BWFE2017-0208J
�/ 4 4 l�N.IIIAGI/ VOICE (760) 777-7125
78-495 CALLE TAMPICO T
FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 ''`'`
DESIGN &DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 11/7/2017
Permit Type/Subtype: WALL/FENCE/CITY STANDARD/PRE-APPROVED Owner:
Application Number: BWFE2017-0208 JULIO VILLALVA
Property Address: 54425 AVENIDA ALVARADO 54425 AVENICA ALVARADO
APN: 774235020 LA QUINTA, CA 92253
Application Description: VILLALVA / 70 LF COMBO WALL AT SOUTH PL
Property Zoning:
Application Valuation:. $3,800.00
Applicant: ® Jp Contractor: `
JULIO VILLALVA OWNER BUILDER
54425 AVENIDA ALVARADO NOV U 7 2O17 ,
LA QUINTA, CA 92253
CITY OF LA QUINTA
DESIGN AND DEVELOPMENT DEPARTMENT
Llc. No.:
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that 1 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.:
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- he applicant to a civil penalty of not more than five hundred dollars ($500).:
. 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 Contractors' State License Law does 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
6e_did not build or improve for the purpose of sale.).
1"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
n r rs' State License Law.).
,I.am exempt under Sec. . B.&P.C. for this reason
Date: ^ ' 0��
-y.
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 Na
Lender's Address: \
WORKER'S COMPENSATION DECLARATION
I 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 3'00 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 insuran:e carrier and policy number are:
CaPolicy Number:
rrier: _
w1 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 agreethat, if I should become subject to the
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with those provisions. I /
WARNING: FAILURE TO SECURE WORKERS'=OMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIIL41NAL 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 Building Official for a permit subject to
the conditions and restrictions set forth on :his 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, aced 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 b 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 oedinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter upon the above-
mentioned property for inspection purposes. I
Date: 11/7/2017
Application Number: BWFE2017-0208 Owner:
Property Address: 54425 AVENIDA ALVARADO JULIO VILLALVA
APN: 774235020 54425 AVENIDA ALVARADO
Application Description: VILLALVA / 70 LF COMBO WALL AT SOUTH PL , LA QUINTA, CA 92253
Property Zoning:
Application Valuation: $3,800.00
Applicant: Contractor:
JULIO VILLALVA' OWNER BUILCER
54425 AVENIDA ALVARADO
LA QUINTA, CA 92253
Llc. No.: .
------------------------------------------------------------- 7 ------------------ -------------
Defail: 70LF OF 6' GARDEN WALL W/ 2' RETAINING AT SOUTH PL[CITY SPECIFICATIONS] PRECISION CONCRETE BLOCK SHALL BE COVERED WITH STUCCO,
PAINT, OR TEXTURED COATING WHERE VISIBLE FROM OUTSIDE THE PROPERTY. THE AREA BETWEEN THE BACK OF;CURB AND ANY FENCING SHALL BE
LANDSCAPED, HAVE A SUITABLE PERMANENT IRRIGATION SYSTEM, AND BE CONTINUOUSLY MAINTAINED BY THE PROPERTY OWNER. 2016 CALIFORNIA
BUILDING CODES.
FINANCIAL
DESCRIPTION
INFORMATION.
ACCOUNT
QTY
AMOUNT
RETAINING/COMBINATION WALL EA 50LF
101-0000-42400
0
$31.20
DESCRIPTION
ACCOUNT
QTY
AMOUNT
WALL/FENCE - FIRST 100 LF
101-0000-42404
0
$52.01' .
DESCRIPTION
ACCOUNT
QTY
AMOUNT
WALL/FENCE -FIRST 100 LF PC
101-0000-42600
0
$65.02
Total Paid for BLOCK WALL:
$148.23
DESCRIPTION
ACCOUNT
QTY
AMOUNT
BSAS SB1473 FEE
101-0000-20306
0
$1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA:
$1.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
RECORDS MANAGEMENT FEE
101-0000-42416
0
$10.00
Total Paid for RECORDS MANAGEMENT FEE:
$10.00
DESCRIPTION
ACCOUNT
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
!CITY
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
s
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State Lic: City Bus Lic:
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Construction Type: Occupancy:
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78495 CALLE TAMPICO .
LA QUINTA, CA 92253
760-777-7000
Fmismil'',.: Al
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P.O. BOX 1504
LA QUINTA, CALIFORNIA 92247-1504
7$-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
'p PROPERTY OWNER'S P)
BUILDING & SAFETY. DEPARTMENT
kCKAGE
(760) 777-7012
FAX (760) 777-701 i
. f
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 submitted in your name listing yourself as the builder of the property.
improvements specified at �.. A- �5� ,7. ,� �k-am d��t!& t*f it 1 t}
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 signify you understand or verify this informaticn.
t rV1 I understand a frequent practice of unlicensed persons is to have.the property owner obtah an "Owner -Builder"
building permit that erroneously implies that the property owner is providing his or, her bwn 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.
400rl I understand building permits are not required to be signed by property owners unless they are responsible for the
construction and are not hiring a licensed Contractor to assume this responsibility.
A010 I understand as an "Owner -Builder" I am the res onsiblepa
rty of record on the ct
myself from potential financial risk by hiring a licensed Contractor and having he permif dpermit. in.is or unerstern me ns ead of y promy
own.
r4. I. understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on
permits and contracts.
A'!,07:5)1 understand if I employ or otherwise. engage any persons, other than California licensed Contrac-ors, and the total value
of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer"
,��undeJJr state and federal law.
IAM06111 understand if I am considered an "employer" under state and federal law, I must register with the state and federal withhold pa roll 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 are to serious financial
risk.
"tVV understand under California Contractors' State License Law, an Owner -Builder who builds si'-igle-family residential
structures cannot legally build them with he intent to offer them for sale, unless all work is Performed by licensed
subcontractors and the number of strictures does not exceed four within any calendar year, or all of -:he 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
financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the
workmanship or materials.
41&69?_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 (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
party,le ally , and financially responsible for pro osed constru tion activity at the . following address:
J11.. I agree that, as. the party legally and financially responsible for this proposed construction activity, I will abide by all
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applicable laws and requirements that govern Owner -Builders as.well as employers.
j ,, , 12,11 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any 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 license, the Contractors' -State -,License Board may be unable to -ass
istryou with any financial loss
you may sustain as a result df a`complaint: Your'onlyremedy 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 arid. 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
tj
Note: The following Authorization Form is required to be completed by the property owner only when designating
an agent of the properly owner to apply fora construction permit for the Owner -Builder.
AUTHORIZATION OF AGENT TO ACTON 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.
Prm
em -lit for my project.
Scope of Construction Project (or Description of Work): y
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:
A`A&WITY OF LA QUANTA SU- NTR:ACTOR. LIST R
JOBADDRESS _ _ PERMIT NUMBER&OgM ER {_...•— - -- - :,BUILDEf��Q
This form shah be�oste(l on the -ob with the Luildir�g ins��ection Card at all times in a consi)ictroiiS~ )I) ace. Only persons appearing on this list or their employees are authorized to work
on this job. Any changes to this list must be approved by. the Building Division prior to commencement of work_ Failure to comply will result in a stoppage of work and/or the voidance
of building permit. For each applicable trade, all information requested below must be completed by t:ipplicant.. "On File" is not an acce.p.table response..
...-.. :. .. .... .. .. .: n.
._.. ; ... ...... ... ......... - � ....:... I3usiress.. CI
_ :.:..:., r Licc i e..:: Wo�kci's Cori�Iicn�at
;.� r _. , .........:., ..COntraclor�:.,:.:.,.: State,:Cbntr�ctb...s..
Classiftca� 0 1 ..,,, .. ..:
r s.
Company Name Classification License Number Exp. Date Carrier Name Policy Number Exp. Date License Number Exp. Date
(e.g. A, B, C-8) (xxxxxx) (xx/xx/xx) (e.g. State Fund, CalComp) (Format Varies) (xxlxx/xx) (xxxx) (xxlxx/xx)
FRAMING:(C_5)'.>
STRUCT:
MASONRY (0,20), �� L
PLUMBING: -,36
: RQ0-ING;(C=391
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1-LO0RING -(G-;I
IlySt3LATION (C 2)
;PAINTING (C 33)
;GEI `l MIG I ILE'.(C 4)::>
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