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09-0709 (BLCK)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 09-00000709 Property Address: 80106 HERMITAGE APN: 762 -231 -016 - Application description: WALL/FENCE Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 575 Applicant: / Architect or Engineer: BUILDING & SAFETY DEPARTMENT BUILDING PERMIT LICENSED CONTRACTOR'S DECLARATION 1 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 Professionals 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 an 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 TT 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: / - f CONSTRUCTION LENDING AGENCY _ I hereby affirm under penalty of perjury that there is a construction lending agent for the perf ante of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name: _ Lender's Address: LQPERMIT Owner: AMEN MICHELLE 5747 BUENA VISTA AVE OAKLAND, CA 94611 ( Contractor_: Owner VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS,L4) ) 777-7153 7/07/09 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 orkers' compe on la s of California, and agree that, if I should become subject to the w k rs' compen ion provisions of Section 3700 of the Labor Code, I shall forthwith comply ith those pro sions. Date:)- _ - LY1'�IN / rl Applicant: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVE G UN FUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINE P TO E H DRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSA ION, DAMA 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. 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 a horize repres as of this county to enter upon the above-mentioned property 4 forinspectionpurposes. t Date: Z agnature (Applicant or Agent)• C . "1 �� 41�fV j Application Number . . . . . 09-00000709 Permit . . . . . WALL/FENCE PERMIT Additional desc . . Permit Fee . . . . 17.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 575 Expiration Date 1/03/10 Qty Unit Charge Per Extension BASE FEE 15.00' 1.00 2.0000 HND BLDG 501-2,000 2.00 ----------------------------------------------------------------=----------- Special Notes and Comments 23 LN FT X 6 FT HT BLOCK WALL PER CITY STANDARDS AND APPROVED PLANS. ---------------------------------------------------------------------------- Other Fees . . . . . .. . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged Paid -------------------- Credited -------------------- Due ------------------ Permit Fee Total 17.00 .00 .00 17.00 Plan Check Total .00 .00 .00 .00 Other Fee Total 1.00 .00 .00 1.00 Grand Total 18.00 .00 .00 18.00 LQPERMIT P.O. BOX 1504 LA QUINTA, CALIFORNIA -92247-1504 78-495 CALLS TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT PROPERTY OWNER'S PACKAGE (760) 777-7012 FAX (760) 777-7011 Disclosures & Forms for Owner -Builders Applying for Construction Pelrmits .LM OAT'ANT! NOTICE TO PROPERTY OWNER Dear Property Owner: An. application for a buildingermit has been su itted in your name listing yourself as the builder of the .property improvements specified at — �� e We are -providing you with an Owner -Builder Acknowledgment and Info ion Verification Form to make you aware 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 building permit until you have read, initialed 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. OWNER'S ACKNOWLEDGMENT ANDYERIFICATION OF INFORMATION DIRECTIONS: Read and initial eachstatement below to signify you understand or venfy this information. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder" burlding permit that erroneously implies that 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. L1J^116__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 licensed Contractor to assume this responsibility.. I understand as an "Owner -Builder" 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. �I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. �I 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. 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 workers' compensation disability insurance, and, contribute to unemployment . compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. `'IbaI understand under California Contractors' State License 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 under contract with a licensed general building Contractor. Imo° I 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 sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. I understand I may obtain more information regarding my obligations as an "employer" from the Internal 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 (CSLB) at 1- 800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the party le ally and finan i tty responsible for proposed construction activity at the following address: k r. _ N n r .,.__ _- %A . _ -..A ---..-.. /1- -_ , - n --- --,,n X- _ - - - - '�I. I agree that, as the party legally and financially responsible for this proposed construction activity, .l will abide by all applicable taws and requirements that govern Owner=Builders as well as employers. �2. 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 financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in;civit court. It is also important for you to: understand 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 asOwner-Builder and wish to. hire Contractors, you will be responsible 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 signed by the property owner and returned to the agency responsible for issrting,ttie.permiL Note: A copy of the property owner's dr-iver's.l cense; form. notarization; or other verification acceptable too the agency is required to be presented when the permit is issued to verify the property owner's signature. Signature of property. owner Date: 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 I understand- is my personal responsibility,.1 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 orAddress: �� H e 2 t'ti � J A G P Name of Authorized Agent: A I ex L— 5 Qy ✓(� L Tel No (� _ Address of Authorized Agent: y Z- l J L P J C V, FgyZ k_ 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 be presented when the permit is issued to verify the property owner's signature.. Property Owner's Signature: \' D ,//1,( �� Date: JAN/08/2009/TBU 11:03 AM The Monarch Group FAX No.760 776 5111 l',UUI December 30, 2008 XGA_ WEST XX M DENTIAL ASSOCIATION, INC. 39755 BEMY DKK STE A PALM DESERT, CA 92211 PHONE (760) 776-5100 • FAX (760) 776-5111 Michelle Amen 5747 Buena Vista Avenue Oakland, CA 94618 Reference: 80-106 Hermitage, La Quinta Architectural Change Request — Adding a Wall from Entry to Common Wall I Removal of Wall Dear Ms. Amen: The Board of Directors of PGA WEST If Residential Association met on December 22, 2006 and again reviewed your Application for Architectural Change for your home at 80-106 Hermitage at PGA WEST II. The Board of Directors has voted in favor of this Architectural Application contingent upon the following conditions being met. - A new application being submitted with new landscape plans to show "the new landscape plan after the wall changes, to be reviewed and approved by the landscape Committee. There must be enough room for landscape equipment access through the main entrance gate. - A maintenance agreement being executed for the improvements that you will be responsible for the maintenance of the improvements when made. - All other normal application forms being submitted with the new landscape application. - Please refer to the City of La Quinta on the wall height. Go tions. The ComMittee's derision with regard bo oroiect deslon will be final. Please refer to the ArchkaM al. Rules for all reoulred submittals. Approvals given by the Architectural Committee and Board are good for only six months from the date on the approval letter. If construction has not commenced within six months after the project approval date, a new application must be submitted. Upon completion of your project, please complete and return the Notice of Completion of Architectural Change. JAN/08/2009/THU 11:03 AM The Monarch Group FAX NO.71JU Tlb 5111 r,uuc Page II Amen, 80-106 Hermitage Architectural Application 12-30.08 If you have any additional questions or concerns, please do not hesitate to contact Joanne Rose, CLAM, Association Manager, at 760/776-5100, Ext. 320. Sincerely, PGA WEST II RESIDENTIAL ASSOCIATION For Architectural Committee and Board of Directors Cc, unit nn,,o�;,�u� JAN/08/2009/THU<:l'1°:`U� AM ;:°1. Tonaren umup r Page II Amen, 80-106 Hermitage Architectural Applicatibn 12-30-08 If you have any additional questions or concems, please do not, hesitate to contact Joanne Rose, ccAM, Association Manager, at 760/776-5100, Ext. 320. Sincerely, PGA WEST 11 RESIDENTIAL ASSOCIATION For Architectural Committee and Boars! of Directors Cr-, unit r FEB/18/20 WED 09: 37 'AM ' The Monarc}i Group February 16, 2009 Michelle Amen 5747 Buena Viso Avenue Oakland, CA 94618 Reference: 80-106 Hermitage, La. Quinta Landscape Change Request Dear Ms. Amen: "FAX Nn. 760''776 5111 PGA WEST II RESIDEN'1 UL A,SSOCUTXON, INC. 39755 SERKEY DRIVE STE A PALM DESERT, CA 92211 PHONE (760) 776-5100 - FAX (760) 776-5111 The Landscape Committee of PGA WEST TI Residential Association met on February 12, 2009 and reviewed your Application for Landscape Change for your home at 80-106 Hermitage at PGA WEST 11, The Committee has voted in favor of this Landscape Application contingent upon the following conditions being met. You will be responsible for replacement, if necessary, of the improvements within 12 months from installation including the irrigation. A maintenance agreement being executed for the improvements that you will be responsible for the maintenance of the improvements when made. All conditions listed in the letter dated December 30, 2006 concerning Architectural Change are adhered to. Review by the Committee and Board is only fnr general Architectural Rules. It is the resoonsibility of the owner to fully ungerstand and conform to th® At+d>litectural/tandsgape Rules criteria whether or not all defiaendess are noted during the review,. It is also the owners full rmonsibiiity to field verify all existing conditions. The Corna ttee's decision with regard to oEfta designwill be final. Please refer to the Arc:hitedural Rulr& for all required submittals. Approvals given by the Architectural Committee and Board are good for only.six months from the date on the approval letter. If construction has not commenced within six months after the project approval date, a new application must be submitted. Upon completion of your project, please complete and return the Notice of, Completion of Architectural Change. If you have any additional questions or concerns, please do not hesitate to contact Joanne Rose, CLAM, Association Manager,. at .760/776-5100, Ext. 320. Sincerely, PGA WEST II RESIDENTIAL ASSOCIATION For Landscape Committee Cc: unit Bin # City Of La Quinta 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: r- 1C7 � - Owner's Name: vz ` . A 1�n s A. P. Number: Address: (a() ^ I o ,A Legal Description: City, ST, Zip:., Contractor: AC2 PcolS Telephone: a ^: Address: l 13 14C �AF. vz (c- fZ Project Description: City, ST, Zip: 9 2 Z V Telephone: P N 5"V-Z I J State Lic. # City Lic. Arch., Engr., Designer: j .. Address: City., ST, Zip: Tele hone: State Lic. �J�a;�o,:•.:..�.y..,.y��.��,Construction _va . ` Type: Occupancy: Project type (circle one . New Add'n Alter Repair Demo Name of Contact•Person: Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: `� Estimated Value of Project:4 12—S6 C,- ,—APPLICANT: APPLICANT:DO. NOT WRITE. BELOW THIS LINE # Submittal Plan Sets; Req'd Recd TRACKING PERMIT FEES Plan Check submitted Item Amount Structural Cates. Reviewed, ready for corrections Plan Check Deposit Truss Cates. Called Contact Person Plan Check Balance. Title 24 Cates. Plans picked up - Construction Flood plain plan Plans resubmitted Mechanical Grading plan ra. Review, ready for correctionsAssue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up. S.M.I. H.O.A. Approval Plans resubmitted Grading INHOUSE:- 'rd Review,.ready for correctionstissue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P.. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees sin # 'a Qty Of La Quint 8T Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet 'Permit # � i I Project Address: _ >ct' Owner's Name: A. P. Number: Address: S ' � Legal Description: City, ST, Zip: • Contractor' Telephone: . �- Address: Project Description: City, ST, Zip: Telephone: :. ::<::, l,+.;:i:....: `;r;.;+: ±..; r n:;> F c:T f .0 16,—T7 State Lie. # : City Lie. #: Arch., Engr., Designer: Address: City., ST, Zip: Telephoner State Lie. #: •: Y:;.;::;:;;o:;: ::•tiff::::.{.::;:::::.:::..::;:.......%?. :::! i?%'<``%;>#" <. >+.S•iir ryti}>ASyy f+i t•^:.:t•'r.`::?j%:ii?. i>i �<.ti:�if,S :i J.cy.;:: i:•�:.y:.}. +•••; r.�ivi:i liAv. ':;:..<.:fi:?:<?>;::>:: :>•,•'<:;: <::.>.>?<;:' Construction Type: Occupancy: Project type (circle one): ew Add, n Alter Repair Demo Name of Contact Person: Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: Estimated Value of Project`I 12 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 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 corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up. S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- '"' Review,xeady for correctionstissue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees