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11-1359 (BLCK)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 CApplication Number: -11=00-0013"59__7 Property Address: 5-40-8"5—EISENHOWER DR APN: 774-215-017-5 -000000- Application description: WALL/FENCE Property Zoning: COVE RESIDENTIAL Application valuation: 1516 Applicant: Titit 4 4 Q" Architect or Engineer: BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: KENNETH W. EVANS 54085 EISENHOWER DR LA QUINTA, CA 92253 contractor: Owner VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 12/23/11 ------------------------------------------------ LICENSED CONTRACTOR'S DECLARATION -- ----------------------------------- .------ - - - - - — WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations: Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided License Class: License No.: for by Section 3700 of the Labor Code, for the performance of the'work for which this permit is issued. Date: Contractor: _ 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 (OWNER -BUILDER DECLARATION—_7 insurance carrier and policy number are: I hereby affirm under penalty of perjury that I am-exempt-from'the-eontractor's.State.License Law for the Carrier Policy Number following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to _ I certify that, in the performance of the work for which this permit is issued, I shall not employ any construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner so as to become subject to the workers' compensation laws of California, permit to filesigned statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I should become subject to the workers' compensation provisions of Section .a License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or _ _ 700 of the Labor C he forthwithcomp) witht e provisions. that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by ii any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: �--Date• �G Applicant: i v� (_ 1 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 WARNING: FAILURE TO SECURE WORKERS' COMPENSAT4&WCOV RA, E IS UNLAWFUL, AND SHALL Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND and who does the work himself or herself through his or her own employees, provided that the DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. 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 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.). Lender's Name: Lender's Address: LQPERMIT 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 this county to enter upon the above-mentioned property for inspection purposes. �> Application Number . . . . 11-00001359 Permit . . WALL/FENCE PERMIT Additional desc . Permit Fee 37.00 Plan Check Fee .00 Issue Date . . . . Valuation 1516 Expiration Date 6/20/12 Qty Unit Charge ,Per Extension BASE FEE 15.00 11.00 2.0000 HND BLDG 501-2,000 22.00 ------------------------------ Special Notes and ---------------------------------------------- Comments 5' GARDEN WALL 70' L.F. PER CITY STANDARD. ---------------------------------------------------- 'Other Fees . . . ------------------------ . . ._. .- BLDG.STDS ADMIN (SB1473) 1.00 Fee summary Charged Paid Credited Due ----------------- Permit Fee Total -------------------- 37.00 ---------- .00 ---------- .00 37.00 Plan Check Total .00 .00 .00 .00 Other Fee Total 1.00 00 .00 1.00 Grand Total 38.00 .00 .00 38.00 LQPERMIT r J SPS P.O. Box 1504 LA QUINTA, CALIFORNIA 92247-1504 .78-495 CALLE TAMPtco LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT PROPERTY OVMER'S PACKAGE (760) 777-7012 FAX (760) 777-7011 Disclosures & Forms for Owner -Builders A.ppiytng for Construction Permits f HQ�C`R 'P(1 P12(YPi7pTv n�uwrran Dear Property Owner: An application for a building permit has bom avbmittaiin your name listing yourself as the builder of the property imPt��ements specified at we am providing you with an Owner -Builder Avknouialgnnent ivad [nfotmatien Vexificatien Form ut mac you aoram of your responsibilities and pooible risk You may M urr by leaving thisp WMt.Mftd in yoff Hama as the OWuec-Builder. We wIl "law a brilding.penmit undtham youa- : read, knhiaW yQuri'- uradersdladlng of cart Itrsvlsioo, signed, and returned tbir form to us at our officW address indicated. An agent of the owner cannot escecatxt t% notice unless YOU, the property owner, obtain the prior approval of the permitting authority - Read amd aridd ea c* sturerrment brow- w signify you arzderstand or desk f y this enfarntadom 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 hex own labor and material pereonalfy. I, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unhotased pexsor and his or her employees while working on my property. My homeowner's insurance may not provide covant for OHM injuries -.l am willhelly acting as an Owner -Builder and am aware of the limits of my insurance coverage for iryuries to wort= ort .my property. 2. I understand building permits are not required to be signed by property owners unless they are responsible for tb construction and are not a respom--bility. %3. hirung lrcen�ad Contractor w assume dein I umdentand as an "Owner -Builder" I am the responsible party of accord on theL I understand flint I may prote myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name mstmd of o 4.1 understand Contractors are required by law to be licensed and bonded in California and to list thou license numbers uts and contracts. {.,fC7/ 5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total vi of my construction is at least five hundred dollars (5500), including labor and materials, I may be considered an to under under state and federal law. W. I understand if I am considered an "employer" under state and federal taw, I must with the state and fer government, withhold r payroll taxes, provide workers, compensation disability iffivrance, and contribute to unemploy compensation for each "employee_" I also understand my failure to abide by these laws may subject me to serious finer 7. l understand under California Contractors' State License Law, an Owner -Builder who builds single-family resid truchues cannot 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 perf under contract with a licensed general building Contractor. • kangciatl understand as an Owner -Builder if I sell the property for which this pertiutisissued, l may be told liable for any or personal. pouries sustained by:any subsequent owner(s) that result from any latent.construction defects in the. wo or materials. 9. U understand I may obtain .more: infdnnation regarding my obligations as an "employer" from 06EEervenue ervice, the Uaitod States Small Business Administration, the California Department of Sencfit Paymt;M. and rile California Division of Industrial Accidents. I -also understand I may contact the California Contractors' State License Board (CSU) at 1- 00-321-CSLB (2752) or www.cslb.cagov for more information about licensed contractors. 0. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the legally and financially responsible for proposed construetion activity at the following address: qZle= Ihat, as theParty legally and financially responsible Eor this proposed conSutiction activity, I will abide by all nd requirements that govern Ov�iuer-Builders as well as employers. I agree to notify the issuer of this form immediately of aay additions; deletions, or chWogca ttraaFy of the iafarnm ion 1 ve provided on this form. Licensed contractors are regulated by laws designed to protect the Public- If you MLtMct With someone who does not have a licenser dw Contractors' State Li xmt Board may be tmabte to asst you with any Onanaiai loss you may sustain as a result of a complaint Your only remedy against unlicensed Contractors mag be invwd cIt is also ourt. itwportant for you to -,understand dw-if srtudWoosod Contractor oe a nVloyoe of that individual Of &M is irdumd wbft ww mg on your property, you may be hoU liabM for damem ages. If you obtain a prit as OwnerBuilder and wish to hot Contssvtors, you will be respp o for verifying or not those Contrmtm are pmpedy I eensed and the status of thW wortme oompensation iasuranoa oovemp. Before a building permit can be issued, Ws form must be completed and aligned by the property Qwuer and reortrmd to the agency responsible for Updft.tw.Irc mtL Note: A copy of NieVrVwV awner s Aiv1W'v&6MW1 fa Al other verification aocep"k to die agmey is reguh ed to be presented when die p0mU is issreei to "* die owner's signature. , Sigpattim of property ot+nfta k)t 96&7 Note: Ilse following Aadsorization Form is required to be completed by the proper. ty owrur only when designatin an agent of the property owner to apply for a construction permit for the Owner -Builder. AOTIiOMAM-N OF AGTNT TO ACT ON VIP PERTY I'S_ Excluding.the Notice to Property, Owner, the s>Eecirtion of which I understand is my Personal trspoa`WUty. I hereby author the following orf to act as my ogooKs) to apply for, sign, and file the documents aecemyy to obtain an Owner -Budde Permit for my project Scope of Construction Project (or Description of Work): Project Location or Address: Name of Authorized Agent: Tel No Address of Authorized Agent: I declare under penalty of perjury that I 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 veri ficateo acceptable to the agency is required to be presented when the permit is issued to verify the property owners signature.. Property Owner's Signature: Date: K�h�NErN w �v�Ns 5'f�8� E�S�NE{at�ee D�id� �R irrA ,cam. 922s3 lo/ 'cry LL. n W -L u L C -64L ,� D 8Ycei,�--Ilox1 a Lo T S LDCX f '-/ b a d s 2 Sfilv.T 1 cIq9 meb rfq- qT MLE . LA (��)OIXM UIVIT :�?-7 ev; oqr CpNST0 Bin' ; . City of La Quinta Building & Sarety• Division P.O. Box 1504, 78-495 Calle Tampico f La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet P g Peit #. j' ll' I Project Address:�J Owner's Name: <EN� �ZIA /(J S' [� -/��� A. P. Number: '74Ci 1. J tI 1-7 'Address:;5110 5 E /S'F/x&Z U Legal Description: 470F Cs"YPLA N City; ST, Zip: V R Contractor: Address: Project Description: City, ST, Zip: Telephone:7/9 State Lie. # : City Lie. #; Arch., Engr., Designer: Address: City, ST, Zip: Telephone: State Lia. . 4 .. YC: Y?y;: S• «c •..< ,:,4s` ` :.. Construction Type:CO NC2.�Tc,p ancy: Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person: kc -1v EV N s Sq. Ft: # Stories: # Units: Telephone # of Contact Person: Estimated Value of Project: 2 APPLICANT: DO NOT WRITE BELOW THIS UNE # 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 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 H.OA. Approval Plans resubmitted Grading IN HOUSE:- '`' Review, ready for correctionsrmue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees