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12-0398 (BLCK)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 - c&ht 4 4 Q" BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Application Number: 12-00000398 Owner: Property Address: 77775 CALLE DURANGO JUAN J ZAVALA APN: 773-231-001-22 -00'0000- 77775 CALLE DURANGO Application description:. WALL/FENCE LA QUINTA, CA 92253 Property Zoning: COVE RESIDENTIAL -------------------- Application valuation: 1500 Applicant: Architect or Engineer: m„mpJ✓ �k LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I em licensed'underuprovisions of Chapter 9:(commencing:with Sectiori`7000) of`Division '3 of the Business and Professionals:Code, and my License is in full force -and effect. License Class: License No.: Data: Contractor: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that 1 am exempt from the Contractor's State,Ucense Law for the following reason. (Sec. 7031.5, Business and Professions'Code: Any city or county that requirss.a.permltto construct, alter, improve, demolish, orrepair 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 a is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any pplicant for a permit -subjects the applicant to a civil penny of not more than five hundred dollars (9500).: (F1 1, as owner of the property, or my employees with wages as theivsole 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 town owner of property whobuilds or lmproverthereon, . and who does the work himself or herself throughhis or her own employees, provided that the improvements are not intended, or offered for sale. If, however, the building or improvement lasold 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.): ' t_ 1 I am -exempt under Sec: , B &P.C. for this reason Date•. ✓ /Owner 2,do wo (/ 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 (Sec. 3097, Civ. C.). Lender's Name: Lender's.Address: LQPERMPP Contractor: Owner ------------ - - - - - - - - ----- - - - - - - - - - - - - - - -------- VOICE (760) 777-7012 FAX (760) 777-7011. INSPECTIONS (760) 777-7153 Date: 4/12/12 ------------------------- "''r541 ------- WORKER'S COMPENSATION DECLARA Ihereby affirm under penalty of perjury one of the, following declarations: _ I have and will maintain a certificate of consent to self -insure for workers' corn tion, 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 works& compensation insurance carrier and policy number are: Carrier Policy Number 1 certify that, in the performance of the work, for which this permit. is: Issued, I shallnot 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 subjeot'to-the workers"compensation provisions of Section 3700 of the Labor Code;; I shall, forthwith comply with those provisions. Date plicam: ��(/�/% # Ll_"I - WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL; AND SHALL SUBJECT AN EMPLOYER'TO CRIMINAL PENALTIES AND CIVIL FINES UP TO'ONItHUNDRED THOUSAND DOLLARS (0100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE, INTERESTj AND ATTORNEY'S FEES. APPIJCANT-ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director. of Building and Safety fora permit subject to the conditions and restrictions set forthon this application. 1. ,Each person upon whose behalf this application. is made, each person at whose request and for whose benefit worksis performed under or pursuant to',anypermit 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 Quints, its officersragents and employees for any act or omission related to -the work being performed under orfollawing 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 that9 have read this application and state that the above information is correm I agree•to complywith all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter upon the above-mentioned property for inspection purposes. �J Date: iq/.J_ruvture (Applicant or Agent): PE L,QrexMrr Application Number . . . . 12-00060398 Permit. . . . WALL/FENCE PERMIT Additional desc . Permit Fee . . 35.00 Plan Check Fee .00 Issue Date Valuation . . . . 1500 Expiration Date 10/09/12 Qty Unit Charge Per Extension BASE FEE 15.00 10.00 2.0000 HND BLDG 501-2,000 20.00 -------------------- - -- Special Notes and Comments BRICK WALL, SURROUNDING HOUSE. ORCO STANDARD. 60 L.F. X 5"-6" HIGH. 2010 CODES. -------------------_----------------------------------------------- Other Fees . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged Paid Credited Due Permit Fee Total 35.00 .00. .00 35.00 Plan Check Total .0.0 .00 .00 .00 Other Fee Total 1.00 .00 .60 1.00 Grand Total 36.00 .00 .00 36.00 Ham CITY OF LA QUINTA BUILDING & SAFETY DEPT. APPROVED FOR CONSTRUCTION DATE i a BT�- f�Dov abo w x t2' K -Ag a- in. MA �Vwawa. P.O. BOX -1 304 LA QUINTA, CALIFORNIA 92247-1.504 .78-495 CALLE.TAMPico LA QUINTA, CALIFORNIA 92253 BUILDING $ SAPETY DEPARTMENT PROPERTY O'4' MR" S PACKAGE (7:60) 777-7012 FAX (760) 777-7011 D sc[ostlres &Forms for Owner-BuRden Anlybg for Constmetion PaWts AM= MUNZY OWN= DOW Pavony Owoec: An: WhOdice for a building permit has beer sulmautoed in ym now1 Ig yoro�atf as dobwlder of de pmpesty SPecified at : ' a @owldag Yoer VO as Qarn�ez-8w7dat paoimawted�teat and laws V Foam W Winn ra sveais of your Owaw4h itias and R bk` lW may M by O�uiao-Builder. We �i'=°0►t• hM � °tee ss tha : � n .p�iCl rms rwbeve read, yaw• secure of eaail sd�d+ and ret reed " form tv ns at oetr.otRdal address hW=tvL An agent of the oweer cannot exeoate Sh arbor ups Yom. the'p"_VC0Y owm, obtain the prior appwval of flue peaew&AWg mono ity. li�ead.esa &sitiat ft'a* SMMMVW6til�rw'�r ' yxra V-0-4 s Wer -hind a flreq. Plactim of unlioeased ��� permit that . Pew is to: have the pmporiy owner obtain an "Owno�r Bim' aroaooesly implies �t W the property owner is Providing his or hex own labor and person L as an Owner -Builder, may be held liable and subject to smous financial risk for any i* ries sustained by an un iaeased pesos and Lis or ber employers wb& iq}uries. I am wiLfy� �"affin8 on my property. my homeowner's ir>suraaoe may not p�cervida c°rot'a®e fOr chose Yacting as an Ow= Builder and an aware of theaimiw of my wee coverage For,injuries to wafmn oa my peopcaty, `j 1 . I understand building Permits am not raelnirod to be ApAd b oosslr>rctie►n alxl era not Y property owners unless they are >v�oasible tier � a liomnsed Contractor to assume this roa�oe . I as ani "wraor-Boilda"'i am:*e le:.Party of eeoad on y Peote myself Mesio potential 6aandal nisi£ b . own Y >k licensed Cont acro: and wring a permit:£fled jn 1q of Lar nasus instead oto I understand Contractors are required by-law to be licensed and bonded in Ca4fornia and to list their Ficem numbers permits and contracts. LL -3- I Mand if I esrlploy or otherwise engage any'pe mos, other than California licensed Coauactors, and the total V1 of my construction is at least five hundred dollars ($500), including labor and .materials, I may be considered an "=Wlo; ender state and federal .law. �6. 1 MWevftnd if I.-. considered an "employer" uadex state and Adexal lsxr< I must register with the VIA", and to Wit, withhold payroll taxes, provide wad ee s' compensation disability i MUUMM, and ooDIibtrte to usumploy compensation fbr each "employee." i also understand my failure to abide by these laws may subject we to se Twos Prna risk- . /. [understand under California Contractors' State_ License Law, an Owner -Builder who builds single-family resid structures cannot legally build. them with the intent to offer them for sale, unless all work is performed 'by lir subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is pe tf under contract with a licensed general building Contractor. 8. I understand as an Orvnar-BuMw if I sell the property for- which this permit is issued, a may. be Wd F"16 ,for My :financial-orpenondbodes by.any sAsoWm owvn*i) that.'resA from any latent ooh dd Wts' in the � � . •; I understand I may obtain :iiom information regarding my 'obligations as an -awwyo " fim' Swease Servioc. tbt United States Small Business Administration, the C Mreia Dq wtwW of S o & Pgmcdt t, and California Division of In&=bW>Accidents. I•abo understand I may conUd the C4&n in Contractors' State Licem Bawd (CSM at V- NO -32 1 -aLB =800-321-CSLB (2752) or www.ca.ca.gov for more information aboat licensed eeauvoW a• 0. I am aware of and consent to an Owner -Builder building permit applied for in,my name, and'uader�*at I am'the. ply k8uy and &nanciagy vespotdrle for rq?wed eoastratuen activity at the following address: I. I age that, as dw WKy kpuy and fmawidlly mW� nsible %r this propoaod non activity, i will abide by all k law: 1W totptiremetrts that govern Omer Btdtdecs as wog as employers. 2. I agnea to notify the issuer of this : form immediately of any ammbw. . ddoti=% or'dtaaW 1V4ryr of do idummim I have provided on this form.. Licensed oasteacm are replaced by laws de*pod to protect d a Oft- I yon enc with soaaaooe wbo,does not boo a asawk tato Cbmeaetors' St .w. Lim me 8oaed say be amble ea =1W Iogitr. with SW *MOM loss you'teary amastia as a malt of a Yow only remedy agaim un iceemd C4attsotoft mW be iawevH'WML is is aho ibop�ocI I Bar you of *l W&it W or &w is its vAdb woeiiirng on 7W Pity. )Vu may be hdd NWW.Nr duagm if ym -a powk as Owww4ftAft sad arm WO Oaotpeoiors, you wiH�be fw vujrjbgj or SM t ose Ceww omtm we peg* seen ed and *a A"' Qdww wo>ms' -eon iae�aoe oo�age,. . Beamer a btt k&g prumit,ean be be"* a& tensa mast be completed and by foe prnparty owaw a>id Meted to the agond7 for isatdlig t#ta @emit. liber Ace" gf d w prrop odfrer nmoegttdbds err slit b t�egadk�ad m hawainaoiiert �e pt�adt t " owaar'8sjgat�e. &gM*WQfPMPCdY o,.maf�,�, 1_ Dates Z !Note. T he fo*iag AuMorimdon Form is riepbW to be comnpleted by the property owner oody when do4wa* an agent: of the Property owner to apply for a construction pavat for the Owner -Budder_ F.xcludiag.the Notice to Ptvpatty Owner, dw eateciWton of which I uademdamd is my perzaanal t sQo y. I hu* ratnhod dW:pticstut(u) to act as my ) m Mft for, 8igtr, and Hie &S m Y -ID ara.Owa _&Ae Pasant for My PWjftL St ape of Coesttactioa Project (or D=dptioa of Work): Ptoject:I,ocatioa,or Address: Name of Audioriaed Agent: Tel No Address of Aud wired Agent: I declare under penahy of perjury that I am the property owner for the address listed above and I peraonsgy filled out the kbrmratiorn and Varity its aocttrtecy.r l bre- A evpy.of'the owner's di*wx Is & nse. fW= notarizatim or oche► vw*ad ' aocq* a to die-ggencyis required to.be,pmaweod when the persalt is issued to wzVy she prupartp owner's sfgaapere• . Pioperty Owner's Signature: Date: BJA: i� a .. Ot)/ of,La %a Quints Butt at Safety Divlston P.O. Box 1SO4,-78-49S-CAeTampkoa La:Qtdnta, CA 92233 --(760) 777-7012 Building Permit Application and'Tracfdng Sheet Permit# Pmect.Addtea:]7an ocvtex'sName : .2 A P.Number .---- Adders _j_rTj5 CAJV Legg Descxiption:. city. sT. DA(A U\ nAA % c*t .a2 53 coat r:�j Ztx�a G+ T ►one- - Address. •1—m Ptnjad Dta Mption: C , ST, Zip: 01 Unte)c� q2Z 3 (K WA I wonwifa Vi ouh-" Telephone I o _"`G State Lie. #: City Lie. lk A=L. EW., Dieser Address:. City, ST. Zip: T&P}<Dae: mon Type: Occupancy: State Lia. #: Project type (diode ow): New Ad'n Alter Repair Demo Name of Conw Pasoa an NU .1 C1 • Sq.. FL: #. Stories: # Univ; . Telephone sof Contact Petco - EsdmuWd Value of Project: APPUCANT: DO NOT WfrM BELOW THISiUNE p Submittal Raga 'Reed'. TRAG[t M PRRM[r FEES Plan Seb Pian Cheek saitm[tted I% jti item Amoaat structural Calm Revlewed,.rady for corns dont Plan Cheek Deposit. . Truss Cale:. Called Contact Person Pisa Chock Balance - Mile Zd Cake. Plant picked up Construction Flood pwn plan Plias resabmltbed Mecharikal Giadiag plan 2`' Review, ready for corrasoasrnme Mect ictal Snbeoataetor List Called Coubut Pesos Plumbing Grant Deed. ' Plaus picked up S.M.1. S.O.A. Approval Plans res"itted Grading IN HOUSE;- Review; ready, for eorreedondissae Developer' Impact Fee Puma ft Approval. Called Contact Person Pub. Wks. Appr " Date of permit issue School Feet Total Permit Fees ,