08-0449 (BLCK)4'4
P.O. BOX 1504 -
78-495 CALLE TAMPICO
LA QUINTA, •CALIFORNIA 92253
A?iplication Number: 08-00000449
Property *Address: �---52950 -AVENIDA VILLA.
APN: 773-334-011-16 -00.0000-
J Application description: WALL/FENCE
Property Zoning: COVE RESIDENTIAL
Application valuation: 2186
Applicant:
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
ALDEN JAMES A
*NOT ON FILE
UNKNOWN, CA 99999
------------------------
Contractor:
Owner
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/13/08
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
pe.rsnn in any manner so as to become subject to the workers' compensation laws u( California, -
permit t0 file a signedstatement 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 Codglall forthwith comply with rhos provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by----
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r
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: -
Date:pplicant:
1 1, 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 safe (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 ($100,000). 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.).
APPLICANT ACKNOWLEDGEMENT
. (_) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
' 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
conditions and restrictions set forth on this application.
- property who builds or improves thereon, and who contracts for the projects with a -contractors) licensed -
1 . Each person upon whose behalf this application is made, each person at whose request and for
- pursuant to the Contractors' State License Law.).
whose benefit work is performed under or pursuant to any permit issued as a result of this application, .
I _ 1 I am exempt under Sec. , B.&P.C. for this reason
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 - -
. r_.- -----) -
3
performed under or following issuance of this permit. -
Date: 1 �-/(/SR Owner:
JZ_within
2. Any permit issued as a result of this application becomes null and void if work is not commenced
180 days from date of issuance of such permit, or cessation of work for 180 days will subject
- ' CONSTRUCTION LENDING AGENCY
_ permit to cancellation.
. f hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
I certify that I have read this application and state that the above information is correct. I agree to comply with all
work for which this permit is issued (Sec.' 3097, Civ. C.). -
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
' - - -
of this county to enter upon the above -mention edproperty for ins ection purposes.
Lender's Name: -
"--- /-' -----_
Date: g` nature (Applicant or Agent): 06 �r
Lender's Address:
-.., -__.--------_—. -- _
LQPERMIT
i
Bin #
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-.
City of La Quints
Building a. Safety Division
P.O. Box 1504,78-405 Calle Tamp°co
U Quinta, CA 922'53 =. (76% 7.77-7012' v
Permit Application and Traking Sheet.
Permit #-
/Building
Project Address: _ Y V
Owner's Name: C7
A. P. Number: ..17
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Address: �. , %S�f% �.(�a c" .
f•
Legal Description:'
,Contractor;-
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n
City, ST Zip: , t�U/011e� C^t '' ?2 �SY�
Telephone:
Address:' • . Z-7 1150. u l
Project Description:
City, ST, Zip. 9,9, Z F33,
f
' sE
State Lic. i:. City Lic.#: '•
Arch., Engr., Designer:
„ �. [ ; //
T42Tl.Y(
/
Ly _ y
Address.'
City; ST, Zip:
! _
Telephone: :.
P
State Lic. #: '
Name of Contact Person:
Construction Type:. Occupancy: _
Project type (circle one): New Add'n r Alter Repair Demo -
Sq. Ft.:
# Stories_
#Units:.^
Telephone # of Contact Person: `
Estimated Value of Project:
APPLICANT:,DO NOT WRITE BELOW THIS LINE
' 4"
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item '" '
Amount
'Structural Calcs.
Reviewed, ready for correctionsPlan
Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Calcs....
Plans bicked up
Construction .
Flood plain plan.
Plans resubmitted
Mechanical
f ..
Grading plan':
2"" Review, ready for corrections/issue
Electrical
Subcontactor List,.
Called Contact Person
Plumbing
1
=y'
Grant Deed
Plans picked up
H.O.A. Approval
Plans resubmitted,
Gradiig
IN ItOUSE:-
'"' Review, ready for corrections/issue
Developer Impact Fee." -
r
Planning Approval
Called Contact Person
Pub. .Wks.Appr °
Date of permit issue
r 3
School Fees
xp• z
3Total
Fermit Fees
_...._'.
OWNER/BUILDER INFORMATION
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.
For your protection you should be aware that'as "Owner/Builder" you are the responsible party of record on 'such a
permit. Building permits are not required to be signed by property owners unless they are personally performing their
own work. If your work is being performed by someone other than yourself, you may protect yourself from possible
liability if that person applies for the proper permit in his or her name.
Contractors are required bylaw to be licensed and bonded by the State of California and t:) have a business license
from the City or County. They are also required by law to put their license number on a1 permits for which they
apply.
If you plan to do your own work, with the exception of various trades that you plan to su contract, you should be
aware of the following information for your benefit and protection:
If you employ or otherwise engage any persons other than your immediate family, and the work (including materials
and other costs) is $200.00 or more for the entire project, and such persons are not licensed as contractors or
subcontractors, then you may be an employer.
If you are an employer, you must register with the State and Federal Government as an emp.oyer and you are subject
to several obligations include State and Federal income tax withholding, federal social security taxes, worker's
compensation insurance, disability insurance costs and unemployment compensation contributions.
There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with
respect to worker's compensation insurance.
For more specific information about your obligations under Federal Law, contact the Interna: Revenue Service (and, if
you wish, the U.S. Small Business Administration). For more specific information about your obligations under State
Law, contact the Department of Benefit Payments and. the Division of Industrial Accidents.
If the structure is intended for sale, property owners who are not licensed contracts are allowed to perform their
work personally or through their own employees, without a licensed contractor or subcontractor, only under limited
conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an " Owner/Builder" building
permit, erroneously implying that the property owner is providing his or her own labor and material personally.
Building permits are not required to be signed by property owners unless they are per.orming their own work
personally.
Information about licensed contractors may be obtained by contacting the Contractors' Sta:_e License Board in, your
community or at 1020 N. Street, Sacramento, California 95814.
Please complete and return the enclosed owner -builder verification form so that we can conErm that you are aware of
these matters. The building permit will not be issued until the verification is returned.
Very truly,yours,
CITY OF LA QUINTA-
'DEPT. OF BUILDING AND SAFETY
78-495 Calle Tampico
La Quinta, CA 92253
(760) 777-7012',
FAX: (760) 777-7011
OWNER'S SIGNATURE/DATE
v
PROPERTY ADDRESS
C
PERMIT NUMBER(S)