Loading...
10-0408 (BLCK)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: 5/10/10 Application Number:_-- 10-000004-08 Owner: Property Address: dress: 78765 VILLETA DR LAURA A HANLON- APN: 604-153-011-159 -23269 - 78765 VILLETA DR Application description: WALL/FENCE LA QUINTA, CA 92253 Property Zoning: LOW DENSITY RESIDENTIAL. (760)9.02-0269 Application valuation: 1000 -- - - - _ _ ------- ---- -- - -- - _ ... _ _ — - _.._. -Contractor:. _.... Applicant: Architect or Engineer: Owner D D Mk '10 2010 CITY QF ILA QUINTA PT 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: _cense No.: - for by Section 3700 of the Labor Code, for the performance of the work for which this permit is C( issued. IF e: Dat.J, 6 Contr--'actor:) '_ 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 insurance carrier and policy number are: " I hereby affirm under penalty of perjury that I am exempt from the Contractor'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 file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I should ecome subject to the workers' compensation. provisions of Section License Law (Chapter 9 (commencing with Section 7000),of Division 3 of the Business and Professions Code) or 700 of the Labor Cshall forthwit c0 omply with those provisions. that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by anVypplicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500):: Daie:� J �(0 Ap-pplican _T ( ) I, as'owner of the property, or my employees with wages as their sole compensation, will do the work, and Uthe structure is notintendedor. offered for sale (Sec. 7044, Business and Professions Code: The WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL Contractors' State License taw does not apply to an owner of. property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND and who does the work himself or herself through his or her own employees, provided that the DOLLARS ($ 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 havethe burden of proving that he or she did not build or improve for the purpose of sale.). APPLICANT ACKNOWLEDGEMENT . (_ 1 I, as owner of the property,. am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Applicationis hereby made to the Director of Building and Safety for a permit subject to the 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application. property who builds or improves thereon, and who contracts for the projects with a contractorls) licensed 1. Each person upon whose behalf this application is made, each person at whose request and for pursuant to the Contractors' State License Law.). whose benefit work is performed under or pursuant to any permit issued as a result of this application, 1 _) I am exempt under Sec. B.&P.C. for this reason 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. Date: Owner: - - 2. Any permit issued as aresult of this application becomes null and void if work is not commenced . within 180 days from date of issuance of such peimit, or cessation of work for 180 days will subject _ CONSTRUCTION LENDING AGENCY permit to cancellation. I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify that I have read this application and state that the above information is "correct. I agree to comply with all work for which this permit is issued (Sec. 3097, Civ. C.). city and co my o dinances and state laws relating to buZopection struction, and hereby authorize representatives ' of this cou ty to nter upon the above-mentioned propepurposes. Lender'sName: Date: < 0 J aSignature (Applicant or Agent) Lender's Address: 11 LQPERDIIT - • Application. Number, 10-,00000408 _ Permit WALL/FENCE PERMIT Additional desc . Permit.Fee 25'.00 Plan Check Fee .00 Issue•Date .. Valuation 1000" Expiration Date 11,/06/10 _.QtY___-Unit--Charge,- BASE FEE 15'.00 5.00 2,0000 HND BLDG 501-2,000 10'.00 Special Notes and'Comments 36 Z.F. X '6' GARDEN WALL" CITY STANDARDS 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 AO .00 1.00 Grand Total -- 26:00 00 .00 26.00 LQPERMIT 0294"d P.O. B.Ox 1504 LA QU'I'NTA, CALIFORNIA 92247-1504 BUILDING & SAFETY DEPARTMENT 78-495 CA(LETAMPICO (760) 777-7012. LA QUI.NTA, CALIFORNIA92253FAX (760) 777-7011,. PROPERTY OWNER'S PACKAGE Disclosures & Foiorm's,.for .Owner=Builders Applying for Construction 'Permits LW -0-81, NT! NOTICE TO PROPERTY OWNER Dear Property Owner. An. -application for a building d of the permit has been b the bufidy .property ,su mitte in yourname I Al -improvements specifiedats .providing You with an Owner -Builder Acknowledgment and In] -make you aware of your Jesponsibilities and risk vi possible ' you may incur by permit issued in your name as the Owner -Builder. . We will net issue -a:building pe rmit until yowhave read, initiated 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. -ETRECTIONS: Read andinitial each statement below td `signify you understand orverift this iifor7natio understand a frequent practice of .unlicensed persons is to have the property owner obtain an "Owner Builder" uildl g permit that erroneously implies that the property owner is providing his or her own labor and material personally- 1, as an Owneir-Builder, may be held liable and subject to serious financial risk for any injuries sustained b' y an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide de . 9 covera e for those injuries. I am willfully acting as -an Owner -Builder and Am aware of the limits of my insurance coverage ,for injuries to w . orkers -on; my property. A2_ I understand building permits are not required to be signed by property owners unless they are responsible for the 0 ction and are not hiring a licensed Contractor to assume this responsibility - 3. I understand as an "0 wner-Buildee, Fam the responsible .party of record on the permit. I understand that I may protect myself from potential financial risk by'hiritig a licensed Contractor and having the permit filed in his or her name instead of in MY 0 — 4- 1 understand Contractors are required by law to be license . d and bonded in California and to list their license numbers on permits and contracts. 4S. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value .f my construction is at. least five hundred dollars ($500), including. labor and materials, may'be.considered an "employer" under state and federal law. 6: 1 understand if lam considered an "employee, I under state. and federal law,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 aws may subject) me to serious financial risk. 7 1 understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential s tures cannot -legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any. calendar year, or all of the work is performed under contract 'with a licensed general building.Contractor. 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 ancial or personal. injuries g by any subsequent owner(s) th6t result from any latent construction defects in the workmanship or materials. 4. 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 (CS LR) at i- 800-321-CSLB (2752) or www.csib.ca.gov for more information about licensed contractors. AI( I 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: 4I. I agree that, as the party..legally and financially responsible for this proposed construction activity,.1 will abide by all p licabte laws and requirements that govern Owner -Builders as well as employers. 4hvef2_1 agree to notify the issuer of this. form immediately of any additions; deletions, or changes to any of the information I prov 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 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 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 the p�J °pertyawner's di+iver's,tieense; form notarization, or other verification acceptable to: the agency is required to be pres%ted when the permit is issued to verify the property owner's signature. �% 1� Signature of property owner== Date: 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. AUTHORIZATION OF AGENT TO ACT ONTROPERTY OWNER'S BEHALF Excluding. the Notice to Property Owner, the execution of which Lunderstand. 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 an Owner -Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: 7'8 _7&S V1 I- L C 1 ,4 b/Z Name of Authorized Agent: . 11AL- e `e Tel No Address of Authorized Agent:/j— I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify, accurac . Note: A copy of the owner's driver's license, form notarization, or other verification acceptable to the agency is req iret to be prrted when the permit is issued to verify the p.operty owner's signature.. Property Owner's Signature: Date: _ 5/< 0 Bin # City of LQ Quin Building si 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: 7,f--'7�— Owner's Name: A. P. Number: Address: Legal Description: i N�G� �, Contractor: City, ST, Zip: 9�z Jr-3 Telephone: • rar��M;>: ��r�; TQ — '+ Address: Project Description: City, ST, Zip:Z TeleP hone.$ ' '..C�' fi�:kC-1'�i •$.Cl%$: y7v,'t�.:+,C'-Atli.` State Lic. # : City Lic. #: Arch., Engr., Designer. Address: City., ST, Zip: Telephone: • $� xxx State Lic. #:'� % Name of Contact Person: L ��� , Construction type: Occupancy: Project type (circle one): New Add'n Alter Repair Demo S.q. Ft.: #Stories: # Units: •Telephone # of Contact Person: 2. Estimated Value'of Project: jo 00d APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES Pian Sets Plan Check submitted Item Amount Structural Cates. Reviewed, ready for corrections Plan Check Deposit Truss Cates. Called Contact Person Plan Check Balance Title 24 Cates. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2°" Review, ready for correctionsfissue 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 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