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12-1185 (BLCK)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA• 92253 ' Application Number: C;7:,�12-00001185 Property Address: 51825 AVENIDA VILLA ' APN: 773-182-016-4' -060000- Application description: WALL/FENCE Property Zoning: COVE RESIDENTIAL Application valuation: 1050 r Applicant: Architect or Engineer: BUILDING & SAFETY DEPARTMENT» . BUILDING PERMIT VOICE (761 ; 0 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 ' Date: •10/08/12 Owner: - KOTHLOW RICHARD J AVE(41 DA V /LL Irl 51.gi5 1_4 qu✓n/rA CA 92253 --------------------------------- Contractor: Owner 4 1lP - - oar Ci LICENSED CONTRACTOR'S DECLARATION - r WORKER'S COMPENSATION DE LA Fp'tlrq 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' comp tion, as rovided License Class: License No.: for by Section 3700 of the Labor Code, for the performance of the work for whic i ermit is issued 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 an 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 the 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 1—) 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.). - (_ 1 I am exe pt under Sec. , B.&P. his reason ' y Date: wner. " CO TRUCTION LENDING AGENCY hereby affirm under penalty of perjury that th re is a construction lending agency for the performance of the, work for which this permit �is issued (Sec. 3097, . C.). Lender's Name: ,l - Lender's Address: 1`r LQPERMIT 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 licy Number . certify that, in the performance oft work for which this permit is issued, I shall not employ any ` person in any manner so as to b o e subject to the workers' compensation laws of California, and agree that, if Iso d m�bject to the workers' compensation provisions of Section 3700 of the Labor_ shat l hwith comply with those provisions. WARNING: FAILURE TO SEC E WORK S' COMPENSTION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TOC INAL I ALTIES ANDACIVIL FINES UP TO ONE HUNDRED THOUSAND . DOLLARS ($100,000)• IN ADDITINQ0 T E COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN - SECTION 3706 OF THE LABOR CODE, TWITREST, 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. ' 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 buildin onstruc on, d hereby authorize representatives Ath'i cc ty enter upon the above-mentioned psi ture (Applicant or Agent 't• • ' • t 7/ •' •rte 1 = y • �. � L� } Application Number . . . . . 12700001185 Permit . . ". -. WALL/FENCE PERMIT - Additional desc -. Permit Fee . . . . 27.00 Plan Check Fee .00 Issue Date Valuation 1050 Expiration Date 4/06/13 Qty Unit Charge Per Extension BASE FEE 15.00 6.00 2.0000 HND BLDG 501-2,000 12.00 ---------------------------------------------------------------.------------- Special Notes and Comments" 42 L.F. COMBO WALL, 2' RETAINING, 4' GARDEN, ORCO SYSTEM. 2010 CODES. ---------------------------------------------------------------------------- Other Fees . . . BLDG•STDS ADMIN (SB1473) 1.00 Fee summary Charged Paid Credited Due ----------------- ------ Permit Fee Total 27.00• .00 .00 .27.00 Plan Check Total .00 .00 .00 .00 Other Fee Total 1.00 .00 .00 1.00 'Grand Total 28.00 .00 .00 28.00 LQPERMIT - _ 0 gyp, 4L�vklk Rdpv' MI'm P.O. BOX 1504 LAQUINTA, CALIFORNIA 92247-1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT (760) 777-7012 PROPERTY OWNERS PACKAGE FAX (760) 777-7011 Disclosures & Forms -for Owner 'Builders Applying for Construction Permits L11QT,VT! tio FICE TO to-PERTY OWNER Dear Property Owner An. application .for a building .permit s been sub tied in your name listing yourself as the Qbuilder of the .property -improvements specified at - t SZ� k-pz.. TL%t Cl- kQ�-��`� 0, We are providing you With an Owner -Builder Acknowledgment -and, Information Verification Form to make you awam:of your responsibilities and possible risk you may incur by having this permit issued in your name as .the Owner -Builder. We will not issue a budding -permit until you•bave read, initialed yourunderstanding 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. - OV R'S ACI NNOWi EDOM>ENT AND VERIFICATION OF R99RUATJ DIRECTIONS: Read and initial each: statement betuw7b signify you understand or verify this information. Q2 L I understand a frequent practice of unlicensed persons -is to have the property owner obtain an "Owner -Builder" building perinit that erroneously implies that the property owner, is providing his or her own labor and material personaff�_ 1, 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 n -t 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 party. 2. 1 understand building permits are not required to be signed by property owners unles3 they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility- . 9�Z 3. 1 understand as an "Owner -Builder" I am thensible respo party of record on the permit. understand that 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. Q4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. X5.1 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, 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 must register with the state and federal government, ,withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." 1 also understand my failure to abide by these laws may subject me to serious financial Tisk. 9- 7. 1 understand under California Contractors' State License Law, an Owner -Builder whc 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 under contract with a licensed general building Contractor. 'et 8. 1 understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal. injuries iusuined by any subsequent owner(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" froia the lnterliel Revenue 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 (CSL13) at 1- 800-321-CSLB.(2752) or www.cslb.ca.gov for more information about licensed contractors. Z 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: s j 1 I.1 agree that, as the party legally and Financially responsible for this proposed construction activity,.l,will abide by all applicable liws and requirements that govern Owner -Builders as well as employers. �- 12. 1 agree to notify the issuer of this form immediately of any additions- deletions, or changes to any of the tnformatiom I an have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with es someone who donot have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint_ Your only remedy against unlicensed Contractors may be, in;6vil court It is also important for you tounderstand that if an unlicensed Contractor or employee of that individual or firm is injured while :working on your property, you may be held liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors, You will be reWmible for verifying whether or not those Contractors are properly licensed and 'the status of their workers' compensation insurance coverage. 1 ' Before a building permit can be issued, this form must be completed and�igued by the property owner and returned to the agency responsible for issue $e. permit. Note: A copy of the property owner's daiver.'s license, farm' rietarz=tioa, or other verification acceptable to the agency is required to be presented wheii`the permit is issued to verify the.property owner's signature - Signature Signature of property own Date: 10�� 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 BEHALF Excluding the Notice to Property Owner, the execution of which 1 understand is my personal responsibility; l hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary 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: 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 certify its accuracy. Note: A copy of the owner'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: i F 8. 1 understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held table for any ' financial or personal. injuries sustained by any subsequent owner(s) that result from any latent constriction defects the workmanship or materials. %f-0 9. I understand I may obtain more information regarding my obligations as an "employer" from the til Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and California Division of Industrial Accidents. 1 also understand I may contact the California Contractors' State, License Board (CM -B) at 1- 800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. 10. 1 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 roposed construction activity xat the following address: iJ 11. I agree that, as the party legally and financially responsible for this proposed consttuc'-"n activity, I will abide by all applicable laws and requirements that govern Owner -Builders as well as employers- - 12. 1 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 die public. If you contract with someone who does not have a license, dw Contractors' State License Board may be unable to assist you with any finaneial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court- It is also important for you to. understand that if an unlicensW Contractor or earployee of that individual or firm is injwtd while worlong on your property; you may be held Gable for damages. if you obtain a permit as Owner-Buiker and wish to hire Contractors, you will be responsib4c for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. Before a building permit can be issued, this form must be completed and �igned by the property owner and returned to the agency responsible for issuf� &@.permit. Note: A copy of the property owner's dsiver'a lice»i f n °r other verification acceptable to the agency is required to be presented wheni tthe permig is issued to rerifythepraperA' owner's signature. l I � ' Signature of property own Date: t J IZ- - 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-Bu.lder- AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which 1 understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents nece3sary to obtain an Owner -Builder Permit for my project. Scope of Construction Project (or Description of Work): TWO ---- Project Location or Address: Name of Authorized Agent: Address of Authorized Agent: KpTH►- N�� 1 declare under penaltyof that li s+axs 1aTA eazu ,_ . information and certify its accuracy. N os 05DNE'�52 acceptable to the agency is required to vilu�2e�ib Property Owner's Signature:r ! Nomre�►wDjB rsonally filled out the abov 0155 or other verification A owner's signature. I s i Bin. # .. _ . '7Y. Cray of La Quanta Building &r Safety Division Permit # P.O. Box 1504,78-495 Calle Tampico A 1.4.Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Pro'ectAddress: J �' � V�, t Owner's Name:. A P. Number. .. i• Address: L Legal Description: City, ST, Zip:t� C't 9 vi 1 Cv �! I i Contractor. r a{���};�w S.. Telephone: % 60 Cu� \ 41 '.s::K I - Address: Project Description: LO "> )q City, ST, Zip: � yU o b,)Telephone: clC?� ?! + Ei 1 y i State Lic. #: City Lic. k ' Arch., Engr., Designer Address: City., ST, Zip: Telephone: Construction Type Occupancy: i • State Lic. #: '~ Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person: Sq. Ft.: #Stories: #Units: i Telephone # of Contact Person: Estimated Value of Project APPLICANT: DO NOT WRITE BELOW THIS LINE N Submittal Req'd'Rec'd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Ca[cs Reviewed, ready for corrections Plan Check Deposit. . Truss Calcs. Called Contact Person Plan Check Balance Tide 24 Cales. Pians picked up Construction' Flood plain plan— — -Pians-resubruitted . --- -Mechanical - - -- Grading plan 2' -Review, ready for correctionslissue Electrical --- _ SubeontactorList Called Contact Person Plumbing—�-_-- -- -- Grant Deed Plans picked up S.M.I. H.O A Approval Plans resubmitted Grading IM HOUSE:- 1n° Review; ready for correctionsfasue Dcveloper Impact Fee ' Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees