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11-0809 (BLCK)4 P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 11-00000809 Property Address: 44790'N HARLAND DR APN: 604-23.1-023-9 -23268 Application description: WALL/FENCE Property. Zoning: LOW DENSITY RESIDENTIAL Application valuation: 1000 c&`qv °F 4v,QaAM Applicant: Architect or Engineer: bAr plr�- LICENSED CONTRACTOR'S DECLARATION BUILDING & SAFETY DEPARTMENT BUILDING PERMIT I hereby.affirm under penalty of perjury that I, am licensed,underprovisions of Chapter 91commencing, with Section 7000) of:0lvI6ion 3 of the Business en&Professlonals Code; and.my:Ucenseds.in full force and effect. License Class. Ucense"No::. Date: Contractor: OWNER-BuLLDER, DECLARATION I hereby affirm under penalty:of perjury that I, am exempt from;theContractor's State License Law for the following reeson,(Sec. 7031.5, Business and Professions Codw Any city or county thavrequires a permit,to construct, alter,improve; demolish, or repaihany 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 Stets Llcense.Law (Chapter9 (commencing with Section 7000) of Division;3,of the Business, and Profes ilons'Code) or that he or she is exempt therefrom.and the basis for the alleged exemption; Any violation of Section :.7031:5 by an��,y}}}pplicant for a permit eubJeetsthe applicant to a Gvil penalty of'nct morethan'flve hundred dollars (6500):: ( �[ 1 1, as owner of -the property, or my employees with wages as their sole compensation,,willdo the work; and `\ the structure is not:iritended.oroNered 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 herown,employesa; provided that improvements are not intended or offered for sale. If,' however, the.buikiing or improvement is sold within one year of completion, the owner=bulkier will have the burden of proving that he orshe:did not build or Improve for the purpose of sale.). (_ 1 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business:and.Brofeaalona Code: The Contractors'tlState License Law does not apply,to an owner of property who builds or Impioves'thereon, and who contracts for the projects with a contractors) licensed pursuant to the Contractore':Stete License Law.). (_) I am exampvunderSec. B.&P.C. for this regsoo X. -t - Owner, CONSTRUCTION LENDING AGENCY \­� 1 hereby affirm under'penalty'of perjury that there is a construction lending agency for the performance otthe work for which this pernitSis'issued (Seca 3097,•Civ: C:). Lender's Name:. Lender's Address: I:QPMMIT Owner: MANUEL SANCHEZ 44790 NORTH HARLAND DRIVE LA QUINTA, CA 92253 Contractor: Owner VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 1127/11 WORKER'S COMPENSATION'DECLARATION I herebyafflrm under penalty of perjury one of the following declarations: I have and Will maintain a certificate ofconsent to self -insure for:workers' compensation, as'provided for by,Section L3700 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'W Section 3700 ofithe Labor Code, for the performance of the work for which this permit is. Issued,. M_ y workers' compensation insurance carrier and policy number are: Carrier Policy Number I certify that, in the performance of -the worktor which this permit is'iasued, l shall, not.erholoy:any person irrany manner sous to become subject to the workers' compensation laws of California, and agree that, If I should become subjgct to the vv�w Its' oomptppation provisions of Section WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE:IS UNLAWFUL, AN HAL SU8JECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDREDTHO ND DOLLARS ($100,000). IN ADDITION TO THE COST'OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION.3708'OF THE LABOR CODE, INTEREST, AND ATTORNEY'S, FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety.fora permit subject to the conditions,and,restrictionns setforth on this application. 1. Each person upon whose;behalf this applieation,is made,.each person at1whose request And for whose benefit work is performed undei'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 Le Quints, its officers, agents and employees for any act or omission related to the work, being performed underor following Issuance of this permit. 2.. Any permit issued a re_sult'of this application becomes null and,vold if woricJs not commenced Within 180 days from date of Issuance.of such permit, or cessation of work for' 180 days.will subject permit to cancellation. 1 certify that: l'have.read this -application and state that the above Information is correct. I a - to comply with'all city and county ordinances.and.statglaws relating^to bullding,cona - ion, and he ' :a o_rlie representatives,, of this county to)Mer upon ;he above-memio rine , Pur 'Dre (Applicant or, Agent): e: N natu Application Number 11-00000809- Permit. . . . WALL/FENCE PERMIT Additional desc . Permit Fee . . . . 25.0.0 Plan Check Pee.. .0.0 Issue:Date Valuation . . .1006 Expiration Date 1/23/12 Qty Unit Charge Per Extension BASE FEE 15.00 5.60 2.0000 HIND BLDG 501-2,OOQ 10.06 --------------------- -------------------------------------- .-------- Special Notes and Comments REPAIR 40 L.F. 61LEANING BLOCK WALL USING SALVAGEABLE AND/OR NEW BLOCK. USE EXISTING REPAR OR NEW IF NEEDED. 2010 CODES. ------------------------------------------------.. Other Fees BLDG - SIDS AI Fee summary Permit Fee Total Plan Check Total Other Fee Total Grand Total LQP&RMIT Charged Paid: --25.00 ----- .00 .00 .00 1.00 .00 26.00 .00 Bin # Qty of La Quinta Building 8r Safety Division P.O. Box 1504, 78-495 Calle Tampico 1a Qtdnta, CA 92253 - (760) 777-7012 Building .Permit Application and Tracking Sheet �� # perm$0 Ok Project,Addcess: Yq% 90 At. WA&AN V Owner's Name: 4AACj(4C-- A. P. Number: Address: Y(/790N MANAN>0 VE Legal Description: Contractor:` `L . City, ST, Zip: L q Ula�hq C g 3 Telephone: ( Address: Project Description: eA3T614& WALL 4 SOW XZ . City. ST, Zip: LL 5 4 '�.:�% Telephone:• State Lic. # : CityL• ic..#cnn/� . Arch.,.Engc., Designer. CO(S lJJ C. N l'i K/ Address: r L,�l�- { 1')f fi 141- City, ST, Zip:` Telephoner Constriction Type:' Occupancy: .State Lic.;#: Project'type.(circle one): New Add'n Alter ep ' 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 TRACMG PERMIT FEES Plan Sets Plan Check submitted item Amount Structural Cales. Reviewed, ready for corrections Plan Check Deposit Tr=s Csles. Called Contact Person Plan Check Balance Title 24 CalcL Plans picked no Construction Flood plaln:.pian Plans resubmitted Mechanical Grading plan 2"! Review, ready for correctionvissue Electrical. Subeontactor_List Called Contact Person Plumbing Grant Deed Plana;pieked up S.M.I. H.O.A.. Approval Plans resubmitted Grading IN HOUSE:= ''' Review; ready for correctionaNsae Developer Impact Fee Planning Approval Called Contact Person A.LP:P. Pub. Wks. Appr Date of permit Issue School Fen Total Permit Fees 1' =I P.O. Box 1504 LA QUINTA, CALIFORNIA .92247-1,504 78=495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT PROPERTY OWNER'S PACKAGE (760) 777-701.2 FAX (760) 777-7011 ?isclosures &L Forms for Owner -guilders Applying for Construction Permits MKWORLIUMI MOTfCE"Tn PA[1P risry C1@VNER Dear PropertyOwner: An. a lication fora Ydildmg pew, has been submitted in your name 1st" yourself as the u_rlder of the property impPo encs specified at lA e ClA53 . We a x wvviding you wi�l;;an OMwn Builder awl reVeosibilitics and edgment and Information V orm to You awana o€your possible risk you may incur by having obis permit immd in your name as the Oma -Builder. We still not'i=e a buildin&pernift until yawbave rend, hd#aled your - of of eack'prarlsion, 619BCd, and returned this form to as at our oineial address indicated. An agent of the owner cannot execute this -notice unless you, the`property owner, obtain the priorappioval of the per miuing authority. bnMalion. I understand a frequeht practice of unlicensed persons :is to have the property owner obtain an "Owner-Buildee' building permit that erroneously implies that° the ,property.owneIris providing his_or her own laborand 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 awarethe limits:of my insurance coverage for injuries to workers on my, property. r/2. `I understand building permits arenot 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., v �, I understand as an "Owner -Builder" I am the responsible party of record` on the permit. I understand .that I may protect mysetf`from potential'financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my. own. V4- FunderstandContractors are required by law to be licensed -and bonded in Califoinia and to list their license numbers on permits and.contracts. 5.1 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" understate and federal law. I undersrtand if'I am considered an "employer" under state and isederal 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 financW 7. I understand under California Contractors' :State_ License Law, an Owner -Builder who builds single-family residentia structures cannot .legally build them with the intent to offer them for sale, unless all work is .performed by license, subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performe under contract with a licensed general building Contractor. I lB understand as an Owner-uilder if I sell the property for which this permit is issued, I May be held `"'Lble' for any, franc ia l- or personaldefectsin the iquries mgmimil by any -subsequent owner(s) that result from any latent construction y obtain mort'information retarding, my obligations :as. an "employee' from the 111temd ROMUe ervios, the llniteid States SWAU BusinessAdministration, the Catifornia Departmentof Elesefit'PaYnlenbs, and the California Division of Industrial Accidents. I also understand'I may contact the California Contractors" State, License 5Oard,(CSLB) At plied f I- IIOID-12 I -CSLB, (2752).or www.cAb.cagov for more information about licensed contractors. t.V 1 am awareof and consent to an Owner -Builder building - permit applied Or, in my name, and understand that I am the % party legally and financially responsible for proposed construction activity at the following address: [agree that, as the party legally and financially, responsible *onsib le for this proposed construction activity, I will abide by all appycable laws and requirements that govern Owner -Builders as well as employers. 12.1 agree to,notify the issuer of this formirainediately of any additignst dela ions, Or chang.0 to any, Of the i8fOrmation I provided on this, form. Licensed contractors are regulated 'by laws designed to protect the public. If you contract with some who does not have WfieemSte Contractors' State License Board maybe unable to ZMW YOU with any financial loss you may sustain as a result of a complaiqt. You only remedy against. unlicensediCodUctors may be incivil coact. It is 3190 - against 1 unlicensed tkp- inl� for you taij�,ul,thatif andfificaised Contractor Or euoloyee,ofthxt,drvidual of &Mis:O*Vd while wWking on Your Property;you,may be,heM Habit Nr damages. If you, obtain.apermit as OwberrBudder and wish to bile 'COMUMOTS, you will be aspomble for verdft.vAndw or not dx= Contractors are, vtopedy- U&MWO Mddw slat" Of thm w0*e& convensationinstirsuft coverage. Before a building permit -can be iwn4 tits form.must be completed and signed by the property owner- -JLRd returned to the agency responsibleifor huft&* per . oft- A copy of theepuperer -owner's driver's Amuto f4m n0t4d=d084 Or other verifkaden awepmbk to &e qMnq is requira to be prarented when tie permit is im"d 90 verify the Pv"M owner's signature. Signature of property owner 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. Excluding'the Notice to, Property Owner, the execution,of which I understand is MY personal gesp9mWfity. I hembyauthDrize the following person(s) to act as my ogej*s) to applyfor, sign, and file the documents necessary to obtain an Owsier-Buiiiier. 'Permit formy-project. Scope of Construction Project (or.Description of Work): Project Location or Addresst Name of 'Authorized Agent: Address of Authorized Agent: Tel No Udeclm underpenalty of perjury that I am the property owner for the address listed above and I pemngllYfilled Out:the above information and certify its accuracy. Note. A copy of the owner's driver's license, farm notarization, or Other vllk601 acceptable to the agency is required to bepresented when the: ermit is issued to verify the property owner's signature- -Property Owner's Signature: Date: