BWFE2018-000278-495 CALLE TAMPICO
LA QUiNTe,'CALIFORNIA''9'2253
Permit Type/Subtype:
Application Number:
Property Address:
APN:
Application Description
Property Zoning:
Application Valuation:
Applicant:
CHERYL RAINES
53715.AVENIDA DIAZ
LA QUINTA, CA 92253
4
DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
WALL/FENCE/CITY STANDARD/PRE-APPROVED
BW FE2018-0002
53715 AVENIDA DIAZ
774111022
RAINES / 42 LF GARDEN WALL AND 39 LF RETAINING WALL
$ 2,000.00
A
JAN 0 8 2018
CITY OF LA OUINTA
COMMUNITY DEVELOPMENT DEPARTMENT'
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
1 -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
a rofessions Code) or that he or she is exempt therefrom and the basis for the
e ed exemption. Any violation of Section 7031.5 by any applicant for a permit
s the applicant to a civil penalty of not more than five hundred dollars ($500).:
o�
,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
wL
thin one year of completion, the owner -builder will have the burden of proving that he
e did not build or improve for the purpose of sale.).
, 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 contractors) licensed pursuant to the
Co tractors' State License Law.).
nawram exempt under Sec. q�&P.C. �fiir this reaso�
VOICE (760) 777-7125
FAX (760) 777=7011
INSPECTIONS (760) 777-7153
Date: 1/8/2018
Owner:
ROLAND RAINES
, 92253
Contractor:
OWNER BUILDER
Llc. No.:
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 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
Section00 of the Labor Code, for the performance of the work for which this permit is
issued. y workers' compensation insurance carrier and.policy number are:
C Policy'Number: _
■ certify that in the performance of the work for which this permit is issued, l
s not employ any person in any manner so as to be ome subject to the workers'
compensation laws of California, and agree that, if I could become subject to the
workers' compensation provisions of Se 'on 3 0 oYthe La r Code, sha I forthwith
comply with those provis s. ,
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVLMRAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL 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 this 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, 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.
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.
CONSTRUCTION LENDING AGENCY) I certify that I have read this application and state that the ab information is correct.
I hereby affirm under penalty of perjury that there is a construction lending agency for I agree to comply with all city and county ordinan Sand ate la s relating to building
the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). construction, and herebyjauthorize representativqspf t s city t enter ugaa the above -
mentioned property f inspection purposes.
Lender's Name:
Signature( pl'1ic�'
Lender's Address:
mar . ___
Date: 1/8/2018
Application Number: BWFE2018-0002 Owner:
Property Address: '=x53715 AVENIDA DIAZ ROLAND RAINES
APN: 774111022
Application Description: RAINES / 42 LF GARDEN WALL AND 39 LF RETAINING WALL. 92253
Property Zoning:
Application Valuation: $4000:00
Applicant: Contractor:
CHERYL RAINES OWNER BUILDER
53715 AVENIDA DIAZ
LA QUINTA, CA 92253
Llc. No.:
Detail: 42LF OF"6' GARDEN WALL AROUND FRONT COURTYARD AND 39LF OF 6' GARDEN W/2' MAX RETAINING NORTH EAST PROPERTY LINE [CITY AND
ANGELUS 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.CONTIN000SLY MAINTAINED BY THE PROPERTY OWNER. 2016 CALIFORNIA BUILDING CODES.
FINANCIAL INFORMATION
DESCRIPTION ACCOUNT
CITY AMOUNT
RETAINING/COMBINATION WALL EA 50LF
101-0000-42400
0 $15.60
DESCRIPTION
ACCOUNT
CITY AMOUNT
WALL/FENCE - FIRST 100 LF
101-0000-42404
0 $52.01
DESCRIPTION
ACCOUNT
CITY AMOUNT
WALL/FENCE - FIRST 100 LF PC
101-0000-42600
0 $65.02
Total Paid for BLOCK WALL: $132.63
DESCRIPTION
ACCOUNT
QTY
AMOUNT
BSAS SB1473 FEE
101-0000-20306
0
$1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION
ACCOUNT'
CITY
AMOUNT
RECORDS MANAGEMENT FEE
101-0000-42416
.0
$10.00
Total Paid for RECORDS MANAGEMENT FEE: $10.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT '.
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: •$5.00
...--.........
PERMIT #
PLAN LOCATION:
Project Address:`ryZ
Project Description: Pool, Remodel, Add't, Elect, Plumb, Mech
APN #:
CSV
Patio/Porch SF
Email:
Applicant• Name.
State Lic: City Bus Lic:
Address:. /S'
State Lic: City Bus Lic:
City, ST,
Telephone: 7 7
Email:
Valuation of Project $��%
Contractor Name:
New SFD Construction:
Address:
Conditioned Space SF
City, St, Zip
Garage SF
Telephone:
Patio/Porch SF
Email:
Fire Sprinklers SF
State Lic: City Bus Lic:
Arch/Eng Name:
Construction Type: Occupancy:
Address:
Grading:
City, St, Zip
Construction Type: Occupancy:
Telephone:
Bedrooms:
Stories:
# Units:
Email:
State Lic: City Bus Lic:
� r
Property Owner's Name: r
�
New Commercial / Tenant Improvements:
Address:
Total Building SF
City, ST, Zip �`
Construction Type: Occupancy:
Telephone:
Email:
78495 CALLE TAMPICO
LA QUINTA, CA 92253
760-777-7000
#
Submittal
Req'd
•Ree'd
Plan Sets
Structural Calcs "
Truss Calcs
Title 24 Calcs
Soils Report
'
Grading Plan (PM 10)
Landscape Plan
.
Subcontractor List
Grant Deed
HOA Approval
School Fees
`
Burrtec Debris Plan
Planning approval
Public Works approval
Fire approval
City Business License
Rt,,T.A I N I.N C-
P,q Av-
January 8, 2018
To Whom It May Concern:
We give our permission to Rolland & Cheryl Raines to build a common wall between their
property (53-715 Avenida Diaz) & our Property (53=705 Avenida Diaz).
If you have any further questions, please let us know.
Thank you.
Sincerely,
4 A
GarVyD ebbie Walker
53-705 Avenida Diaz
La Quinta, CA. 92253
T4hf 4� 41, a "I
P.O. Box 1504
LA QUINTA, CALIFORNIA 92247-1504
78-495 CALLS 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 Construction Permits
IMPORTANT! .NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application for a building permit has been s matted in your name listing yourself as the builder of the property
improvements specified at `�j / /gym ;
We are providing you with 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 signer you understand or verify this information.
L 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 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
inj 'es. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers
&3.
roperty.
understand building permits are not required to be signed by property owners unless they are responsible for the
tion and are not hiring a licensed Contractor to assume this responsibility.
understand as an "Owner -Builder" lam. 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
(;4 -sl
understand Contractors are required by law to be licensed and bonded in California and to list theirlicense numbers onitand contracts.
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"
Tove
te and federal law.
understand if I am considered an "employer" under state and federal law, I must register with the state and federal
ent, 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
4.I understand under California_ Contractors' State License Law, an Owner -Builder who builds single-family residential
ct�r/escannot 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 *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
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.
0L. 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:
11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all
pp sand requirements that govern Owner -Builders as.well as employers.
L12�e to notify the issuer of this form immediately of any additions, deletions, or changes toany of the information I
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 firmis 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, s form must be completed and signed by the property owner and returned to.
the agency responsible.for.' suing a t. Note.'A copy'of the property owner's driver's license, form notarization, or
other verifu.ation accep, le to the ty " equired t e seated when the permit is issued to verify the prope►ty_
owner's signature.
Signature} of property er 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 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
Permif for my project.
Scope of Construction Project (or Description of Work):
Project Location or Address:
Name of Authorized Agent: Tel No
Address of Authorized Agent:
I declare under penalty of perjury t I the property owner for the address listed above and I .personally filled out the above
information and certify its accurac . N te: A copy of theowner' ri er's license, form notarization, or other verification
acceptable to the agent requ' d t be r ent when th it is issued to v h–e–property owners signature
Property Owner's gnature:l — . � r
Date: