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BWFE2015-006778-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application Description: Property Zoning: Application Valuation: Applicant: BRYON BREWER COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT BWFE2015-0067 46735 WASHINGTON ST 643194013 JANE BREWER BLOCK WALL LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 70001 of Division 3 of the Business and Professions 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 permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: (_X) 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.). (_) 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. for this reason Date: I S Owner: CONSTRUCTION �ENFING AGENCY I hereby affirm under penalty of perjury that th//ere 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: Owner: JANE BREWER 119 COMPTON RD ITHACA, NY 92253 `-g- 1 VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 4/8/2015 Contractor: JANE BREWER/ OWNER BUILDER 45735 WASHINGTON LA QUIUNTA, CA 92253 (607)277-3550 Llc. No.: 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 subject to the workers'_ compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 f the Labor Code, I shall forthwith comply with those provisions.. 2pte: Applicant: WARNING: FAILURE TO SECURE WORKERS' C MP NSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLYER OTO CRIMIN 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 Building Official 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. 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 of this city to enter upon the above- mentioned property for inspection purposes. Date:Z� Signature (Applicant or Agent): FINANCIAL •• 1 �TCF"DESCRIP,TION k*':rr1 w'F jACCOUNTt'`e e CITY '� AMOUNT k+:r y Y 14 PAID"` z PAID DATE `s,`'r :..:.'• BSAS SB1473 FEE 101-0000-20306 0 $1.00 $1.00 4/7/15 PAID.BY ' `METHOD fi.Wyr4y �'s RECEIPT;# 'CHECK#.43 �. CLTD BY �'.: �_ - BRYON BREWER DEBIT R4787 PJU Total Paid for BUILDING STANDARDS ADMINISTRATION BSA $1.00 $1.00 #� �i'`, ''' CZTY, ; w., +AMOUNT . i PAID " PAID DATE . yiy+DESCRIPTION �,* rr F �;�:'A000UNT a «a > F. WALL/FENCE - EA ADDITIONAL 50 LF .101-0000-42404 0 $14.50 $14.50 4/7/15 PAID� BY tMETt HOD RwECEIPT'#4: Z7 f_K# t CLTD BY , . , v , .�z . ..,, .. .,. ,'_x _..,.:; BRYON BREWER DEBIT R4787 PJU f)ESCRIFTION '. +', ='+ Y CITY AMOUNT rt+r, PAID K ' PAID'DATE ,+ .ACCOUNT WALL/FENCE - FIRST 100 LF 101-0000-42404 0 $47.86 $47.86 4/7/15 . PAID BY METHOD RECEIPT# `�Y` "CHECK #; r,` CLTD BY i r�- BRYON BREWER ' DEBIT' R4787 PJU *<:DESCRIPTIONs,'T� a�M ,CITY l"� AMOUNT ? PAID. PAID'.DATE: e?ACCOUNT�� WALL/FENCE - FIRST 100 LF PC 101-0000-42600 -0 $60.91 $60.91 4/7/15 `tt _ �.. a PAID BY t:4 s `', x METHOD `' j' ., r', ;RECEIPT°# �:..; a a; CHECK'# CLTD BY-, , BRYON BREWER DEBIT- R4787 PJU Total Paid for FENCE OR FREESTANDING WALL• $123.27 $123.27 TOTALS: $124.27 $124.27 Description: JANE BREWER BLOCK WALL Type: WALL/FENCE Subtype: Status: ISSUED Applied: 4/7/2015 PJU Approved: 4/7/2015 PJU Parcel No: 643194013 Site Address: 46735 WASHINGTON STLA QUINTACA 92253 Subdivision: TR 2117 Block: Lot: 68 Issued: 4/7/2015 PJU Lot Sq Ft: 0, Building Sq Ft: 0 Zoning: Finaled: Valuation: $2,600.00 Occupancy Type: Construction Type: Expired: 10/4/2015 PJU No. Buildings: 0 No. Stories: 0 No. Unites: 0 Details:. 128L . NFT X 6 FT HT BLOCK WALL PER CITY STANDARDS & APPROVED PLANS (2) STEEL MOUNTED SWING GATES (1)STEEL MOUNTED SWING GATE PER -APPROVED PLANS APPROVED PER J F/JW.PRECISION CONCRETE BLOCK SHALL BE COVERED WITH STUCCO, PAINT, OR TEXTURED COATING WHERE VISIBLE FROM OUTSIDE THE PROPERTY. 2013 CBC. TOTAL OF 28 PILASTERS PER CITY STANDARDS &APPROVED BY JJ.; ADDITIONAL SITES N, AMOUNT "RECEIPTCK# METHOD-', PAIDBY�--CLTD� DESCI ACCOUNT ux AID. PAID DATE. #]� CHECK BSAS SB1473 CHRONOLOGY CONDITIONS CONTACTS :w4m E—T-Y—P- NAME"' DRESS1' CITY AT. APPLICANT BRYON BREWER CONTRACTOR JANE BREWER/ OWNER BUILDER 46735 WASHINGTON LA QUIUNTA CA 92253 OWNER JANE BREWER 119 COMPTON RD ITHACA NY 92253 DESCRIPTION 101-0000-20306 0 $1.00 $1.00 4/7/15 R4787 DEBIT BRYON BREWER PJU Total Paid forBUILDING STANDARDS ADMINISTRATION BSA: $1.00 $1.00 Printed: Wednesday, April 08, 2015 10:19:32 AM loft CRSYSTEMS OE PARENT PROJECTS BOND INFORMATION �AMOUNT,`.- to, ATTACHMENTS INSPECTIONS arc-tirTie nt DESCRIPTION ACCOUNT I PE ��DATEl i,,PAID PAID DATE RECEIPT,#' CHECK#-! BOND BEAM BLD ISSUED PERMIT BWFE2015-0067.pdf r .0 FINAL" BLD BY WALL/FENCE - EA FOOTINGS BLD 101-0000-42404 0 $ 14.50 $14..50 4/7/15 R4787 DEBIT BRYON BREWER PJU ADDITIONAL 50 LF . WALL/FENCE - FIRST 101-0000-42404 0 $47.86 $47.86 4/7/15 R4787 DEBIT BRYON BREWER PJU '100 LF WALL/FENCE - FIRST — 101-0000-42600 0 $60.91 $60.91 4/7/15 R478*7 DEBIT BRYON BREWER PJU 100 LF PC Total Paid forFENCE OR FREESTANDING WALL $123.27 $123.27 TOTALS: $124.27 $124.27 PARENT PROJECTS BOND INFORMATION ATTACHMENTS INSPECTIONS arc-tirTie nt z� ""INSPECTION T I PE ��DATEl DATE APPROVED PLANS BWFE201S-0067 APPROVED PLAN 0 BOND BEAM BLD ISSUED PERMIT BWFE2015-0067.pdf r .0 FINAL" BLD FOOTINGS BLD PARENT PROJECTS Printed: Wednesday, April 08, 2015 10:19:32 AM 2 of 2 CRW.IYSTEMS r BOND INFORMATION ATTACHMENTS arc-tirTie nt _E; OWNER5�; ;DESCRIPTION DESCRIPTIO 1; HN. A M i,�'SUPDIR-.k. LED' '.'ETRAKIT�TNAB DOC DOC 4/8/2015. CECILIA PATINO APPROVED PLANS BWFE201S-0067 APPROVED PLAN 0 DOC 4/8/2015 CECILIXPATINO ISSUED PERMIT BWFE2015-0067.pdf r .0 Printed: Wednesday, April 08, 2015 10:19:32 AM 2 of 2 CRW.IYSTEMS r 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 Professions 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 DivisionCCC3,,, 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).: ) 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.). (� 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 I am exempt under Sec. . B.&P.C. for this reason Date' S Owner: CONSTRUCTION L NDN AGENCY I hereby affirm under penalty of perjury tha the is a construction lending agency for Ili the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Lender's 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 subject to the workers' compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Section 370 of the Labor Code, I shall forthwith comply w[i-tgthose provisions. as e: 1 - 1 Applicant: WARNING: FAILURE TO SECURE WORKERS' COMP SATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMI� AL ' ENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100, 0). N 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 Building Official 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: 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 of this cyiy to enter upon the above- mentioned property for inspection purposes. 6te. J Signature (Applicant or Agent) •4 VOICE (760) 777-7125 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153 • BUILDING PERMIT Date: 4/7/2015 Application Number: BWFE2015-0067 Owner: Property Address: 46735 WASHINGTON ST JANE BREWER APN: 643194013 119 COMPTON RD Application Description: JANE BREWER BLOCK WALL ITHACA, NY 92253 Property Zoning: Application Valuation: $2,600.00 D Applicant: Contractor: BRYON BREWER JANE BREWER / OWNER BUILDER APR 0 7 j' 46735 WASHINGTON LA QUIUNTA, CA 92253 CITYOFLA QUINTA COMMUNITYDEVELOPMENTOEPARTMENT (607)277-3550 LIC. No.: 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 Professions 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 DivisionCCC3,,, 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).: ) 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.). (� 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 I am exempt under Sec. . B.&P.C. for this reason Date' S Owner: CONSTRUCTION L NDN AGENCY I hereby affirm under penalty of perjury tha the is a construction lending agency for Ili the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Lender's 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 subject to the workers' compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Section 370 of the Labor Code, I shall forthwith comply w[i-tgthose provisions. as e: 1 - 1 Applicant: WARNING: FAILURE TO SECURE WORKERS' COMP SATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMI� AL ' ENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100, 0). N 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 Building Official 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: 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 of this cyiy to enter upon the above- mentioned property for inspection purposes. 6te. J Signature (Applicant or Agent) BUILDING & SAFETY DEPARTMENT 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 PROPERTY O"ER'S PACKAGE (760) 777-701,2. FAX (760) 777-7011 Disclosures & Forms for Owner-Buliders. A.ppI I g for Construction Per>nits kWlQRTANTr NOTICE TO PROPERTY OWNER Dear Property Owner An application for a buildingpermit has submitted in your nate listing yourself , as the builder of . the property improvements specified at We are providing you with, an Owner -Builder knowh dg tent,and infbimAtion Verification Form to =ke you awavi of your resportstbi4ties-and possrble risk -you may. incur by hmving:this permit issued in your, name as the Owner -Builder. 'We .will.not issue a. building.pet-mit until•yota have read, irirti'ial!ed 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. AC'1KP46WILEi}Clgj!TV IC AN1D,V—E—RMCATI0N OF I(1jltl �N: IafRFCTIONS iiod cm$ ir%iclal eaeii°stdtt'nierrt Lelvw to signifyyou underswnd or:i4rify.this: rrifornration. I. 1 .understand a frequent practice of unlicensed persons is to have Qie ptolierty ownerobtain an `0wner-i3wldci"` building pernii.t. diat erroneously implies that the property owner is providing Itis or lier.own labot;:and. material. Persona;]ly. I, as; an OW"ner-Builder, may be hctd:liable and subject to serious financial risk *for any injuries:sustaiiied.by an unlicemod 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•coveragc for injuries to workers on my prim'. rL 2. I understand building permits are not required to be signed by properly owners unless they are responsible for the onstruction and are not hiring a licensed Contractor to assume this responsibility. 1�7 3. I understand as an "Owner-Buildee,,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 7 4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. 5A 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 "employer" under state and federal law. 6. 1 understand if I am considered an "employee under state and federal law, I mi register with the state and federal ---government—wi:thbold-payroll--taxes,—provide-woi-kml-compensation--disability-insurance,—and--contribute-to-unemployrnent-- --- compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. 7. I understand under California Contractors" State License Law, an Owner -Builder who. builds single-family residential fractures 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.wifh a licensed general building Contractor. 8. I understand a5 an Owner -Builder if I sell the property for which this pe is issued 1 may be hem liable, for any financial or. personalin ucres sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship <ir`ir * ,terials. 09. I understand I may obtain more infonuation cegardi►rg niy obligaliom'as an "emiiloyee frons thb Internal IL.evcnue Service, the United States Small Business Administratioh, Clic Californi3i Department of Benefit Payments, and the California Division of Industrial Accidents. i also understand I :may:contact.tlre Cali Eotnia Contractors' State License Hoard (CSL'CI) :at 1- 800-321-CSLB (2752) or www.cslb.ca.gov for more informatioo 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 financiallyy responsible ,for proposed construction activity at the following address: 17 1 L I agree that, as the party legally and financially responsible for this proposed construction activity, 1 will abide by, all applicable laws and requirements that govern Owner -Builders as well as employers. 12. I agree to notify the issuer of this form immediately of any additions; deletions, or changes 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 license, the Contractors' State License Board may be unable to assist you with any finaneiRl loss you may sustain as a result of a complaint_ Your only remedy against unlicensed Contractors may be iwavil court It is also innportant for you to. understand that if an uIdl used Contract(ii of e"inliloyce of that individual or firm is injured wixile working on your property, you may be held -liable: foe dauu cs::If you o)Win a:peM— -t.as Owncr=Builder'aud wish to him Conbutors, you will be responsblo for veixfying afar &iiot tltcise Coctiraetors arc prooperty liccxisoci and -:tire si to of their walkers' compensation inp� coverage. Before x building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for iss%dit,1»ke,.pfer=kL Nota: A copy of tin property owner's driver'sUwrtsef farm nota eery or other verd,ticadon acceptable to the agency is required to be presented when the permit is iin" to ver* the prop ry owner's signature. Signature of property owner Date: 4 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. AUTIIORIZAtION QF -AGENT TO ACT ON PRQPERTY OWNER'S..BEHALF Excluding the Notice to Property Owner, the excursion of which I undemtand.is my personal responsibility, I hereby authorize the following person(s) to act as my agents) to apply for, sign, and file the documents necessary to obtain an Owner-BuiWet Permit for my project_ Scope of Construction Project (or Description of Work): Project Location or Address: Name of tAuthorized Agent: Address of Autborized Agent: Tel No 2, 1 145 4y- �11'1t' I declare under penalty of perjury that 1 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 miner's driver's license,_ form notarization, or other verification acceptable to the agency is required to bepresented when the permit is issued to verify the property owner's signature_ Property Owner's Signature: Date: 0 0 Awe 0 0 O �o� 000pn� p OHO � o a Qi Eil p o O ¢¢ o 0 9 0 Q 0 4A p n Qo9Qki P � ��9 9 7 Q P 0 �'J11? g o n 0 0 O ° 0 ID ��OD�D QDq 0 r FINANCIAL INFORMATION`DESCRIPTION �_:+"` �' ' 'ACCOUfVT�`�, tx�;�C�TY AMOUNT`� �' _ PAID�t PAID;DATE. BSAS SB1473 FEE 101-0000-20306 0 $1.00. $0.00 " AID BY ar'+C`fr. r �' M METHOD x1�sY �� A-'-`��RECEIPTi# s `> s CHEC JCLTD BY, Total Paid for BUILDING STANDARDS ADMINISTRATION BSA $1.00 $0.00 4 p DESCRIRTION rs' , t- ! k:`A000UNT,'�':i } =CtTYs :{S AMOUNT �`K PAIDe.r tPAID DATE WALL/FENCE - EA ADDITIONAL 50 LF 101-0000-42404 0 $14.50 $0.00 r " s'rPAID BY r:Y# t�7"ft; ar:-.,, :"METHOD. }iYr .'` RECEIPT,# CLTD BY.. DESCRIPTION z u, r y 3`::" a ,ACCOUNT : '*, tCiTYy a`.+ ,AIV16UNT _`k .. 3:y: PAID PAID DATE WALL/FENCE - FIRST 100 LF 101-0000-42404 0 $47.86 $0.00 �. DBY 'tMETHOD + x � CHECK # CLTD..BY• } + i r r,:DESCRIP7ION "" p KV4 —�, ;ACCOUNTa ,}p t , "ATY ,x�r,', AMOUNTS ;:' x �«•` PAID, ,, ` PAID DATE`: WALL/FENCE - FIRST 100 LF PC 101-0000-42600 0 $60.91 $0.00 �•- r `" ;i �a" PAID BY. 'tsr METHOD'`.> RECEIPT'# CHECK :# �' CLTD BY' Total Paid for FENCE OR FREESTANDING WALL $123.27 $0.00 TOTALS:r 00 r Description: JANE BREWER BLOCK WALL Type: WALL/FENCE Subtype: Status: UNDER REVIEW Applied: 4/7/2015 PJU Approved: Parcel No: 643194013 Site Address: 46735 WASHINGTON ST LA QUINTA,CA 92253 Subdivision: TR 2117 Block: Lot: 68 Issued: Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: r Finaled: Valuation: $2,600.00 .. Occupancy Type: Construction Type: Expired: No.'Buildings: 0' :. No. Stories: 0 No. Unites: 0 Details: 128 LN FTX 6 FT HT BLOCK WALL PER CITY STANDARDS & APPROVED PLANS (2) STEEL MOUNTED SWING GATES(1)STEEL MOUNTED. SWING GATE PER APPROVED PLANS APPROVED PER JF/JW.PRECISION CONCRETE BLOCK SHALL BE COVERED WITH STUCCO, PAINT, OR TEXTURED COATING WHERE VISIBLE FROM OUTSIDE THE PROPERTY. 2013 CBC. ADDITIONAL SITES Printed: Tuesday, April 07, 2015 2:03:38 PM 1 of 2 SYSTEMS CHRONOLOGY CONDITIONS CONTACTS 3...r..- +. iw�s'.-n ah.Y. '►s:yr 9?e.:- I'. .w- •.¢"� Hi. .r -.sM . "�+�' .err;...,.-. ...c: .:: ei.. 1 NAME;TYPE_,"'NAME'= .,� 1. �r�-,•�.;,�.;,, an.xr' ._�. � . ��.�,ADDRESSI'� �� STATE �,. `�ZIP,�� .;PHONE•'' � a.�...'. ..� .'.'4�.r�.'+rt.'�.,. - ..�Y. ,.F FAX .;,;.�- � - �� EMAIL? � APPLICANT BRYON BREWER CONTRACTOR JANE BREWER/ OWNER BUILDER 46735 WASHINGTON LA QUIUNTA CA 92253 OWNER JANE BREWER 119 COMPTON RD ITHACA NY 92253 FINANCIAL INFORMATION �.. �T � �-.a'..;'�f� r c,'r x.4`i " t '_._ -i• a n'i? - x ...: _.: .`� } Mit. � �;. y,DE56R *PYLON. �p „ ACCOUNT ,., QTY AMOUNT } ''.; PAID y " -. ,, 4:� a .t. . PAID DATE ';RECEIPT #, .:.'� � .. ,CHECK #, , :METHOD -... .7 ��r PAID BY - BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00 Total Paid forBUILDING STANDARDS ADMINISTRATION $1.00 BSA: $0.00 Printed: Tuesday, April 07, 2015 2:03:38 PM 1 of 2 SYSTEMS W'� '1, DESCRIPTION;` -- .0� AMOUNT 71A 'RAID DATE" ',,RECEIPT# # . ... .. PAI D '6Y " i- CLTD 0 ; -, , :, :'ACCOUNT QTY , QTY ,;'AM PAID, P 4 N PE4 ..CHECK —METI-19E� BOND BEAM BLD FINAL" WALL/FENCE - EA FOOTINGS BLD 101-0000-42404 0 $14.50 $0.00 ADDITIONAL 50 LF WALL/FENCE -FIRST 101-0000-42404 0 $4 7.86 $0.00 100 LF . WALL/FENCE - FIRST 101-0000-426000 $60.91 $0.00 100 LF PC - Total Paid for FENCE OR FREESTANDING WALL $123.27 $0.00 TOTALS: $124.27 $0.00 I PARENT PROJECTS �y I BOND INFORMATION Printed: Tuesday, April 07, 2015 2:03:38.PM 2 of 2 CB?WYSTEMS INSPECTIONS ASE ID" P 4 N PE4 DATE DATE..%��, BOND BEAM BLD FINAL" BLD FOOTINGS BLD �y I BOND INFORMATION Printed: Tuesday, April 07, 2015 2:03:38.PM 2 of 2 CB?WYSTEMS Bin # -� c►ty Qf . b Q urn to . Building &r Safety Division ti P.O.:Box 1504, 78-495 Calle Tampico . La Quinta, CA` 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # Project Address: 4913 5 w0.5 1 r Owner's Name: fQli� A. P. Number: Address: COs') o� Legal Description: city, 'ST,Zip: C N.L7 85b tr C0 0 n act r . Telehne: 0 7- 5 P S d Address:. Project Description: UIOeK WQ ( l) S lei sco c Vli V• City, ST,'Zip:x scored, JRt:6r� W 1 S Telephone:d - • I L fb "Al I] O \vim a State Lic. 4: City. Lie. #t s ou"Aia Arch., Engr., Designer: i neq * 8 Cia 11 Address: l . s I manual 5�, "Al City, ST, Zip:f,, S sR\ oA 'nval SUJ1 q.. e jj Telephone: <;.::.:;.; .;;;::•>;>:«:>:•;;:::: Construction T Occu aric Type: P Y State Lic. #: Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person:r. otn�W e,C Sq. Ft.: # Stories: #Units: Telephone #,of Contact Person: (o Estimated Value of Project: (Q60' . APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets 'Plan Check submitted Item Amount Structural Calm Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Pc rson Plan Check Balance.. . Title 24 Calcs. Plans picked up Construction .. Flood plain plan , . Plans resubmitted Mechanical Grading plan 2qe Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Decd Plans picked up S.M.I. H.O.A. Approyal Plans resubmitted.. - Grading IN IiOUSE:- 'rd Review, ready for correctionsrssue .. Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. .Pub. Wks. Appr Date of permit issue School Fees Total.Permit Fees