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10-0995 (BLCK)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 10-00000995. Property Address: 51081 EL DORADO DR APN: 772-250-996-191 -31349 - Application description: WALL/FENCE Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 450 Applicant: ,JM 6A_ T-iht 4 s(P Q" Architect or Engineer: BUILDING & SAFETY DEPARTMENT BUILDING PERMIT //v,&_, /L//,9. - 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 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.). 1 _ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contr cors' State License Law does not apply to an owner of property who builds or improves thereon;se nd o c ntracts for���%%%e pc fie/Jt/�/with a contractor(s) licensed pursuant to the Contractors' State Licenws 0 / / 1 1 I am exempt under Sec. B.&P.0this o Date: / Y / 0 Owner: I hereby affirm under penalty of perjury that there is a constru on lendik§ agenc)Kor the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name: Lender's Address: LQPERAfIT Owner: HARPER RULON 51081 EL DORADO LA QUINTA, CA 92253 (801)231-5610 Contractor: Owner VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 9/24/10 (�►�P2 � 1 SI4= 2701 CITY OF LA 4WINiA 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 th ork or which this permit is issued, I shall not employ any person in any manner so as to b ome s ject t t orkers' compensation laws of California, and agree that, if I should be m sub t ers' compensation provisions of Section 3700 of the Labor Code, 1 or h co ith rhos provisions. Date:�l _ Applicant:, WARNING: FAILURE TO SECURE O KERS'COMP VERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIE CIVI FINES UP -TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE C T OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTERE , 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. 1 certify that I have read this application and state that the above infor n is orrect. I ag o comply with all city and county ordinances and state laws relating to building constr tion, r e representatives of this county to enter upon the above-mentioned property for ins ion s Date: Signature (Applicant or Agent): 1 LQPERMIT Application Number .. . . . . 10-00000995 Permit . . . WALL/FENCE PERMIT Additional desc . Permit Fee . . . . 15.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 450 Expiration Date 3/23/11 Qty Unit Charge Per Extension BASE FEE 15.00 ---------------------------------------------------------------------------- Special Notes and Comments 18 LN FEET OF GARDEN WALLS TOTAL (2) COLUMNS 4LN FT X 8 FT HT PER ORCO STANDARDS. ; 14 IN FT X 6 FT HT GARDEN WALL CITY STANDARDS.APPROVED PER AJ. --------------------------------------------------------=------------------- Other Fees . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged Paid ------------------------------------- Credited Due Permit Fee Total 15.00 -------------------- .00 .00 15.00 Plan Check Total .00 .00 •.00 .00 Other Fee Total 1.00 .00 .00 1.00 Grand'Total 16.00 .00 .00 16.00 \,-� ex ItD ,-, ""-a fa�e� S -7- /IQ >'---Debr o., C P.O. BOX 1504 LA QUINTA, CALIFORNIA 922247-1504 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 ORT NT1 NOTUCE TO R WERTY OWN= Dear Property Owner. An. application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at We are providing you with an Owner -Builder Acknowledgment and Information Veri€ieat on Form to make youaware of your responsibilities and possible risk you may incur by having this permit issuedin your name as the Own" -Builder. We will not issue a buRdiug.pwmit untlj you have read, initialed your. nuderstauding of ea&provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot exeeirte this 'notice unless you, the property owner, obtain the prior approval of the permitting authority. Bead and &rWat-each: statement*d o to signify you orvet* tkis Komtation. V I. 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 pemnaft. 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 insurancemay 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. property- Z-2. roperty y 2. I understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to .assume this responsibility.. C 3. 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. _1.L_4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on perm/ its and contracts. V 5. I understand if I 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 "employee' under state and federal law. % V 6. I understand if I am considered an "employee' 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. V 7. 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 performer under contract with a licensed general building Contractor. 8. I understand as an Owner -Builder if I sell the property for which this pemut is issued, I may be held liable for any financial or personal. 4.uries sustained by any subsequent ownef(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 InterMA Rekenue Service, 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 (CSLM 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 party legally and financially responsible for proposed construction activity at the following address: 1 LI agree that, as the party legally and financially responsible for flys proposed construction activity, I will abide by all applicable laws and requirements that govern Ovaria -Builders as well as employers. 12. 1 agree to notify the issuer of this, form immediately of any additions, deletions, or chgoges 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 limnse.the, Contractors' State License Board may be unable to asnA you with any financial toss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in`eivil court. It is also itupFortant for you to: understand that if an u alicensed Contractor or ewployee of that individual or firm is injured while working on your proP�Y; You may be held liable fbr damages. If you obtain a permit as Owner -Builder -and wish to hire Contraetaors, You will be responsible for v whether or not those Contractors are property liceased and the status of t min 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; #w..pw=tL NOW A copy, of tires grope V owner's &*er silt sv- forne notadcatteN or other verification acceptable to the .aggeney is re4OW to b pre�smkd when dw permit is iamed to verify the propert3+ owner's signature. Signature of property owner _r L - Date Note: The following Authorization korm 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 i'ROPERTY OwNEws DRE -VAI Excluding.the Notice to property Owner, the execution of which I understand is my personal r-esponsibility, I hereby authorise the followin s person(s) to act as my ageat(s) to apply for, sign, and file the documents necessaEr}r 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: Tel No 749- 6a/- G pl / Address of Authorized Agent: $'O S-�O ��j�--Lq I declare under penalty of perjury that i am information and certify its accuracy. No acceptableto the agency is required fit be E Property Owner's Signature: rty owner for the address listed above and I personally filled out the above the owner's, river's License, form notarization, or other verification wh th ermit is issued to verify the property owner's signature.. Date: Bin # Permit tK r l Protect Address: / 0 / City of La QUinta Binding 8z Safety Division P.O. Box 1504, 78-495 Ute Tampko La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet d r4 O Owner's Name: A. P. Number: Address: 5-/&000/ Do r4 D Legal Description: City. ST, Zip: LQ 0k Contractor. �'� Telephone: - -Address: Address: Project Descriptioh: �a City, ST, Zip: Telepherm State Lie. # : City Lie. #: 8 Arch., Engr., Designer: Ad4ress: City., ST, Zip:r Telephone: State Lk. #:. Name of Contact Person: Construction Type: occupancy: Project type (circle one): New Add'n Alter Repair Demo Sq, ; # Storios: #Units: Telephooi # of Contact Person: # Submittal Req'd Plan Sets Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE Reed TRACKING PERMIT FEES Plan Check submitted Item Amount Structural Calra. Reviewed, ready for corrections Pian Check Deposit Truss Cala. Called Contact Person Platt Cheek Balance. ' Tide 24 Cafes. Plana picked up nstruction Flood plain plan Plans resubmitted echanical ;EFAtetTical Grading plan 2'! Review, ready for correctionsfinue Subeoatactor List Called Contact Person Plumbing Grant Deed Plans picked cap S.M.L H.O.A. Approval Plans resubmitted Grading IN HOUSE:- ' Review, ready for correctionsfasue Developer Impact Ree Planning Approval Called Contact Person A.LP.P. Pub. Wks. Appr Date or permit issue School Fees Total Permit Fees