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14-0554 (BLCK)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 14-00000554 Property Address: 46645 WASHINGTON ST APN: 643-182-014-71 -2117 Application description: WALL/FENCE Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 500 Applicant: T4'yl 4 4 Q" Architect or Engineer: BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: MARTIN NORIEGA 46645 WASHINGTON ST LA QUINTA, CA 92253 (949)291-7464 Contractor: Owner VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 5/01/14 2V'11�J' _N —TA ili .. G►�' i1�= f.�► �tJ7 Wit,"•.':, �_–PT. LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION - hereby affirm under penalty of perjury that I a Alice!dder provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations: Section 7000) ofDivision 3 of the Business andsCode, 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: icense 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 "`P'Y✓//1 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. L/ person in any manner so as to become subject to the workeis' 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 Code, I shall 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 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.). �) 1, 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.). lI am exempt under Sec. ,, BB.&P.C. for this reason Date�S/I /.-I Ownnet:/ 2% �Y] �-----I 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: " LQPERMIT �o ttee S' 1 14 Applicant:,,' M A AT 1 N7 N o iZ t E 4f^,A -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. Icertify 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 of this county to enter upon the above-mentioned property for inspection purposes. Date: '51 A I Signature (Applicant or Agentl LQPERMIT Application Number . . . . . 14-00000554 Permit . . . WALL/FENCE PERMIT 2013 Additional desc . . Permit Fee. . 47.19 Plan Check Fee .00 Issue Date . . . . Valuation . . 500 Expiration Date 10/28/14 Qty Unit Charge Per Extension 1.00 47.1900 LS MISC WALL, FIRST 100 LF 47.19 ---------------------------------------------------------------------------- Special Notes and Comments 11LF OF 5' BLOCK WALL WITH COLUMN IN FRONT YARD (EXISTING FOOTING PREAPPROVED BY J.JOHNSON AND B.HANADA] PRECISION CONCRETE BLOCK SHALL BE COVERED WITH STUCCO, PAINT, OR TEXTURED COATING WHERE VISIBLE FROM OUTSIDE THE PROPERTY. 2013 CALIFORNIA BUILDING CODES. - --------------------------------------------7------------------------------- Other Fees . . . . . . BLDG STDS ADMIN (SB1473) 1.00 PLAN CHECK, WALLS 60.06 Fee summary Charged Paid Credited ----------------- ---- - ----- ---------- ---------- ---------- Due Permit Fee Total 47.19 .00 .00 47.19 Plan Check Total .00 00 .00 .00 Other Fee Total 61.06 .00 .00 61.06 Grand Total 108.25 .00 .00 108.25 LQPERMIT Bin # Qty of La QurnM Building 8r 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: u Owner's Not%rz 'A. P. Number: Address:,t 46(e4 -S ST Legal Description: City, ST, Zip: x ` C 4 9'1 Z• �+ 3 Contractor:Telephone: x 1 � V 9 y92 <[ Address: 0 Project Description: L 8� «, p `� N g` p C. y� City, ST, Zip: W FLIM T Tele h n P o e:t v 11� , N O P H e Z ►'1 State Lie. # : City Lie. #; Ga►pe... CASE. l�0`� N ME 0.0 f�rT A Arch., Engr., Designer: Address: IF V City, ST, Zip: Telephone: le one: T Construction Occupancy: YPe• P Y: State Lac Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person: A M A Q.T M4 NOR 1 e 4A Sq. Ft.:y, (� � # Stories: # Units: Telephone # of Contact Person: y= 9 291 -14 64, Estimated Value of Project: 500 APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2". Review, ready for correctionslissue Electrical Subcontaetor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN MOUSE:- ''d Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appi• Date of permit issue School Fees Total Permit Fees ti Ir- r . v 4 fly -W ffm Y/ P_O_ BOX 1504 LA QUINTA, CALIFORNIA 92247-1504 78-4.95 CALLE TAMPICO. LA QUINTA, CALIFORNIA 92253 - KNIki RTY`0 BUILDING &SAFETY DEPARTMENT (760) 777-7.012 FAX (760) 777-7011 'S PACKAGE Disclosures & Forlris for Owner-Bniiders Appl in�g `for Construction Permits , IDDn tTX O 'NSR Dear Property Owner An, imMication,.for:a;building permit:has::bew-subinitted.-in' name': urxclf as ttic buitdec of the your listing yo ProPy WWF6vancats spocified aitA'%i0 4 S W ASSN ►N GtTo N -,:. We are praoviding you with an Owner -Builder Acknowledgmentaad Information`Verifieat oa Form to make }you aware of your respo sib'nitres-and,posublc.nsk-..ou may b 1 his t issued in ` ur name ss tlic ; Y y incury vurg permr -5"0 : . _ •.:, Owner -,Builder. -Weiwi.ittLbtissue-a building,:pexmit until your kiive read; utitiaicd yotw,widefstnndiug of eri 'provision, signed, and returned this form to us at our official address indicated. An agent of the ownu`eazuot execute=this :notice unless you, the property owner, obtain the prior approval of the permitting authority. n�7GC�'i3��:.A,!'!tflwT!•1fii�ir7iLa.ar::;,...,.3�~ .... ., .., _ ..... 7M+'1 1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder" building permit that erronoously.implies thzit 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 property_ 'I t -'K 2. I understand building permits are not required to -be signed by property owners .unless they are responsible for the construction and are,not,Kirin-a,licensed,Contraetor.(o.assume this r :..: > g esponsibility. ,. "'11: understand as. an "Owner -Builder" Lam the responsible party of record,on the,permrt .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 n...a.iurstead of my own. me 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. '1�h►1 5. 1 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, Imay, be;considered an "employer" under state and federal law. H '4A 6. I understand if I am considered an "employer" under state and fedecal.iaw,I must register with the state and federal ),ovecnment, .withhold,payroll ,.taxes, provide workers' compensation disability. insurance, and contribute to .unemployment .ompensation for each "employee_" I also understand my failure to abide by these laws may subject me to serious financial isk. IMA 7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential tnictures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed ubcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed ender contract with a licensed general building Contractor. 7" 8. I understand as an. Owner -Builder. if I sell the property for which this pernut is issued, I may be held U010-: for. any financial or personal. uynnms sustained by any subsequent owners) that'resuht from any latent construction defects ,in the. worlamanship or materials. ' `9. I understand I may obtain more information regarding my obligations as an "employer" from the Iuternat R11- - " Service, the United States Small' Business Administration, the. California Deparinrent of Benefit Payments, a' ''Ca}ifornia 'ti Division,af Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CLB) at 1- 800-321-CSLB (2752) or www.csib.ca.gov for more information about licensed contractors. %4n1y10. 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 . -fore proposed .construction activity at ,the following address: 4(otoy5 wAL►F)4 fa. s't•: %g", : 'Cs .: '9w -L V" 11. I ag= that,. as the party legally and ftnaucially responsible for.this proposed construction activity, I will abide by all applicable laws requircifttfits that govem'Owner=Buildeis as well as employers. -4.4, 12.1 agree to notify the issuer of this form immediately of any additions; *letioas 4 chafes 'to any of':thc nformation I have provided on this form. Licensed contractors are regulated by laws designed to protect the public.1f you;contraat with someone.who:doesmot,Irave.a howsc the C ntrAcWrs' State. License Board.snaay-bc unable to f=loss you may sustain as a result of a•compWmt Your only remedy against unlicedsed Contractors may' be-intcivd.,,C 11t,iv�aiso tmportaut for you to:.undcmtandithat,ifanuWkcusod:Cc�fitmctor.or:employee•of that-individug,or,,f=.is injuccd`wi ile woddag on your property; You may be t dd:; liaL0le,:for dama$es; If you .obtain a :permit£as :O.wner-Builder and :wisltytn ;hire Co aetors, you: .il:be.sespoastblo for:v. wberCr'orotlhose Coractors are-properhy.:lcensed;and;the status otkeir woriecis' compensation rmruanoe;ooverage 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 ssatt .fie pcxm#.�Yote. A copy ojtkcprcrty owner's driYer'rlt-ft lao*va, or other verification acceptable to th% agency u required o be presenled tvllccn the permit u: issued `to verify the ;pt+op i owner's signature. Signature ofproperty owner) Date: S Note: The following Authorization Form is required to be completed by the property owner only when.designatng an agent of the property owner to apply for a construction permit for the Owner -Builder. AUTHORIZATION OE A-GENT'TO A:CT`ON PROPERTY OWN—MIRK—HALF Excluding the Notice to Property Owner, the execution of which I understand..is my personal responsibility, I hereby authorize the followurg persons) in act as: my`agetit(s.) to'apply`for, sign, and file the iiocuments necessaryto" obtaun:an'Own€i-Builder P&T iit foi in 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 perjury that I am the property owner for the address listed above and I personally filled out the above information and cel tify its accuracy. Note`Aleopy ofthe owner's drivers license, form notariadtion,' or other'verifrcation acceptable to the ageircyis required'to 6epresented when thepermit is issued to'verify the property owner's signature: Property Owner's Signature: Date: c. r . Q 2. 0 o .. LL z V 00996