BWFE2016-0054s:
Carrier: Policy Number: Cn
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State
I certify that in the rformance of the work for which this permit is issued, I
52
78-495 CALLE TAMPICO
'
O�i D
VOICE (760) 777-7125
LA QUINTA, CALIFORNIA 92253
comply with those provisions.
Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division
FAX (760) 777-7011
3 of the Business and Professions Code) or that he or she is exempt therefrom and the
Date: '�Y Applicant:
COMMUNITY DEVELOPMENT DEPARTMENT
INSPECTIONS
(760) 777-7153
WARNING: FAILURE TO SECURE WORKERS' OMPENSATION COVERAGE IS UNLAWFUL,
($500).:
BUILDING PERMIT
tjgn I, as owner of the property, or my employees with wages as their sole
ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
'compensation, will do the work, and the structure is not intended or offered for'sale.
COMPENSATION, DAMAGES ASPROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
(Sec. 7044, Business and Professions Code: The Contractors' State License Law does not
INTEREST, AND ATTORNEY'S FEES.
Date: 2/26/2016
Application Number:
BWFE2016-0054
APPLICANT ACKNOWLEDGEMENT
Owner:
IMPORTANT: Application is hereby made to the Building Official for a permit subject to
Property Address:
52325 AVENIDA VELASCO
he or she did not build or improve for the purpose of sale.).
JOSE TORRES
I, as owner of the property, am exclusively contracting with licensed contractors
Ak:
773264015
issued as a result of this application, the owner, and the applicant, each agrees to, and
52325 AVENIDA VELASCO
shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and
Application Description:
TORRES / BLOCK WALL
the Contractors' State License Law.).
LA QUINTA„CA 92253
I am exempt under Sec. . B.&P.C. for this reason
Property Zoning:
Application Valuation:
$4,700.00
D
Applicant:
Contractor:
JOSE TORRES
�� 6. 2� 1S
JOSE TORRES
52325 AVENIDA VELASCO
52325 AVENIDA VELASCO
LA QUINTA, CA 92253
CITY DELA QUANTA
LA QUINTA, CA 92253
COMML'NITYDEVELOPMEV"OERARI !ENT
(760)564-2104.
Llc. No.::CONV:140528101254115447
LICENSED CONTRACTORS 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 Professions Code,
and my License is in full force and effect.
License Class: License No.::CONV:140528101254115447
Date
Contractor:
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
9-w- 1 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
Se ion 3700 of the Labor Code, for the performance of the work for which this permit
is issued„.MyJ workers' compensation insurance carrier and policy number are:
OWNER -BUILDER DECLARATION
Carrier: Policy Number: Cn
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State
I certify that in the rformance of the work for which this permit is issued, I
License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
M11-5ot employ any person in any manner so as to become subject to the workers'
city or county that requires a permit to construct, alter, improve, demolish, or repair
compensation laws of California, and agree that, if I should become subject to the
any structure, prior to its issuance, also requires the applicant for the permit to file a
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
signed statement that he or she is licensed pursuant to the provisions of the
comply with those provisions.
Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division
—aC 4
3 of the Business and Professions Code) or that he or she is exempt therefrom and the
Date: '�Y Applicant:
basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a
-A ' -[
permit subjects the applicant to a civil penalty of not more than five hundred dollars
WARNING: FAILURE TO SECURE WORKERS' OMPENSATION COVERAGE IS UNLAWFUL,
($500).:
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
tjgn I, as owner of the property, or my employees with wages as their sole
ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
'compensation, will do the work, and the structure is not intended or offered for'sale.
COMPENSATION, DAMAGES ASPROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
(Sec. 7044, Business and Professions Code: The Contractors' State License Law does not
INTEREST, AND ATTORNEY'S FEES.
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
APPLICANT ACKNOWLEDGEMENT
are not intended or offered for sale. If, however, the building or improvement is sold
IMPORTANT: Application is hereby made to the Building Official for a permit subject to
within one year of completion, the owner -builder will have the burden of proving that
the conditions and restrictions set forth on this application.
he or she did not build or improve for the purpose of sale.).
1. Each person upon whose behalf this application is made; each person at whose
I, as owner of the property, am exclusively contracting with licensed contractors
request and for whose benefit work is performed under or pursuant to any permit
to construct the project. .(Sec. 7044, Business and Professions Code: The Contractors'
issued as a result of this application, the owner, and the applicant, each agrees to, and
State License Law does not apply to an owner of property who builds or improves
shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and
the and who contracts for the projects with a contractors) licensed pursuant to
employees for any act or omission related to the work being performed under or
the Contractors' State License Law.).
following issuance of this permit.
I am exempt under Sec. . B.&P.C. for this reason
2. Any permit issued as a result of this application becomes null and void if work is
Date: f;t- d �” 99 1 4 Owner: 1-6 S.2 -n rt(,2 S
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:
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 city to enter upon the
above-mentioned property for inspection purposes.
Date: �01(r Jv lL Signature (Applicant or Agent): qT4 411)(1
)C- A
DESCRIPTION',ACCOUNT
FINANCIAL ••
•
CITY • .
AMOUNT::
PAID
PAID DATE`
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$1.00
2/26/16
PAID BY
METHOD
RECEIPT #'
.CHECK #
CLTD BY -
JOSE TORRES
DEBIT
R13297 •
RSE
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA:
$1.00
$1.00.
DESCRIPTION
ACCOUNT
QTY z
' AMOUNT
PAID
PAID DATE
WALL/FENCE - FIRST 100 LF
101-0000-42404
0
$47.86
$47.86
2/26/16
PAID BY
METHOD
RECEIPT # , -.'
CHECK #' :
CLTD BY
JOSE TORRES
DEBIT
R13297
RSE
DESCRIPTION
ACCOUNT.
QTY
.'.AMOUNT
PAID
PAID DATE
WALL/FENCE - FIRST 100 LF PC
101-0000-42600
0
$60.91
$60.91
2/26/16
PAID BY
METHOD
"
..RECEIPT#
CHECK.# '
CLTD BY
JOSE TORRES
DEBIT
1113297
RSE
Total Paid for FENCE OR FREESTANDING WALL:
TOTALS:0•
$108.77
$108.77
0•
12,11
Permit Details PERMIT NUMBER
City of La Quinta BWFE201:;- _ 4
Description: TORRES / BLOCK WALL
Type: WALL/FENCE Subtype: CITY STANDARD/PRE- Status: UNDER REVIEW
Applied: 2/26/2016 RSE
APPROVED
Approved:
Parcel No: 773264015 Site Address: 52325 AVENIDA VELASCO LA QUINTA,CA 92253
Subdivision: SANTA CARMELITA VALE LA QUINTA Block: 84 Lot: 4
Issued:
UNIT 10
Lot Sq Ft: 0 Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $4,700.00 Occupancy Type: Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0 No. Unites: 0
STATE
Details: 84LF OF 6' GARDEN AND SIX PILASTER [CITY SPECIFICATIONS] PRECISION CONCRETE BLOCK SHALL BE COVERED WITH STUCCO,
PAINT, OR TEXTURED COATING WHERE VISIBLE FROM OUTSIDE THE PROPERTY. 2013 CALIFORNIA BUILDING CODES.
CHRONOLOGY
CONTACTS
NAME.TYPE
NAME
ADDRESSI
CITY
STATE
ZIP
PHONE
, FAX
EMAIL
APPLICANT
JOSE TORRES
52325 AVENIDA
VELASCO
LA QUINTA
CA
92253
(760)564-2104
CONTRACTOR
JOSE TORRES
52325 AVENIDA
VELASCO
LA QUINTA
CA
92253
(760)564-2104
OWNER
JOSE TORRES
52325 AVENIDA
VELASCO
LA QUINTA
CA
92253.
(760)564-2104
Printed: Friday, February 26, 2016 9:29:07 AM 1 of 2 CA?
SYSTEMS
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID BY
CLTD
BY
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$1.00
2/26/16
R13297
DEBIT
JOSE TORRES
RSE
Total Paid for BUILDING STANDARDS ADMINISTRATION $1.00 $1.00
BSA:
WALL/FENCE - FIRST
101-0000-42404
0
$47.86
$47.86
2/26/16
R13297
DEBIT
JOSE TORRES
RSE
100 LF
WALL/FENCE - FIRST
101-0000-42600
0
$60.91
$60.91
2/26/16
R13297
DEBIT
JOSE TORRES
RSE
100 LF PC
Total Paid for FENCE OR FREESTANDING WALL: $108.77 $108.77
TOTALS:0• 0• .77
INSPECTIONS
PARENT PROJECTS
BOND INFORMATION
ATTACHMENTS
Printed: Friday, February 26, 2016 9:29:07 AM 2 of 2 c;?
SYSTEMS
-
,�
w
loo
L
�E 5T f .o 011A I
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVE
FOR CONSTRUCTION
DATE Z-7-6-/6 BY
RECEIVED
6 '016
CITY OF LA OU1NTA
COMMUNITY nFVE-LOPMENT .
FOOTING OPTION ".A"
I
HEIGHT FROM TOP
OF FOOTING
FOOTING OPTION "B"
#4 HORIZONTAL REBAR
(USE BOND BEAM BLOCK)
6" OR 8" BLOCK
#4 HORIZONTAL AT 32" MAX. O.C.
(USE BOND BEAM BLOCK)
SEE TABLE "A"'
— FOR REBAR SIZE
AND SPACING
(LOCATE REDAR IN CENTER OF CELL)
t
r
R-IIII—IIII
REVERSE
DIRECTION OF W" —�1
(FI
HOOK ON EVERY OOTING WIDTH)
OTHER REBAR SEE TABLE "A"
H"
HEIGHT FROM TOP
OF FOOTING
SEE TABLE "B"
FOR REBAR SIZE—
AND SPACING
(LOCATE RFSA14 IN CENTER OF CE.U)
FINISH GRADE
(1.) - #4 REBAR
CONTINUOUS
(2) - #4 REBAF
IIII CONTINUOUS
ALL FOOTINGS ADJACENT TO
SLOPES TO BE AT LEAST 5' TO
DAYLIGHT AS SHOWN BELOW.
o Yr
BOTTOM QF
OF 5' MIN.
FOOTING
NOTES:
1) THIS DESIGN DOES NOT ALLOW GRADE DIFFIEHE
,
10„ 12".
"W" -
I(FOOTING WIDTI
SEE TABLE "B"
TABLE "A"
H
W,
VERTICAL
REINFORCEMENT
3'
17"
#4 @ 48" O.C.
4'
20"
#4 @ 48" O.C.
5'
23"
#4 @ 48" O.C.
6'
29"
#4 @ 24" O.C.
H"
HEIGHT FROM TOP
OF FOOTING
SEE TABLE "B"
FOR REBAR SIZE—
AND SPACING
(LOCATE RFSA14 IN CENTER OF CE.U)
FINISH GRADE
(1.) - #4 REBAR
CONTINUOUS
(2) - #4 REBAF
IIII CONTINUOUS
ALL FOOTINGS ADJACENT TO
SLOPES TO BE AT LEAST 5' TO
DAYLIGHT AS SHOWN BELOW.
o Yr
BOTTOM QF
OF 5' MIN.
FOOTING
NOTES:
1) THIS DESIGN DOES NOT ALLOW GRADE DIFFIEHE
,
10„ 12".
"W" -
I(FOOTING WIDTI
SEE TABLE "B"
CHECK WITH_THE._BVILDING._DEPARTME_.i 1T_TO
VERIFY IF_._A_BUILDj.NG._P.E_RMIT IS. REQUIRED.,
MORE THAN 6" ON OPPOSING SIDES OFFOPPt l IWm LA Q F,*I
NOT ARETAINING WALL. BUILDING Ol SAFETY
2) FENCE HEIGHTS ARE REGULATED - CO ULT ZO I _Cq�N,
REGULATIONS BEFORE BEGINNING CON TRUCT� R�VNEL IN
3) NO WATER COURSE OR NATURAL DRAIN GE SHM ff CONSTRUC l(j Y FIR
OBSTRUCTED., T R AR/
4) GROUT ONLY THE CELLS CONTAINING REBAR. _THIS WALL
IS NOT DESIGNED FOR ALL CELLS TO B c9FtDlT�Zl Ib BY
5) ALL REBAR TO BE ASTM SPEC. A61 5, G
6) ALL REBAR LAP SPLICES TO BE 24" MINIMUM.
7) ALL MASONRY UNITS TO BE ASTM C-90 GRADE N.
8) REBAR TO BE CENTERED IN MASONRY CELLS.
'SEE PAGE 2 FOR ADDITIONAL INFORMATION'
DISCLAIMER:
ALTERNATE DESIGNS MAY BE POSSIBLE
WHEN PROVIDED WITH AN ENGINEERED
ANALYSIS. USE OF THIS STANDARD DESIGN.
IS AT THE USER'S RISK AND CARRIES NO
IMPLIED OR INFERRED GUARANTEE AGAINST
FAILURE OR DEFECTS.
MIT IS REQUIRED, THE FOLLOWING
5PECTIONS ARE REQUIRED:
EXCAVATION TRENCH CLEAN WITH
ACE AND SUPPORTED 3" ABOVE AND
THE SURROUNDING EARTH/DIRT.
tE-G.ROUT: BOND BEAM REBAR AND
--BAR IN PLACE - INSPECTION PRIOR TO
EEjEjjZR GROUT IS PLACED - PRIOR TO ANY
DECORATIVE CAP PLACEMENT.
WESTERN RIVERSIDE COUNTY CODE UNIFORMITY PROGR/AM;.
FREESTANDING BLOCK WALL
r"�varn.t �
LE TAMPICO
PHONE (760) 777-71,25 7AL
LAA QUIIINTA, CA[.1.FOKNIA 92253
PAX (760) 777'-701 1. 10/972014 COMMUNriY DFVELOPMENP DliYI. PAGE 1 UI 2
TABLE -"B"
H"
„W„
VERTICAL
REINFORCEMENT
3'
19"
#4 @ 48" O.C.
4'
22"
#4 @ 48" O.C.
5'
29"
#4 @ 48" O.C.
6'
34"
#4 @ 24" O.C.
CHECK WITH_THE._BVILDING._DEPARTME_.i 1T_TO
VERIFY IF_._A_BUILDj.NG._P.E_RMIT IS. REQUIRED.,
MORE THAN 6" ON OPPOSING SIDES OFFOPPt l IWm LA Q F,*I
NOT ARETAINING WALL. BUILDING Ol SAFETY
2) FENCE HEIGHTS ARE REGULATED - CO ULT ZO I _Cq�N,
REGULATIONS BEFORE BEGINNING CON TRUCT� R�VNEL IN
3) NO WATER COURSE OR NATURAL DRAIN GE SHM ff CONSTRUC l(j Y FIR
OBSTRUCTED., T R AR/
4) GROUT ONLY THE CELLS CONTAINING REBAR. _THIS WALL
IS NOT DESIGNED FOR ALL CELLS TO B c9FtDlT�Zl Ib BY
5) ALL REBAR TO BE ASTM SPEC. A61 5, G
6) ALL REBAR LAP SPLICES TO BE 24" MINIMUM.
7) ALL MASONRY UNITS TO BE ASTM C-90 GRADE N.
8) REBAR TO BE CENTERED IN MASONRY CELLS.
'SEE PAGE 2 FOR ADDITIONAL INFORMATION'
DISCLAIMER:
ALTERNATE DESIGNS MAY BE POSSIBLE
WHEN PROVIDED WITH AN ENGINEERED
ANALYSIS. USE OF THIS STANDARD DESIGN.
IS AT THE USER'S RISK AND CARRIES NO
IMPLIED OR INFERRED GUARANTEE AGAINST
FAILURE OR DEFECTS.
MIT IS REQUIRED, THE FOLLOWING
5PECTIONS ARE REQUIRED:
EXCAVATION TRENCH CLEAN WITH
ACE AND SUPPORTED 3" ABOVE AND
THE SURROUNDING EARTH/DIRT.
tE-G.ROUT: BOND BEAM REBAR AND
--BAR IN PLACE - INSPECTION PRIOR TO
EEjEjjZR GROUT IS PLACED - PRIOR TO ANY
DECORATIVE CAP PLACEMENT.
WESTERN RIVERSIDE COUNTY CODE UNIFORMITY PROGR/AM;.
FREESTANDING BLOCK WALL
r"�varn.t �
LE TAMPICO
PHONE (760) 777-71,25 7AL
LAA QUIIINTA, CA[.1.FOKNIA 92253
PAX (760) 777'-701 1. 10/972014 COMMUNriY DFVELOPMENP DliYI. PAGE 1 UI 2
FOC
.................
DESIGN PARAMETERS:
ACTIVE SOIL PRESSURE (PSF) =30
PASSIVE SOIL BEARING (PSF) =150
COEFFICIENT OF FRICTION = 0.25
ALLOWABLE SOIL BEARING (PSF) =1500
WIND = 80 MPH. EXPOSURE C
SEISMIC:
NA= 1.3. Nv=1.6. Z=0.4, SOIL PROFILE=SD
WESTERN RIVERSIDE COUNTY
}CODE UNIFORMITY PROGRAM
;p�u;�
oc `Y
$- Ci
n c
j'cp �7 FREESTANDING BLOCK WALL
yOF11�t4
PHONE (760) 777-7125 78-495 CALLG TAMPICO
LA QUINTA, CALIFORZNIA 92253
RAX (760) 777-7011 10/9/2014 COMA7UNITr vevr_I OPMENT DGPr. NGE 27172
STEEL REBAR
SECTION VIEW
BLOCK
(12" X 12" OR 16" X 16")
(4) - # 4 REBAR
(ONE AT EACH CORNER)
ALL FOOTINGS ADJACENT TO
SLOPES TO BE AT LEAST 5' TO
DAYLIGHT AS SHOWN BELOW.
CHECK WITH THE BUILDING D F@0V§IE'fd'f=
TO VERIFY IF A, BUILDING PERM, _.
WHEN A BUILDING PERMIT IS REQUIRED.
THE FOLLOWING INSPECTIONS ARE ALSO REQUIRED:
1) EOOTING: EXCAVATION TRENCH CLEAN WITH STEEL
IN PLACE AND SUPPORTED 3" ABOVE AND AWAY FROM
THE SURROUNDING THE EARTH/DIRT.
2) REBAR/PF2E_GROUT; VERTICAL REBAR IN PLACE -
INSPECTION PRIOR TO PLACING GROUT.
3) FINAL; AFTER GROUT IS PLACED - PRIOR TO ANY
DECORATIVE CAP PLACEMENT.
DISCLAIMER:
ALTERNATE DESIGNS MAY BE POSSIBLE WHEN PROVIDED WITH
AN ENGINEERED ANALYSIS. USE OF THIS STANDARD DESIGN IS
AT THE USER'S RISK AND CARRIES NO IMPLIED OR INFERRED
GUARANTEE AGAINST FAILURE OR DEFECTS.
NOT EXCEED 20 FT. WHEN OTHER INFILL FENCING
I?XpfXrVPpAlM ENC DSSTER L O TY ING (SUCH AS WROUGHT FENCING MAY NOT SE AITTACHED TO PILASTER.RON) MAYBE ATTACHEDTO
TUgj�rEl� (�)��}OORS A ACHED TO PILASTER ARE LIMITED TO 200# MAX,
4.�11H�SfER DESIGN IS
PER PILASTER.
FT. M
S INTENDED TO BE USED ONLY, AS A FENCING
FEATURE W IS NOT INTENDED TO SUPPORT ANY OTHER LOADS.
5 ENR GULATED —CONSULT ZONING REGULATIONS BEFORE
g _ONGTRU ON.
RIC CIRCUITS; CONDUITS: OR LIGHTING FIXTURES
REQUIRE ELECTRICAL PERMITS AND INSPECTION.
7. FOOTINGS TO BE PLACED IN UNDISTURBED SOIL OR PROPERLY COMPACTED
AND ENGINEERED FILL.
8. FOR DESIGN PARAMETERS, SEE FREESTANDING BLOCK WALL STANDARD.
WESTERN RIVERSIDE COUNTY CODE UNIFORMITY PROGRAM I
4 SOD"
oa c
MASONRY PILASTER
iCR� nF.n1f.
PHONE (760) 777-7125 78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
FAX (760) 777-7011 10/9/2014 1 COMMUNITY DEVELOPMENT DEPT. PAGE 1 OF 1
Bin #
City of La Quinta
Buifding &r Safety Division
78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
®S`'1 Building Permit Application and Tracking Sleet
Permit #
_
g\Nt-T-- 2olb—
Project Address. a� v�S&ewd4
Owner's Name:
® Q-r yds
A. P. Number:
Address: a'3 e l Gp
Legal Description:City,
ST, Zip: L4 dild _ '72;f 3
ntra
Co ctor: W �
Tele hone:
P o� 0
� b
Address: Sr�— 3� AVe4j 1 ac VUZG,
_.
Project Description: Q 5 Kwo
City, ST, Zip: LR I A+4 . Ca. "I . X53
(,U 4 SIX, CO ld. I L�4S 7-1E
Telephone: b —
I
State Lic. # :
City Lie. #.:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
n e:
...
... ........
�a
Construction tn TYP e.t S O ccti aneY•
e ic. #.
Ject tYPe icitcle one)• w Add'n
Repair Demo
PAlter
Name of Contact Person:
Sq. Ft.:: �_ # Stories: # Units:
Y-s d
Estimated Value of Project: P176 a 06
Telephone # of Contact Person:
APPLICANT: DO NOT WRITE BELOW THIS LINE
H
Submittal
Req'd
Rcc'd
TRACKING
PERMIT FEES
Plan 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 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
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'"! Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees,
Total Permit Fees
P.O. BOX 1504
LA QUINTA, CALIFORNIA 92247-1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
4aah&
BUILDING & SAFETY DEPARTMENT
PROPERTY OWNER'S PACKAGE
(760)777-7012
FAX (760) 777-7011
Disclosures & Forms for Owner -Builders Applying for Construction Permits
IMPORTANT! NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application for a building permit has been submitt d in our name listing yourself as the builder of the property
improvements specifieftl 3�_JS V 111 a5C,
We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of your
responsibilities and possible risk you may incur by having this permit issued in your name as the
Owner -Builder. We will not issue a building permit until you have read, initialed 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.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
DIRECTIONS: Read and initial each statement below to signs you understand or verify this information.
i
1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder"
uilding permit that erroneously implies that the.property owner is providing his or her own labor and 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 aware of the limits of my insurance coverage for injuries to workers
on my property.
2..I understand building permits are not required to be signed by property owners unless they are responsible for the
on tru'dion and are not hiring a licensed Contractor to assume this responsibility.
01 I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect
self from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my
own.
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.
I understand if I am considered an "employer' 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. 1. 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 performed
under contract with a licensed general building Contractor.
f . `
K8? -I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any
nacial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the
workmanship or materials.
XI understand I may obtain more information regarding my, obligations as an "employer" from the Internal Revenue
ce, 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 (CSLB) at 1-
800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors.
I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the
egally, , and frnanci4lly rgsppnsible for proposed construction activity at the following address:
��=� I agree that, as the party legally and financially
responsible for'this proposed construction activity, I will abide by all
'applicable laws and requirements that govern Owner -Builders as.well as employers.
r2:_I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I
ve 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.ainy 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 property 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.
Signature-of-property-ownera� _!JZ°24Jd r0
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 ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize
the following person(s) to act as my agent(s) 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:
Name of Authorized Agent:
Address of Authorized Agent:
Tel No
1 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 verb the property owner's signature.
Property Owner's Signature: Date: