14-0507 (BLCK)r
P.O. BOX 1504 4
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 14-00000507 Owner:
Property Address: 53725 AVENIDA VILLA STONE MARK
APN: 774-133-026-12 -000000- 53725 AVENIDA VILLA
Application description: WALL/FENCE LA QUINTA, CA 92253
Property Zoning: COVE RESIDENTIAL (760) 992-6275 I
Application* valuation: 3594
s
Contractor:
-
Applicant: /� Architect o�eer: • Owner
VOICE (760) 777-7012.
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/28/14
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION - T
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, 1 shall not employ any _
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the . t person in any manner so as to become subject to the workers' 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 andProfessionsCode) or - 3700 of the Labor Code, 150!1 forthwith comply with those provisi
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).: ate: q•�/gApplicant:
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 sale (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 .
(_ 1 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 apermit 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,
(_ 1 1 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
�/ performed under or following issuance of this permit.
Date: Teel Owner: 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
CONSTRUCTION LENDING AGENCY permit to cancellation.
I 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-mentioned property for inspection purposes.
Lender's Name:
Date: y� Signature (Applicant or Agent):
Lender's Address:
LQPERAI IT
Application Number . . . . . 14-00000507
Permit . . . WALL/FENCE PERMIT 2013
Additional desc .
Permit Fee . . . . 75.79 Plan Check Fee
.00
Issue Date. Valuation . . .
. 3594
Expiration Date 10/25/14
Qty Unit Charge Per,
Extension
1.00 47.1900 LS MISC WALL, FIRST 100 LF.
47.19
2.00 14.3000 EA MISC WALL, ADDL 50 LF
28.60
-------------------------------------------------
Special Notes and Comments
96LNFT X 6FTHT,47 IN FT X'5FTHT,4COLUMNS
5 FTHTALL ORCO STANDARDS,& 20LNFT
ROLLING DRIVEWAY WRT IRONGATE (1)3FT X
.5FTHT WRT IRONGATE PER APPROVED PLANS &
AJ..PRECISION CONCRETE BLOCK SHALL BE
COVERED WITH STUCCO, ,PAINT, OR TEXTURED
COATING WHERE VISIBLE FROM OUTSIDE.THE"
PROPERTY_•2013 CBC.
------------------------
------- ------------------------------------------
-- ------------------------------
Other
Other FeesBLDG STDS ADMIN (SB1473)
1.00
PLAN CHECK, WALLS
60.06
Fee summary Charged Paid Credited
Due
-- ---------------------
Permit Fee Total 75.79 .00 .00,
75.79
Plan Check Total 00 :00 .00
.00
Other Fee Total 61.06 .00 .0.0
.61.0.6
Grand Total 136.85 .00 .00
136.85
LQPEFN1IT
Bin #
City of La QuinO
Building &r 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: 5-1. j!; P 1) elI G`e' 0,10'r,
Owner's Name:
A. P. Number:
Address: 0�1��
Legal Description:
City, ST, Zip:
Contractor:`
Telephone:
":
Address:
Project Description:
City, ST, Zip:
e
TelP hone• 3S
.
State Lic. # : �. 6
City Lie. #;
Arch., Engr., Designer:
66,
Address:
3 �Q� �C"�
City., ST, Zip:
Telephone:
>:>:«<s ><.
T' u c
Constructi n e• Occupancy:
YP P Y:
State Lic. #:
ProJja circle one): New Add'n Alter Repair Demo
type Project ) P
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT- WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cates.
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
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN I10USE:-
''' Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
.l
rQQ
w
r
13y -
.l
rQQ
w
r ' f CITY OF LA O.UINTA'S_ EJ—
B-CONTRAC R LIST
JOB ADDRESS -'
Q�t �4 v t l ( PERMIT NUMBER F OWNER f .� -BUILDER Q� �S
This form shall be posted on the iob with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employees are authorized to work
+►.:..: ,ti A.,., f-tinr,nAc to this list must he approved by the Building Division prior to•cominencement of work. Failure to comply will result in a stoppage of work and/or the voidance.
• permit. For each applicable trade, all information requested below must be completed,by applicant. "On File" is not an acceptable response.
of building PP
9
Trarla � Clas�if�catiOn
Con Erector
'or" Lice s
' ct s
St ate Contra
nab on In surance .
Wo rkers C omes
Y...
CompanyName
Classification
License Number
Exp. DateCarrierName
Policy Number
Exp. Date
Number
1
Exp. Date ;
xx/xx/xx
)xxlxx/xx)
(e.g. AB C-8)
xxxxxx)
xx/x x xx)
e.9. StateFund, CaIComP)
rmatVaries
xxxx
:CONCRETE (C 8}
�
-
rSTRUCT STEEL
MASONRY (C )
r,
V1......._
30/5
�e
PLUtVIBING {C 36),
.
y
y
•
:DRYWALL (C 9)
...... <:
*
r
`
f
ELECTRICAL
..............:.
.k
' _
T
M ETAt C 43
:SHEET (..... )......
T
£ J
i
..
• •.
-
.,
..
> :.
j
F
cLAZIN� is 17)
((
y
t
_
SEWQGF.DISP..IC
CERAMIC T1LE !C
FENCING.(C 13)
. ... > <
t
.;;:.;::;.;::.:;:.::::::.
P_O.'Box' 1504 -
LA QUINTA, CALIFORNIA 92247-1504 Bt1ILDING &SAFETY DEPARTMENT '.
78-495 CnLLE TAMFIco (760) 7.77-7.012
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011
lPROPERTY` "' 'ER'S' PACKAGE
Disclosures & Forms for Owner-Brtft&is Appl ng'for_Con tructioa Permits ,
IMT'ORTAN7'-! - NOTICE TOTEMPRTX OWNER
Dear Property-Ownw.
pu ap�licaiion dor a building Peanut .}gas;:. tied. m mare :listin
/�yg yo if as tha builder of-the::.ProPY
iniproveaxnts spocified at, S3 jQ
We are providing.yow-with an Owner=Builder Acknowfcd
gmezrt and tnfortriahon — crificatioa Form tbi make you aware :of your
i4udes
respotis .i.. and possible.nsklyou may incur by hatvuig-t)ispeinut issued�in�-yo�ii'nazue�as
O.vs�t-Builiier. Wewill. issue : btuidiog; emit untilSyou-un ve rexci; i iid", your undek. n Mgt* - eaCk'provision,
signed, and returned this form to us at our official address indicated. An agent of thc-owncr`catl ot' ex6cute:tris40tice
unless you, the property owner, obtain the prior approval of the permitting authority.
A6. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder"
buildingrmit that erronaousl lies that the property personally. I, as
� Y �P p perry owner is providing his. or her own labor •aril' material ' '
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 workingon 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_
!/AL3. 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;hcensod,Contraclorto.assume this responsibility., ;
3. I understand as,an "Owner -Builder" I.am rile responsible party. of-record,ou the,pernii�J 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
�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.
5- I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value
of my constriction is at least five hundred dollars ($.500), including labor and materials, I may, be:considered-.an"employer"
under state and federal law.
I understand if I am considered: an "employer"under state and federal law, I must register. with the .state and federal
government, .withhold payroll .taxes, provide woiicers' compensation disability. insurance, and -contribute .to unemployment
:ompensatioir for each "employee." I ,also understand my failure to abide by these laws may subject me to serious financial
isk.
2-7. 1 understand under California Contractors' StateLicense 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 performed
inder contract with a licensed general building Contractor_
"18. I understand as an Owner-Builder.if I sell the property for which this permit is issued, I may be hem .liable,:for:any
financial or personal. igjaries sustained by say subsequent owners) that -result from any latent construction defects ,in the.
workmanship or materials. '
understand I may obtain more information regarding my obligations as an "employee" from the Igfernal Revenue
Service, the, United States Smallbusiness Administration, the California Department of benefit Paymeats'.3i ' h Caa.lifornia . k,
.Division.of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (C�-:L at 1-
800-321-CSLB (2752) or www.cslb.ca.gov for more information about liceused contiactors.'
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 • respoasibte , . for. proposed construction activity_ -al the - following address:
11. I agree that, as the party legally and finaucially responsible for.tbis proposed construction activity, I will abide by all
applicable laws and requirements that govern 0o;;; =Builders as wetl aS employers.
12. I agree to notify the issuer of this form immediately of aay.additioas; *ktioas or changes to shy of`.the informatioia I
have provided on this form: Licensed contractors are regulated by laws designed to protect the public. If you-eoatract with
:someone who:does: nothave a licensc; -.thc Contractors' State: License Boamd:may-bc unable to
You may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in 1aivil7court::It�-is>,also
_. .
important for :you .to, understand that if anua lk4used.C( thtractor;oneaVioyee,of that individual�ovfirm is injured`avinlevwoddng
on your property; you may be:hdd:hable..for damagcs:If you ,obtaiaa:permitas.:Owner-Builder and:: wish:lo:hirc:C0ntraetors,
you .w dt_•be .respousthle. for: verifyiag VAK;4w :or not those Contractors amp y, :licensed, and :the :status Of.:ttkI -WMkt&
compensation mauranoe;ooverage.
Before x building permit can be issued, this form must be completed and signed by the property owner and returned to
the agency responsible fordsswt g,*e pert. Nate. A cop -qf t1C- pr ertey owner's driver a1lcr sei, focm,rtota ooty .or
other verification acceptable to thy' agony rs rcquued to bereserited wtiiien .the gerncrt u'issued`to reify tke;:pt!op,rty
owner's signature.
Signatiue of property owner
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.
AUTHORIZATION OF AGENT TO ACT `ON PROPERTY OWNER'S BEIIALF
Excluding the Notice to Property Owner; the execution of which I uaderstand..is my personal responsibility, I hereby authorize
the following persons) to act as my Agent s.)`fo apply'for, sign, arid`file the'documents necessary to obtain an'Owuer-Builder.
Petrait`for mYP ect ...
ro J
Scope of Construction Project (or Description of Work):
Project Location or Address:
Name of Authorized Agent: Tel No
Address of Authorized Agent:
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 ceftify. its accuracy. Note_'A'copy of the owner's drivers license, form notarization; or otherverifccation
acceptable to the agency is required to be presented when the permit'is issued io verify the property owner's signature:
Property Owner's Signature: Date:
10
• .+• _
r
_Lr a+y '3�
1. � �
'r f �
.
#` M1 •
r 1 C
-Yl,.>"F
_ r
>
� 3I.'YT+
• ' ' I' _ `wt� � ,?t1��i�r �j �+-_�._.--�'��*��� �`
DRI _E LI 1,' � �__�" ,.�
4w I
:.
i°ki/
����
•
j � ,i J #�1G �' �
O E� „
.t-,,.�
0�,8�i/��ENDt
('=sMARVIN
MA
., BLUE JAY
t
31 511967--
x oBAl
_ — 0325196
Ott
ke
_{�_ t� 't. - .r •a".• ,�+..` l
•�-
.. .!, tl ��.`" t •
��� `-,}...! r
N• ., . -+
� -• -
� _}�
�:
Vit''
# � ,-
�
t,.+
+
41
wv
5
U , "i .tel �• {.%�' { t k� yi fi
r 14 «
41
r�
IN
. 1.N .�
V 1 F
- -
t L 1, V� �Li !* y 'j
•
V .� �[ my �V "!•71 �,� ,
h'3. [
- • r
- \ 1 �� .n{y.` ..#
•. e' 3 Jy+' •(F. *+��� i
.
J\ t�+�. J 7 ,t+fit. �,*4rj.
��T+ �"i �� �
• '�' t ri :� �� �'e 'aJ. y{ f•. �..! k�T.,F 4L ],4'.
�t ..
r.