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10-1018 (BLCK)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA .92253 T 'a t t 4 4Q" Application Number: 1,0-0000101-8 Property Address: 78900 VILLETA DR APN: 604-152-001-50 -23269 - Application description: WALL/FENCE Property Zoning: I,OW DENSITY RESIDENTIAL Application valuation: 575 �yApplicant: Architect or Engineer: BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner HURJA KIMIE 78900 VILLETA LA QUINTA, CA 92253 ( VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Contractor: Owner T� O - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - --- - - - - - - - - - - - - - - - - - - - - - - - - - -,;^- LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DEC LARA 1 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 workerscompensation 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, Ishall 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' comp ' n 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 become subject to the workers' compens ion provisions of Section License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3 00 of the Labor Code, 1 sh forthw' co with those provis ns. that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by. any a licant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars 155001:: Date: Applicant: - ( 1, 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 SECU ORKERS' COMPENSATION OrNLAWFUL, 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 INE 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 COMPE SAGES AS PROVIDEDFOR 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 ATTOR Y •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.). APPLICANT ACKNOWLEDGEMENT - . (_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is 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 ser forth on this application. property who builds or improves thereon, and who contracts for the projects with a contractor(s) 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 _ 1 I am exempt under Sec. B.&P.C. for IN 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 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 CONSTRUCTION LENDING EN permit to cancellation. I hereby affirm under penalty of perjury that there is a construction lending enc for tM performance of the I certify that I have read this application and state that the above inf mation is correct. I agree to comply ith all work for which this permit is issued (Sec. 3097, Civ. C.). - city and county rdi nces and state laws relating to building cons uction, and hereby authorize represen tives - - of this co o e er upon the above-mentioned property for i ection rposes._ - "Date: _Signature (Applicant or.Agent): - Lender's Address: - ---. - Date:- 9/29/10 LQPERMIT Application Number 10-00001018 Permit ''WALL/FENCE PERMIT Additional desc . Permit Fee . . . . 17.00 Plan Check Fee .00 Issue Date . . . Valuation 575 Expiration Date 3/28/11 Qty Unit Charge Per Extension . BASE FEE 15.00 1.00 2.0000 HND BLDG 501-2,000 2.00 ------------- ---------------------------------------- Special Notes"and Comments REPLACING WOODEN FENCE WITH 6 FT HT X 23 LN FT BLOCK GARDEN.WALL CITY STANDARDS. APPROVED K.K.& PLANNING. ----------------------------------------------------------------------------- Other Fees BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged Paid Credited Due Permit Fee Total 17.00 .00 00 17.00 Plan Check Total .00 .00 .00 .00 Other Fee Total - 1.00 .00 .00 1.00 Grand Total 18.00. .00." .00 18.00 LQPERMIT .. i P.O. Box 1504 LA QUtNTA; CALIFORNIA 92247-1504 78-495 CALLS TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING &c SAFETY DEPARTMENT PROPERTY OWNER'S PACKAGE (760) 777-7012 FAX (760) 777-7011 Disclosures & Forms, for Owner-Hailders Applying for Coostrucilon Permits, fiagArAff-7 AMC—Ex-0, PROVE R'['v Dear Pvaperty Owner. An. application for a building permit has beensu�mitred in . ur name listing yourself as the builde€ of the .property improvements specified at s. -We are providing you with an Owner -wilder Aclrno*iedgmemt arrd n€ormation Verification Form to make you awana_of your eespenstbilities and possible risk you may incur by having this-permit,issued in your name as the Owner -builder. We will not issue a building.permlt until; yau: have read, initiated your nad,erstauding of each. mon, signed, and returned this form to us at our official address indicated. An agent of the oiweer cannot execute tl}is':notice unless you, the property owner, obtain the prior approval of the permitting authority. or=s &eNMWLD � DN—RU FWATION 61FOMU N D CMNS. Rend and initial -e=, h stn wreW-be& "ib signify you understand or ver#yJ thisWarmat on. 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 persori.1, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries ;ustained.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 aware of the limits of my insurance coverage for injuries to workers 'on ffiy. party. . I understand building permits are not required to be signed by property owners udess they are responsible. for the construction and are not hiring a Licensed Contractor to :assume this responsibility. 3. I understand as an "Owner-i3uilder" I am.the responsible party of record on the permit. I understand that I miy protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instep of my own. 4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. 5. I 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' ($500), including labor and materials, I may be considered an "employer" under state and federal law. A6. I understand if I am considered an "employee, under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute -to unemployment compensation for each "employee." I also understand 'my failure to abide by these laws may subject me to serious financial risk 7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential structures cannot .legally build them with the .intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four .within any calendar year, or all of the work is performer under contract with a licensed general building Contractor. J�h8. I understand as an Owner -$Milder if I sell the property for which this permit is issued, I may be held liable for any financial or personal. j4uries suss ked. by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. A 9. I understand I may obtain more information regarding my obligations as an "employer" from the Iutternat Revenue L. 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 (C3LB) at 1- 800-321-CSLB (2752) or www.cslb.ca gov for more information about tic. ensed contractors. 10. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the Pte' legally and f naa ially respo�it .for pro construction /J�ctivi at the following address: 11. I Ww that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable I'iws and regdireinents that govern Owner -Builders as well m employers. Y 12. 1 agree to notify the issuer of this. form immediately of any additions, deletions, or changes to guy 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 heense,. die, Cortraetors' State License Board may be unable to assist you with any finanei:at loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in'crivd court. It is also imWMtarrt for you to: understand that if art w*censed Contractor or employee of that individual or firm is injured while working on your property; You may be hold, liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for ver*ing whether or not those Contractors are prope€try licensed and the status of their workers' compensation insuranve 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 permtL Note: A copy of the properfp owqgrs.dWvees Almar, form not r4 or other verification acceptable to the agency is required to beth p when. th-V permit is. issued to verify e pMer't' owner's signature. Signature of property owner Date: �a 0 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 fora construction permit for the Owner -Builder. AUTHORMATION 4 AGENT TO ACT ON PROPERTY OWNEWS BEEF Excluding.the Notice to Property, Owner, the exewtion of which I understand is my personal responsibility, I hereby authorize the following persons} to act as my agent(s) to apply for, sign, and file the documents necessaFy to obtain an Owner -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 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 its accuracy. Note: A copy of the owner's driver's license, form notarization, or other verification acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature.. Property Owner's Signature: Date: Bin # Citi Of La Quinta ' BmIding &r Safety Dh4sion Permit .# P.O. Box 1504, 78-495 Caffe Tampico La Qufnta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Project Address - A. P. Number: Legal Description: Owner's Name Address: _ Q � r, City. ST, Zip:2Z.S`�1 Contractor. /•/ Address: Telephone: _ Project Description: City, ST, Zip: Telephone: s.: MEMIL Stale Lic. # : City Lie. !i: P a a� .. ' Arch-, Engr.. Designer. Aftess: City, ST. Zip: Telephone: State Lit;. #: Name of Contact Person: Construction Type: Occupancy: Project type (circle one): New Acd'n Alter Repair Demo Sq, FL: !} Stories: i< Units: Telephone # of Contact Person; Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS UNE N Submittal Plan Sets Req'd Recd TRACK NG Plan Cheek submitted PERMIT FEES Item Amount Structural Coles Reviewed, ready for corrections Plan Chalk Deposit Truss Cala. Caped Contact Person Plan Check Balance Title 24 Cake. Flood plain plan Plans picked up Plans resubmitted Construction Mechanical Grading plan 2" Review, ready for eorreetiourt sue Electrical Subeontactor List Called Contact Person Plumbi ag Grant Deed Plans picked up S M.L H.O.A. Approval IN HOUSE:- Plans resubmitted ''' Review, ready for corrections/issue Grading Deveoxr Impact Fee Planning Approval Called Contact Person A.LP.P. Pub. Wks. Appr School Fees Date or permit issue Total (Permit Fees