12-0439 (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: 4/23/12
Application Number: C-12-00000439 Owner:
Property Address: 53405 EISENHOWER DR MICHAEL PINTER
APN: 774-085-021-9 -000000- 53405 EISENHOWER DRIVE
Application description: WALL/FENCE LA QUINTA, CA 92253
Property Zoning: COVE RESIDENTIAL. ------------------------ �
Application valuation: 953 , t
/A\
Contractor: A W R �D � O
Applicant: Architect or Engineer: Owner 201
------------------------------
CITY OF Lfl ,lulidiA
IPIdRICE DEQ'*.
--------------------------------------------------
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
any /applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
(1✓ 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
Y� the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
Contractors' State License Law Coes 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.).
(_ 1 I am exempt under Sec. , BAP.C. for this reason
QE ner:
/ 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 ISec. 3097, Civ. C.). -
Lender's Name:
Lender's Address:
LQPERMIT
------------------
WORKER'S COMPENSATION DECLARATION
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 r 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 workers' compensation laws of California,
and agree that, if I should become subject to the workers' compensation provisions of Section
3XTO
Labor Code, I hall fort/hw�ith comply with those provisions. .
ate: YlVk l_�
WARNING: FAILCURE 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 and county ordinances and state laws relating to building construction, and hereby authorize representatives
of thi cou�ntt to enter upo he above-mentioned property for ' sp coon purposes.
te: Y0'3 nature (Applicant or Agent):
Application Number . . 12-00000439
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 25.00 Plan Check Fee
.00
Issue Date Valuation . . .
.953
Expiration Date 10/20/12
Qty Unit Charge Per
Extension
BASE FEE
15.00
.5.00 2.0000 HND' BLDG 501-2,000
10.00
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Special Notes and Comments
44 L.F. 5' GARDEN WALL & RETURN.AT FRONT
P/L. CITY STANDARD. 2010 CODES'.
---------------=------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged. Paid. -Credited
Due
Permit Fee Total 25.00 .00 .00
25.00.
Plan Check Total .00 .00_ .00
.00
Other Fee Total 1.00 .00 .00
1.00
Grand Total 26.00 .00 .00
26.00
LQPERMIT '
CITY OF LA C UINTA
BUILDING & SAFETY DEPT.
APPROVE®
FOR CONSTRUCTION
eSGbl��'�1q tram.
WAI
ffr�# J_ f __
P.O. BOX 1504
LA QUINTA; CALIFORNIA 92247-1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
PROPERTY O` "ER S -PACKAGE
(7.60) 777-7012
FAX (760) 777-7011
Disclosures & Forcers For Owner -Builders Applying for Constructlon Fees
AMMIANT1 NOnCE JW p WEgTy owlvE
Dear Putty Owner:
An- epptieatioa for a building permit has been submitted in your name Ustm yourself as the budda of do Plop"
We are Woviding You UM an Owner -Builder Ae wo* todgment and Werimaden Yaffieem form to Mabe YOU swam of your
Ibil M and possible risk you may intra by dds pe rmit.imod. int parr triune as die
Ovruec udder. We wis not ism a b .permit ung yam -have read, ialt dcd yaw undue of eaclr'ItMds1on,
signed, and returned this form to us at our. official address indicated.. An agent of the owner c=NA exemft CAS notice
unless YOU, the property owner, obtain the prior approval of the permitting authority.
1. 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 pmnuslt . I, as
an Owner -Builder, may be held table and subject to serious financial nsle for any injuries sustained by an unho and person
and his or her employees while worlang on my property. My homeowner's insurance may not provide eoverate for thmse
ig(uries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance.covtMt for iyjurias to worimn
on MY property.
A2 1 understand building permits are not required to be signed by property owners unless they are responsible for tb
construction and are not hiring a licensed Contractor to assume this rbility.
I understand as an'XNmer-Builder" I an the responsible party of revord on the permit. I undersuind 6311 my Prote,
mysel from potential financial rusk by hiring a licensed Contractor and having the permit filed in tris or Iter nae�t ipsir~ad of n
own
V - I understand Contractors are required by law to be licensed and bonded in California and to list their licepse numbers
permits and contracts.
S. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total va
of m construction is at least five hundred dollars (5500), including labor and materials, I may be considered an "emplol
under state and federal law.
6. 1 anderstartd if I 'am considered an "employer" under state and federal law, I must register with the state and for
go ent, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to ttnernployr
compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious final
risk
7. I understand, under California Contractors' -State License Law, an Owner -Builder who builds single-family reside
Simcannot legally build them with the intent to offer them for sale, unless all work is performed by tic,
subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is perfr
under contract with a licensed general building Contractor.
t A. I understand as an Owner -builder if I sell the property, for which this PCTM1 is issued, 1 may be held liable for any
financial or personal. b juries sustatned� by.any subsequent owner(S) that result from any latent construction defects in the
worlamansWup• or matexi4k
„ �4'1 understand I may obtam.more information regarding my 'obligations as an `employee" from the IhtemBd Rv"nue
Servioe, the United States Small Business Administration, the California Department of Benefit PaymeM, and tho California
Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CS -2) at 1-
800-321-CSLB (2752) or www.cslb.ca gov for more information about licensed contractors.
'*�4_l0- I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the
party legall and financially rasponsibte for proposed conspuetien activity at the following address:
11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all
app le laws and requirem(mts that govern Owner -Builders as well as employers.
12.1 agree to notify the issuer of this form immediately of any additions, ddc ions, or Wary Of do iafenm 6w 1
have providod on this form. Licensed contractors are regulated by laws designed to protect the public. If you Oontract with
someono: who does not have a B=ran, tiro Contractors' State Lioease Dowd twy be unable to ash ytra with any finmufat loss
you may sustain as a result of a complaint flour only remedy against unlicensed Contractors may bo lnvtvd eovst. h is also
9WOM t fir you to anderstmd that if tar unbc mod C onUactor at caVloyee of that individual Of &M is Mudd what
woting
on Your property, you may be he# fiatnM fbrdamages. If you obtain a permit• as Oww-Builder and vradr to ldre Ow"M s.
you vdl be mon e> for vedfyiug v&edm or not those Comtrsctora are proper Homed cad the "A of60vis'
o en instrainoe; covenge.
Before: a bnllding permit can be Inueal, his form mast be completed and sigae d by the property Owner: and returned to
the agency respondWe for WrOft **gw=tL Note: A Gaff qf skeproperV oeruw's '$ rf4 °1
other verTiieadon aerzgm*& to d rt pmq fs mgwl ed to ba Frav+tka when tie Faink is issSWA m the prop"
owner's s4pux r re. .
Signature of property ovmer Dais: L/ -a 3 – /a —
Note: The following Authorization Form is required to be completed by the property owner oidly whOn designatin
an agent of the property owner to apply for a construction perrrrit for the Owner-Builder-
MaMMIMUON OF AGMT TO ACT ON MOPLRTk f OWN01 89—BALF
Excluding -tie Notice to Property Ownw, the ea cp ion of which I uaderstan& is my porsomal mWo$sibility, I katby a Wwri
the fanowing pe rson(t) to act as my Ogago to apply for, sign, and file rho documents accessary to obuin as Owntet-Buikk
Permit for my pmjecL -
Scope of Construction Project (or Description of Work) -
Project Location or Address:
Name of Iluthoriaod Agent:
Address of Authorized Agent:
Tel No
I declare under penalty of perjury that 1 am the property owner for the address listed above and I personally filled out the
information and certify its accuracy. Note: A copy of the owner's driver's License. form notarization. or other ver&atio,
aoceptable to the agency is required to be presented when die permit is issued to verify the property owner's signapire. .
Property Owner's Signature: Date:
Bin.#
CJty �f iLC( Qi(llZta
BulkUpg &r Safety Division
P.O. Box 1504,•78-495 Calle Tampico
I.a.Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
ermit # n
l
L��'�
Project Address: 3t >i Ds
Owner's Name: . r.eA &0 awl
A. P. Number.
Address:Z4 At
Legal Description:
City, ST, Zip: CAL
Contractor.
Tel hone:
Address:
Project Description:
City, ST, Zip:
Telephone:
State Lie. 4:
City Lic. M.
0 iJ B-
Arch., Engr., Designer.
Address:
City., ST, Zip:
Telephone: y
-Construction type:. _ Occupancy:
Project type (circle one): New Add'n Alter Repair Demo .
State Lie. #: �M Awl/ : :�,;�
Name of Contact Person:
Sq. Ft.: # Stories:
#Units:
Telephone # of Contact Person:
Estimated Value of Project a &J
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Recd
TRACK'IPIG PERMrr FEES
Plan Sets
Plan Cheek submitted item Amount
Structural Cales.
Reviewed, ready for corrections Plan Check Deposit. .
'Russ Cales.
Called Contact Person Plan Check Balance •
Title 24 CA
Plans picked up Construction
Flood plain plan
Plans resubmitted.. Mecharilcal
Grading plan
2`' Review, ready for correctiouslissue Electrical
Subcontactor List
Called ContactPerson Plumbing.
Grant Deed
Plans picked up S.M L
H.O.A. Approval
Plans resubmitted Grading
M ROUSE:-
'^' Review; ready for correetions/issue Developer Impact Fee
Planning Approval
Called Contact Person
Pub: Wks. Appr
Date of permit issue
School Fees
Total Permit Fees