BWFE2017-0057�aurw
78-495 CALLE TAMPICO .
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT .
Application Number: BWFE2017-0057
Property Address: 53245 AVENIDA DIAZ
APN: 774041023
Application Description: MARTINEZ / 240LF OF 5/6' BLOCK WALL
Property Zoning:
Application Valuation: $15,000.00
Applicant:
JONATHAN MARTINEZ
53245 AVENIDA DIAZ
LA QUINTA, CA 92253
LICENSED CONTRACTOR'S 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.:
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 the applicant to a civil penalty of not more than five hundred dollars
( 0) :
f, 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 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'Wnstruct 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
tth-C ntractors' State License Law.).
(.4x� am exempt under Sec. B.&P.C. for this reason
CX
-t Date: ' Owner:
CONSTRUCTION LENDIG A ENCY
I hereby affirm under penalty of perjury that there i nstruction lending agency for
the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's
uta
Llc. No.:
. WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one o* the following declarations:
I have and will maintain a certificat-e of consent to self -insure for workers' '
compensation, as provided for by Section 3709 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 insurance carrier and policy number are:
Carrier- Policy.Number. _
(�,}�� �lp�.I certify that in the performance of the work for which this permit is issued, I
s ah llW employ any person in any manner so as to become subject to the workers'
compensation laws of California, and agree that, if I should become subject to the
workers' compensation provisions of Section _700 of the Labor Code, I shall forthwith
comply with those provisions. C
Date: 1 '(-31 _N ` r_
WARNING: FAILURE TO SECURE WORKERS' CCMPE SA ON COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMMAL PE AL ES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ION 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 thi: application.
1. Each person upon whose behalf this applcation 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 Lie 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 ord-nances and state laws relating to building
construction, and hereby authorize representatives of thi 'ty to enter upon the
above -m do . d property for inspection purposes.
Date: Signature (Applicant or Agent):
VOICE (760) 777-7125
FAX (760) 777-7011
INS@ECTI 3
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z Date:. 17
n.
Owner:
o n
JONATHAN MARTINEZ
53245 AVENIDA DIAZ
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LA QUINTA, CA 92253
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Contractor:
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OWNER BUILDER.
9
uta
Llc. No.:
. WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one o* the following declarations:
I have and will maintain a certificat-e of consent to self -insure for workers' '
compensation, as provided for by Section 3709 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 insurance carrier and policy number are:
Carrier- Policy.Number. _
(�,}�� �lp�.I certify that in the performance of the work for which this permit is issued, I
s ah llW employ any person in any manner so as to become subject to the workers'
compensation laws of California, and agree that, if I should become subject to the
workers' compensation provisions of Section _700 of the Labor Code, I shall forthwith
comply with those provisions. C
Date: 1 '(-31 _N ` r_
WARNING: FAILURE TO SECURE WORKERS' CCMPE SA ON COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMMAL PE AL ES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ION 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 thi: application.
1. Each person upon whose behalf this applcation 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 Lie 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 ord-nances and state laws relating to building
construction, and hereby authorize representatives of thi 'ty to enter upon the
above -m do . d property for inspection purposes.
Date: Signature (Applicant or Agent):
Application Number: ,
BWFE2017-0057
Property Address:
53245 AVENIDA DIAZ
APN:
774041023
Application Description:
MARTINEZ / 240LF OF 5/6' BLOCK WALL
Property Zoning:
Application Valuation:
$15,000.00
Owner:
JONATHAMMAR—INEZ
53245 AVENIDA DIAZ
LA QUINTA, CA 92253
Date: 4/12/2017
Applicant: Contractor: ,
JONATHAN MARTINEZ OWNER BUILDER t
53245 AVENIDA DIAZ
LA QUINTA, CA 92253
Llc. No.:
---------------------------------------------------------------------------------------------
Detail: 240LF OF 5/6' BLOCK WALL ON NORTH, SOUTH AND EAST [CITY SPECIFICATIONS] PRECISION CONCRETE BLOCK SHALL BE COVERED WITH STCXUCCO,
PAINT, OR TEXTURED COATING WHERE VISIBLE FROM OUTSIDE THE PROPERTY. THE AREA BETWEEN THE BACK OF CURE AND ANY FENCING SHALL BE
LANDSCAPED, HAVE A SUITABLE PERMANENT IRRIGATION SYSTEM, AND BE CONTINUOUSLY MAINTAINED BY THE PROPERTY OWNER. 2016 CALIFORNIA
BUILDING CODES.
I
•DESCRIPTION
FINANCIAL •• •
ACCOUNT QTY
AMOUNT
WALL/FENCE - EA ADDITIONAL 50 LF
101-0000-42404 0
$45.60
DESCRIPTION
ACCOUNT QTY
AMOUNT
WALL/FENCE - FIRST 100 LF
101-0000-42404 0
$50.67
DESCRIPTION
ACCOUNT CITY
AMOUNT
WALL/FENCE - FIRST 100 LF PC
101-0000-42600 0
$63.33
Total Paid for BLOCK WALL:
$159.60
DESCRIPTION
ACCOUNT
CITY
AMOUNT
BSAS SB1473 FEE
101-0000-20306
0
$1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA:
$1.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE:
$5.00
Bin #
Permit 7
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Project Address: 5�46
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City of la QUinta
Guifding &r Safety Division
78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-701,2
Building Permit Application and Tracking Sheet
n a Owner'sName:1—Jo
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
Contractor:Dw
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TeleP ho c•
Address:
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Project Description:
City_ ST, Zip:
Tele h 0 ne:
P
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State Lic. # :
City Lie. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
w
Telephone. ne.
Co frac tonType: Occupancy:
ic. _
'Demo
PToJectnP (circle one): Add'nAIter Re air'
Name of Contact Person:
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Sq. Ft.: #Stories: #Units:
Estimated Value of Project:6460
Telephone # of Contact Person: „
# Submittal
Jr
APPLICANT: DO NOT WRITE BELOW THIS LINE
Req'd Rcc'd 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
T4echanical
Grading plan
2" Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
M.O.A. Approval
Plans resubmitted
Grading
IN MOUSE:-
'`'. Review, ready for correctionstissue
Developer Impac: Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees,
Total Permit Fee:
TWy 4 ,(F'au1KYa
P.O. Box 1504
LA QUINTA, CALIFORNIA 92247-1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
PROPERTY OWNER'S PACKAGE
(760)777-7012.
FAX (760) 777-7011
Disclosures & Forms for Owner -Builders Applying for Construclion Permits
IMPORTANT! NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application for a building peimit has beubmitted in y� name listing yourself � thel builder of the property
improvements specified at 53 n Ave,�L (A ()f- &I— /(AZ
We are providing you with -an Owner -Builder Acknowledgrile''nnt and Information Verification F "awar to make yoofour
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 information.
4!11. I understand a frequent practice of unlicensed persons is to have the property owner obtain. an "Owner -Builder"
1dling 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 lield 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
construction and are not hiring a licensed Contractor to assume this responsibility. ,
�3. I understand as an"Owner-Builder" I am the responsible party of record on the permit. I understand that I may protect
myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my
own.
_k4.'l understand Contractors are required by law to be licensed and bonded in California and to list their license num
bers on
permits and contr4&s. „ , ..
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"
yxder state'and federal law. '
6. I understand &I am considered an "employer" under state and federal law,'I must -register with the state e and federal
government, withhold payroll taxes, provide workers' compensation disability insurance, and contribrte to unemployment
compensation for each "employee." I also understand my failure to abide by these laws may subject me. to .serious financial
risk.
`t7. 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 tle 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 owners) that result from any latent construction defects in the
workmanship or materials.
VA -19. 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.
__:T91 0. 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:
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.
12. I 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 assist you with any financial loss
you may .sustain as a-result0 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 obtaina 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 notarixdon, or
other verification acceptable to the agency is ejuir7d to be presented when the permit is issued to verify the property
owner's signature.
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 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 agents) to apply for, sign; and file the documents necessary to obtain an Owner -Builder
Permif for project. 1
Scope of Construction Project or Description of Work) :
Project Location or Address: 3v'� J �� til (�Ol, r^4 L4101111,64 4 '4,JS
Name of Authorized Agent:67aTel No
Address of Authorized Agent:
cA9'-,)as 3
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 wner's driver's license, form notarization, or other verification
acceptable to the agency is required to a presente hen the permit is issued to verify the prope ry owne s signature.
Property Owner's Signature: Date:
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTI N
DATE ` ``EIL `BY
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X OF LA QUINTA
ILDING & SAFETY DEPT -
FOR CONSTI RUCTION
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June 1, 2017
To whom it may concern;
I ��j11�l`j•S%%l, give Jonathan Martinez permission to pour foundation
and wall on his property located at 53-245 Avenida Diaz, La Quinta, CA 92253. Furthermore, I
understand and except any risk in the event the cement poured for the foundation
inadvertently encroaches my property.
Signature Date
76o S- 7 K- 7a/�
JUIN 0 2 2017
CITY OF LA QUIr4TA
COMMUNITY DEVELOPMENT
. 41 - -)
June 1, 2017
To whom it may concern;
give Jonathan Martinez permission to pour foundation
and wall on his property located at 53-245 Avenida Diaz, La Quinta, CA 92253. Furthermore, I
understand and except any risk in the event the cement poured for the foundEtion
inadvertently encroaches my property.
Signature
-7
Date
CI1Y OF LA QUIWA
COMMJNIV DEVELOPMENT