiration Date 4/27/11 Qty Unit Charge Per Extension BASE FEE 15.00 Special Notes and Comments INSTALL 46 L.F. 5' WROUGHT IRON FENCING TO SATISFY CODE CASE #10-5544. 2007 CODES. Fee summary Charged Paid Credited Due Permit Fee Total 15'.00 .00 .00 15.00 _ Plan Check Total .00 .00 .00 _ .00 Grand Total 15.00 .00 .00. 15.00 . LQPERMIT P.O. BOX 1504 Q LA UINTA, 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 R MOA-TANT! NOTICE TO gRQURTX OWNER Dear Property Owner. .,An. application for a building perput has been, submitted in ur name listmR list'yourself as the builder of the property improvements specified at H . C)o ► r c.,_ ffi(I. We are .providing you with an Owner -Builder iAclonowl gment and Information Veri€ication Form to make you aware of your responsibilities and possible risk youmay incur by having Ods, perzmt� issued in your name as the Owner -Builder. We will not Issue a building permit until you -have read, initialed 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. Oi &'S Aei ? I El Q1VW'4r AND VEREMATWROYETTEROMMAnON D&ECTIONS. dead and initial each statement below to signify you, understand or very this information. \,,a1. 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 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 propel'- J2- I understand building permits are not required to be signed by property owners unless they are responsiblefor the oetion and are not hiring a licensed Contractor to assume this responsibility.. QA3. I understand as. an "Owner -Builder" I am the responsible.party of record on the permit. I understand that I may protect myself 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 permrts and contracts. U-5- I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value omy construction is at least five hundred dollars' ($500), including labor and materials, I may be considered an "employee' 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 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 CA7. 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. 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. bouLdes suMined 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 "employer" from the Internal Revenue- Service, evenueService, 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.cslb.ca.gov for more information about licensed contractors. p10. I am aware of and consent to an, Owner -Builder building permit applied for in my name, and understand that I am the ay legally and financially responsible for proposed construction activity at the following address: Alt I agree that,. as the party legally and financially responsible for this proposed construction activity, .1 will abide by all app rcable lows and regiiirements that govern Owner -Builders as well as employers. CA2. I agree to notify the issuer of this. form immediately of any additions; deletions, br.changes to, 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,. flue 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 inicivil court It is, also important for -you to understand that if an unlicensed Contractor or eImployee 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 r€spmibie 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; he,;permit. Note: A copy of the property owner's diiver.'s teasei form nota*ado or other verification acceptable tothe agency.' is.requued to be presented whenthe permit is issued to. verify the property owner's signature. ' Si tyre of owne Date - CJ" p l 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. r;. AUTHORIZATION OF AGENT TO ACT ONTROPERTY OWNER'S BBHA—L Excluding. the Notice to Property Owner, .the execption of which I understand is my personal responsibility, I hereby authorize the followingpersons) to act as. my ageat(s) to_ apply for, sign; and foie the documents necessary. to obtain ar► 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 perjurythat 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, force 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: SITE REQUIREMEHM INTERIOR LOT SIDEYARD: 5 FEET REARYARD: 10 FEET MINIMUM FACH SIDE Ir�IrIIlviUM FRONTYARD: 20 FEET Ivi1NIMUM//' 'ROPERTY LUMS CURBLiNE Bin # Cit/ Of La Quinta Building a 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:�,5 q bb 77 7k z -Owner's Name: A. P. Number: Address: 5 L4 . > Legal Description: City, ST, Zip: Contractor:lz-Telephone: ( ' 4 '' P �..:. Address: City, ST, Zip: Proj t Description: ZK rfre Telephone: % < State Lie. # : City Lie. #.: Arch., Engr., Designer. Address:— y City., ST, Zip: Telephone: , •.•+• , a Construction Type: Occupancy: Project type circle one) New Add'n Alter Repair Demo State Lie. #: Name of Contact Person: Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: Estimated Value of Project: At 0 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 Cates. Called Contact Person Plan Check Balance Title 24 Cafes. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2" Review, ready for correctionsrissue Electrical Subcontoctor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- ''" Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees I I I I I ' Total Permit Fees I . COACHELLA VALLEY WATER DISTRICT CASH RECEIPT DETAIL Received Fero lm:, �. '/ �/� �� Address: "/ • 1 F��� Gl l� i,�� /T� _�� Account No/ �� �' �<� ��• �� Lot(s) g� Water Servlce'�l J2 Cashier CVWD-438 (11189) Service Address Check J Meter(s) /_/!i /i �✓ Service(s) /7 `❑ Backflow(s) ❑ House Lateral(s) ❑ DetectorCheck(s) ❑ Meter Surcharge ` Sanitation Capacity Charge ❑ W.S.B.F.C. ❑ Temporary Construction Meter r ❑ Turn on Charge ❑ Uncollected Account - Name ❑ Inspection Fee - Tract - Fee - ❑ Plan Check Fees Water I Sewer - Tract - 11 Bond Payment - A.D. - Bond Assmt. ❑ Customer Deposit ❑ Other Remarks: G.A. Code $��•�� TOTAL / D� ❑Copy to: • g� Water Servlce'�l J2 Cashier CVWD-438 (11189) Cash Check Money Order