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14-0043 (BLCK)4 P.O. BOX 1504 VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 1/16/14 Application Number: 14-00000043 Property Address: 51365 AVENIDA HERRERA APN: 773-084-018-6 -000000- Application description: WALL/FENCE Property Zoning: COVE RESIDENTIAL Application valuation: 1250 Applicant: Architect or Engineer: -------------------------------------------------- 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 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 1 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 Licen aw (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that a she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by _,r,lcant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: 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.). 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 . . -i(-1 I am exempt under Sec. , B.&P.0 or this re on Date: caner: -1 I hereby affirm under penalty of perjury that t s-a-cor work for which this permit is issued ISec. 309L7, Civ. C.). Lender's Name: _ Lender's Address: LQPERMIT LENDING AGENCY m lending agency for the performance of the Owner: FISCHER DENISE' 51365 AVENIDA HERRERA LA QUINTA, CA 92253 ( Contractor: Owner ---------------------------=------------------- 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, 1 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 of the Labor Code, I shall forthwith comply with those provisions. Date: Applicant: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL 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 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 ISO days will subject permit to cancellation. I certify that I have read this application and state that t ve ormation is orrect. I agree to comply with all city and county ordinances and state laws relating to b i i cons uction, and ereby authorize representatives of thisi unty to enter upon the above-mentioned pr y �insp ction purpo s. Date: Signa (Applicant or Agent Application Number . . . . 14-00000043 Permit . . . WALL/FENCE PERMIT 2013 Additional desc . . Permit Fee . . . . 47.19 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 1250 Expiration Date 7/15/14 Qty Unit Charge Per Extension 1.00 47.1900 LS MISC WALL, FIRST 100 LF 47.19 ---------------------------------------------------------------------------- Special Notes and Comments GARDEN WALL PER ANGELUS SPECS. 50 LN FT X 6 FT HT PER APPROVED PLANS PER J.J. ---------------------------------------------------------------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 PLAN CHECK, WALLS 60.06 Fee summary Charged Paid Credited ----------------- Due ---------------------------------------- Permit Fee Total 47.19 .00 .00 47.19 Plan Check Total .00 .00 .00 .00 Other Fee Total 61.06 .00 .00 61.06 Grand Total 108.25 .00 .00 108.25 LQPERMIT Bin # C.ty of La Quinta Building & SafetyDivision P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Per -Project Address: S) ?j (p�j Y%� ( wner's Name: ;D 6 ti} -156 6 J al.(h' _ A. P. Number: -Address: a.Z5 Legal Description: eity, ST, Zip: GQ t`s�t -)Ljt„k e A - Contractor: Q LJu elephone• ,,>, >':u:>::>:;: :. , ;.:: <•:: ,,.. Address: roject Description: City, ST, Zip: e DA)SCM( C< 6 -W -'J ,6 VJ Rt,t_, a &UA_ Telephone: p A)6 State Lic. # : City Lic. #: y7 S o (9R C Arch., Engr., Designer: 5 Address: City., ST,. Zip: Telephone: p ':::':`::::::' ' ":" ` :: :: Construction Type Occupancy <`<:>:;::<>:<;<.:>::::#<:`•:%:::::<:<:>::::>: .?:v}:{.{:)?r:�•+.�'ii:invn:. h:.}'rf.}:C.^:Cti?i:;ywx"� f (Cri?$if r:;:i%%{5:}:;r}�:; ri;: tir:::'•'�i:'.•?*i:iiji Project type (circle one): New Add n Alter Repair Demo State Lic. #: e of Contact Person: (,' Vi, I C; �� W .5 Sq. Ft.: Sd # Stories: #Units: Telephone #,of Contact Person: (p (�� 1j % o 'mated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE N 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 Caics. 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:- 3a Review, ready for correctionsfissue Developer Impact Fee Planning Approval Called Contact Person • A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees GfflfC`/cpj'� i3c o c.<< L,—A L r Rear Yard Fence Interior Lot 51365 Avenida Herrera La Quinta, CA Property line ICY ® LA QUINTA BUILDING & SAFETY DEPT. APPROVSD :7-r= �Ilft Fjj 7 January 15, 2014 To whom it may concern, / 4 I, �/1%/�. "!, S� �/y� give my consent to the City of La Quinta to issue a building permit to facilitate the construction of a brick wall on the property line of 51365 Avenida Herrera & my residence at 51360 Avenida Vallejo. P.O. BOX 1504 LA QUINTA, CALIFORNIA 92247-1504 78-495 CALLE 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 Permits P0HUNT! NOTICE TQ FRQPERTyOWNER Dear Property Owner. An. application fora buikling permit has been submitted* in your name listing yourself as the builder of the Property imprdvements specified at 13 o5 rkU e-0 I Is k- L� d C__ -VLA We are providing you with an Owner -Builder Acknowledgment and Information' Verification Form to make you aware of your responsibilities and possible risk you may incur by having'this permit issued in your nate as the Ownez<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. D11,�7ONS: Read and irtkial each statement below to signify you understand or verify this informs tion. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder" b ding 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 Willy acting as an Owner -Builder and am aware of the limits of my insurance -coverage for injuries to workers on , party I understand building permits are not required to be signed by property owners unless they are responsible for the c truction and are not hiring a licensed Contractor to assume this responsibility. 3. I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect If from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my PrMits 4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on and contracts. 5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value f y construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" un r state and federal law. 6. I understand if I am considered an -employee' under state and federal law, I must register with the state and federal g rnment, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment co enation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial 1ct . I understand- under California Contractors' State License Law, an Owner -Builder who builds single-family residential ures 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. 6anc I understand as an Owner -Builder if I sell the property for which this permit is issued, I'may be held liable,. for any l or personal. qunes sustained. by any subsequent owner(s) that result from any latent construction defects in the Vcve,anship or materials.I understand I may obtain more information regarding'my obligations as an "employee' from the Internal Revenue the United States Small Business Administration, the California Department of Benefit Payments, and the California Divis'on of Industrial Accidents. i also understand I may contact the California Contractors' State License Board (CSLB) at I- 8 -3 -CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. 4-110. 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: /// V I. I agree that, as .the party legally and fnaucially responsible for this proposed construction activity, .I will abide by all able laws and requirements that govern Owner -Builders as well as employers. =1 I agree to notify the issuer of this form immediately of any additions; deletions, or changes to any of the information I provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who doesnot have a license,. die Contractors' State License Board :may be unable toistyreu ­; -M— ...th MY financial 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 tounderstand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property; you may be heldliable for damages. If you obtain a permit as Owner -Budder and wish to hire Contractors, you will be .responsible forv why or not those Contractors are property licensed and the status of their workers' coition 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 issuing. &e..permIL Note: A copy of du property owner's dkiver'sJkenae; farm ftOft*09014 or other verification acceptable to the agency ' required to be presented "ch the permit is issue to verify the property owner's signature. Signature of property owner Dater 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, I hereby authorize the following persons) to act as, my agent(s) to apply for, sign, and file,the documents necessary to obtain an Owner -Builder Permit -'for my project- n A15, � Adel ��� Scope of Construction Project (or Description of Work): � 51kUti- &� b& l�Jl4 e,(_ OZ 't Project Location or Address: 51 („� Ax J 91)14 ta 4"P( Name of Authorized Agent: LrVl w- (4'50,1E' Tel No Address of Authorized Agent: '5ls24,!!� &)e0o l w- 6"A 4- Lk Qv- tV,.<k) C -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, forret 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. � L4Z / Property Owner's Signature: r ` ,g,�� Date: