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09-0619 (BLCK)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 09-00000619 Property Address: 53655 AVENIDA HERRERA APN: 774-123-020-8 -000000- Application description: WALL/FENCE Property Zoning: COVE RESIDENTIAL Application valuation: 2000 Tit!t 4 4a Q" Applicant: Architect or Engineer: ------------------ LICENSED CONTRACTOR'S DECLARATION BUILDING & SAFETY DEPARTMENT BUILDING PERMIT 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 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 , 777"��� 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 -/S-- CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.I. Lender's Name: A Lender's Address: / � LQPERMIT Owner: STEPHEN F) 73140 AJO PALM DESEF Contractor: Owner VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 6/15/09 ----------------------------------------------- WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 1 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 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 3700 of the Labor Code, I shall f hwith comply with se provisions. ate: ✓' © cant: WARNING: FAILdRE 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 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 d county ordinances and st to laws relating to building construction, and hereby authoriz presentatives this county to enteeerrr upon th bove-mentioned property r inspec"i4 purposes ' Date: .0 ure (Applicant or Agentl:N1002 V-Lgfw Application Number . . . . . 09-00000619 Permit . . . WALL/FENCE PERMIT Additional desc . Permit Fee . . . . 45.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 2000 Expiration Date .. 12/12/09 Qty Unit Charge Per Extension BASE FEE 15.00 15.00 2.0000 HND BLDG 501-2,000 30.00 -------=-------------------------------------------------------------------- Special Notes and Comments' 80 L.F. COMBO WALL, 1-4" RETAINING, 6' GARDEN,CITY STANDARD. 2007 CODES ---------------------------------------------------------------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary. Charged Paid Credited ------------------------------ ---------- Due ----------------- Permit Fee Total 45.00 .00 .00 45.00 Plan Check Total .00 .00 .00 .00 Other Fee Total 1.00 .00 .00 1.00 Grand Total 46.00 .00 .00 46.00 LQPERMIT CITY OF LA QUINTA BUILDING & SAFETY DEPT. APPROVED FOR CONSTRUCTION DATE b --15-C9 gY K� PM LM Bin # City of is 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 # Project Address: 63 (o 5: 5'��i�/Y aJ�'l��f � Owner's Name: S ey) raw A. P. Number: .7 -7 % 2 3 Q 2.0 Address: � pTelephone: 60Contractor: {, »= <;; 't a>> Address: Project Description: City, ST, Zip: c Telephone: :>:>:<%':::>:::>;s>:>::::;:�: .82&&%/G 1-141 State Lic. # : City Lic. #; Arch., Engr., Designer: P Address: City, ST, Zip: Telephone: :::v:`;>: c,::< ;;::;:<;;:,:::; :: <:: ; z z;:: ; : State Lic. #: r :: <.:.... ,.;:::::;;:• •:_<> f <:•::;>.;>:.::> :%::.;:<%:>;;z::::<%z :•:»%'s:` :< <» 3 Construction Type: Occupancy: 5/ /e -Peu / i6 Project type circle one New Add'n Alter Repair Demo Name of Contact Person:5 fwh Sq. Ft.: # Stories: # Units: Telephone # of Contact Estimated Value of Project: 3 APPLICANT: DO NOT WRITE. BELOW THIS LINE # Submittal Req'd Rec'.d 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, 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 r AV & SAFETY DEPARTMENT (760) 777-7012 FAX (760) 777-7011 �Er ruction Permits the builder of the :property rtn to make you aware of your ;rstanding of .each'provision, ner cannot execute dus:•notice ormatcon. Ler obtain an "Owner -Builder". or and material personally. I, as ;twined by an unlicensed person not provide coverage for those coverage for injuries to workers ;ss they are responsible for the I understand that I may protect in his or her name instead of my id to list their license numbers on A Contractors, and the total value nay be considered an "employer" register with the state and federal and' contribute to unemployment . ay subject me to serious financial ho builds single-family residential f work is performed by licensed tr, or all of the work is performed 8. 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. 4..uries smained 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" 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_it_10. I am aware of and consent to an.Owner-Builder building permapplied for in my name, and understand that I am the party legally and financially responsible . for proposed construction activity . at the following address: 11. I agree that, as the party. legally and financially responsible for this proposed construction activity-, .I will abide by all applicable 18ws and requirements that govern Owner -Builders as well a$ employers. fiyl2. 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'civil court. It is also important for you to ui nderstand 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. 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 issuing; the.,permit. Note: A copy of tke property owner's dklver:'sifeensei form notanzatlon3 or other verification acceptable to . the agency is required to be pp ted when the permit is issued, to verify the property owner's signature. g,ignature of property. owne k 'Lot", Date: Note: The following Authorization Form is required to be completed by the propertyowner only when designating an agent of the property owner to apply for a construction permit for the Owner -Builder. AUTHORIZATION OF AGENT TO ACTON PROPERTY OW.NER'S BEHALF 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 agents) to apply for, sign, and file the documents necessary to obtain anOwner-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 1 declare.under penalty of perjurythat 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 acceptableto the agency is requiredto be presented when the permit is issued to verify the property owner's signature.. Property Owner's Signature: Date: