11-1155 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number:
11-00001155
Property Address:
51905 AVENIDA HERRERA
APN:
773-172-020-8 -000000-
Application description:
WALL/FENCE
Property Zoning:
COVE RESIDENTIAL
Application valuation:
1675
Applicant: Architect or Engineer:
air
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 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
ay pplicant 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
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 Law.).
(_) I am exempt under Sec. , B.&P.C. for this reason
ate: Owner: 4.41
tthere
NSTRUCTION LENDING AGENCY '
I hereby affirm under penalty of perjury tis a construction lending agency for the performance of the
work for which this permit is issued (Seciv. C.).
Lender's Name: n
Lender's Address: sem'
LQPERMIT
Owner:
BECERRA RODOLFO
51905 AVENIDA HERRERA
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: P 10
^ C.
--------------------------
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
.J 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 workers' compensation laws of California,
and agree that, if I should become subject to the workers' compensation provisions of Section
v3700 of the Lab se de, I shall fort�i '' complyAwit a provisions.
�✓`�`' �l V
scant:
WARNING: FAILURE TO SECUREi ORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO C INAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADD ION 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 Buildingand 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, indemnity 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 authorize representatives
of sJc,1oun2ty to enter upo the above-mentioned prop(e/ct0/�1�fopr//i�n�spe�c�tion pur sesfi�,�,,/J�/
Date: IV �4 6 �a ignature (Applicant or Agent): \L'^�(i" /a - �^� O
2
LQPERMIT
Application Number . . . . . 11-00001155
Permit . . . .WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 39.00 Plan Check Fee
00
Issue Date . . . . Valuation
1675
Expiration Date 4/17/12
Qty Unit Charge Per
Extension
BASE FEE
15.00
12.00 2.0000 HND BLDG.501-2,000
24.00
-----------------------------------------------=----------------------------
Special Notes and Comments
67 L.F. 6' GARDEN WALL AT SIDEYARD, CITY
STANDARD. 2010 CODES.
-----------------------------------------------------------------
Other Fees . . . . . . . . BLDG STDS ADMIN (SB1473)
-----------
1.00
Fee summary, Charged Paid Credited
Due
---------------------------------------------------------
Permit Fee Total 39.00 .00 .00
39.00
Plan Check Total .00 .00 .00
.00
Other Fee Total 1.00 .00 .00
1.00
Grand Total 40.00 .00 .00
40.00
2
LQPERMIT
fiut I) ell( r6Z—
lG�
UN +
P.O. BOX- 1504
LA QUINTA, CALIFORNIA 92247-1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
PROPERTY OVMEW S PACKAGE
(T60) 777-7012
FAX (760) 777-7011
Disclosures & Forms for Owner-Bullders Applying for Construction Permits
-OTANTI NOTICE TO iPRICiPRUTV OUIP -
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 at
We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you ay.hna of your
r+espons` 4lities and possible risk you may incur by having thispermit.issued in your name as the
Ownex-Builder. We will aot ism s building permit until yon -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.
OZ'S Ael�iQi�1�EDI'�'T ASID ��`iCA'>�Ol�l �� II�4�N
DZIMMNS: Read and aridd park statement -below- 16 signify you w dw3tand or very tris irtjormadon.
12(31. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder"
building permit that erroneously implies that the property owner is providing his or her own labor and material personally -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 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.
%&2. 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.
U3. 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 leis or her name instead of my
own.
�4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on
permits and contracts.
A5. 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, 1 may be considered an "employer"
understate and federal law.
%Z56. I understand if I am considered an "employer" under state and federal law, I must register with the state and federa
government, withhold payroll taxes, provide woikers' cornpeiisation disability insurance, and contribute to unemploymen
compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financis
risk
gff7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residenti
structures cannot .legally build them with the .intent to offer them for sale, unless all work is performed by licenst
subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is perform'
under contract with a licensed general building Contractor.
/ d8. I understand as an Owner -Builder if I sell the property for which this perQ►it is issued; I may be held liable for any
financial or personal. ,.4ur es susQained by any. subsequent owner(s). that result from any latent construction defects in the
workmanship or materials:
/k I understand'1. may obtain. more. information regarding my obligation's -as an "employer" from the Internal Revenue
Service, the United States Small Business Administration, the California Department ot`Benefit Payments, and the Califortr,+s
Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-
8tI0-321-CSLB (2752) or www.cstb.ca.goy_ for more information about licensed contractors.
Ota. l 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:
-a11. 1 agm that, as the party legally and financially responsible for this proposed construction activity, t will abide by all
applicable laws and requirements that govern Owner -Builders as well as employers.
gB 12.1 agree to notify the issuer of this .fotm immediately of any additions; deletions, or changes WanY o'f the wformation 1
have provided on this forts Licensedcontractors are regulated by laws designed to protect the public. If you contract with
someone who does not have a l eem, the Contractors' State License Board may be unable to asset you with any frnancig loss
you may sustain as a result of a complaint Your only remedy against unlicensed Contractors may be W'civd cottzt. 11 13 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 as OwaffIBuiMer and wish to hire Contractors,
you will be responsibto for verging whedhee or -not those Contractors are propetty licensed and the status of tlreir workers'
00=1 WS 011 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 issue: tte:p,er=t, Note: A copy of aw property owner's dbvec'sts i fwm +town+ or
other veriftwation acceptable to the agency is rr4u&a to be Presented when the permit is snue�6 to rerlfy the ptbperty
owner's signature. _
(► 'JI t 1 ! 1 I.y 1 1 r "Pr PF
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.
a
AUTRORUATION OF AGENT TO ACT ON PROPERTY OWNEWS REHA&LF
Excluding.the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize
,the following person(s) to act as my agent(s) to apply for, sign,. and fife 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
Bin #
.
Cl & .iLA Quinta-
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 #\\(i��
Project Address: _ �� !/G Eip `
Owner's Name:
A. P. Number:
Address: j - yD U 67
Legal Description:
City, ST, Zip: G j C
Contractor.s,3
D.`/f/.
n.ysb::;;;•,:t iw:W'Y:✓,w''•':`` °'`5;t
Telephone % (-, � >,:;N;
Address:
Project Description:
City, ST, Zip:
( G,
Telephone:
..,�:•<:..:>..>;.:.:r;:;;:s:;::.h:?:>::;<'<•
�j::a�:a<b. ::x;;;::; or •: •r>r:9?::;:•r..if3;Vri¢
State Lic. # :
City Lic.
6.17 '
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. #:
,'.
Construction 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:
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 Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2pd Review, ready for correction0ssue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
7nd 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