BWFE2018-006378-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Permit Type/Subtype:
Application Number:
Property Address,
APN:
Application Description:
Property Zoning:
Application Valuation:
Applicant:
CORY GREEN
53875 AVENIDA DIAZ
LA quinta, CA 92253
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DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
WALL/FENCE/CITY STANDARD/PRE-APPROVED
BWFE2018-0063
53875 AVENIDA DIAZ
774151019
GREEN / PROPANE WALL
$500.00
A
JAR 2 GIM
I CITYOFLAQUINTA
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.::CONV:140528101254131346
Da • Con ctor:
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 ($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
r she did not build or improve for the purpose of sale.).
( as owner of the property, am exclusively contracting with licensed contractors to
con uct 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
Contractors' State License Law.).
(� I am exempt under Sec. . B.&P.C. for this reason
Date: 3 0: Owner:
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
VOICE (760) 777-7125
FAX'(760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/26/2018
Owner:
CORY GREEN
53875 AVENIDA DIAZ
LA quinta, CA 92253
Contractor:
CORY GREEN
53875 AVENIDA DIAZ
LA quinta, CA 92253
(508)801-8968
Llc. N6.::CONV:140528101254131346
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
oft ork for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by
Section 00 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: _
_ I 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 agree that, if I should become subject to the
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with those provisions. s _
Date: )/d /M/ X Applicant
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE 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.
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^oned reinspection purposes.
Date: 3 oz Signature (Applicant or Agent):
Date: 3/26/2018
Application Number: BWFE2018-0063
Owner:
Property Address° ' " 53875 AVENIDA DIAZ
CORY GREEN
APN: 774151019
53875 AVENICA DIAZ
Application Description: GREEN./ PROPANE WALL
LA quinta, CA 92253
Property Zoning:
Application Valuation: $500.00
Applicant:
Contractor:
CORY GREEN
CORY GREEN
53875 AVENIDA DIAZ
53875 AVENIDA DIAZ
LA quinta, CA 92253
LA quinta, CA 92253
(508)801-8968
-----------------------------------------------
Lic. No.::CONV:140528101254131346
----------------------
------------------------
Detail: 15LF OF 4' GARDEN WALL AROUND PROPANE TANK IN FRONT YARD [CITY SPECIFICATIONS] OPTION A 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.'
H
DESCRIPTION'ACCOUNT
FINANCIAL INFORMATION
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:
$117.03
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
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
N.
2
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PERMIT # SCO
`
PLAN LOCATION:.
Project Address:.Project
5.3875 j?vFfJrDA Dr 04z.
Description: -Pool, Remodel, Add't, Elect, Plumb, Mech
Garage SF.
Telephone:
Patio/Porch SF
Email:
Applicant Name: f~ o M% G rEs
State Lic: City Bus Lic:
Address: S-3
State Lic: City Bus Lic:
City, ST, Zip: A,
Telephone: d – Oi– 8110
Email'
. AlAloIc"
C o / Z Zoa0
Valuation of Project $
J �.��y
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:
Property Owner's Name: C oYLG LAN
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
OFFICE USE ONLY
#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
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING SAFETY DEPARTMENT
(760) 777-7012
FAX (760)'777-7011
Considering Becoming an Owner -Builder?
Important information you need to know BEFORE pulling your permit!
The term "Owner -Builder" can mean three different things::
"Owner as Worker", "Owner as Contractor" or "Owner as Emphyer"
Understand each has Benefits or Risk, and it is possible to combine them!
Hiring a California Licensed Contractor means you do not personally perform any of the construction work, the permit is not taken
out in.your name, you are not personally responsible for the construction and you are not an Owner -Builder. Instead, you become a
"Customer" and California law provides you the benefit of protection from poor workmanship, failure to finish the job and financial
risk due to worker injury.
Benefit/Risk: Highest Benefits and the Least amount of Risk
Owner -as -Worker is a type of Owner -Builder where you personally perform the construction, work, th& permit is taken out in your
name and you are personally responsible for the construction management, knowledge, workmanship, and completion of the job. You
benefit by not paying others to perform this work for you and your risk depends on your own ability to complete the job successfully.
Benefit/Risk: 'Possible Benefit with Low Financial Risk
Owner -as -Contractor is a type of Owner -Builder where you personally act as your own General Contractor, the permit is taken out in
your name and you hire California licensed sub -contractors to perform portions of the construction work. WARNING: The benefit:of
protection provided -by law when you hire only California licensed sub -contractors can turn to serious financial risk if you hire
unlicensed contractors to perform any of the work.
Benefit/Risk:' Possible Benefit and Significant Financial Risk
Owner-as-Employer.is a type of.Owner-Builder where you pay any unlicensed individual to perform any -construction work valued at
more than $500.00, the permit is taken .opt in your name and you are•personally responsible for their em loyment requirements,
supervision, performance, safety and welfare while on your property. WARNING: Cost savings benefit can tum'to serious financial
risk if you fail to deduct payroll taxes or provide workers compensation insurance for each worker.
Beneflt/Risk: Possible Benefit with Significant Financial Risk
LF
(Health and Safety Code Section 19827) The California Legislature .declares an "urgent and statewide
public interest . in .assuring" that contractors comply with Contractors' License Law, Business and
Professions Code and Workers' Compensation ' Insurance requirements to ensure property owners are
informed about,, and protected from the following when improving their property as Owner -Builders:
Fraudulent representations • Liability for worker's injuries • Liability for material and labor costs unpaid by
contractors • Licensing requirements - Employers tax liabilities
Over 20,000 consumer complaints are filed each year. Many complaints relate to owner/bu'ilder projects
and include workmanship and workers' compensation issues Homeowners. suffer financial harm due to
defective workmanship and injured employees.
Following are alarming examples of what has occurred with Owner -Builder permits:
Example 1: Homeowner received insurance money to rebuild burned -down home.
• Owner/Builder permit pulled to rebuild structure.
■ Unlicensed contractor built substandard structure — must be torn down and replaced.
■ Estimated financial injury is $225,000.
■ Additional financial injury - IRS threatenedto- tax insurance payout if house not completed by the end of
the year.
Example 2: Brother-in-law had active license .but fled an exemption from Workers Comp.
■ Owner -Builder hires brother-in=law to install a new roof.
■ Employee falls and sustains multiple spinal and extremity fractures as. well as a head injury and
remains in a coma to this day.
■ . The Owner -Builder, who has sold the home, is now a defendant..in a lawsuit for reimbursement for
benefits paid to the injured worker.
Example 3:,Employee of contractor without.Workers Comp is hired by Owner -Builder to install septic
system and suffers injury that results in permanent disability.
■ The Owner -Builder did not have a homeowner's insurance policy on the- house against which to submit
a claim.
■ The Owner -Builder is now a defendant in a lawsuit for reimbursement for benefits paid.to the injured
worker.
Did you know unlicensed persons frequently have the property. owner obtain an "Owner -Builder" building
permit which erroneously implies that, the property owner is providing his or her own labor and material
personally?
Did you know — your homeowner's insurance may not provide coverage for injuries. sustained on your
property by an unlicensed contractor and his/her employees?
Did you know — if you are considered an "employer" under state and federal law, you must register with
the state and federal government, withhold payroll taxes, provide workers compensation and'disability
insurance and contribute to unemployment compensation for each "employee"?
Did you know — that if you fail to abide by these laws you may. be subjected to serious financial risk?..
OWNERS BEWARE AND CONSIDER THE RISK BEFORE ACCEPTING FULL RESPONSIBILITY FOR
YOUR CONSTRUCTION PERMIT .
i
L
F:U. 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 Construction Permits
IMPORTANT! NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application for a building permit has been s/up tted in your name listing yourself as the 'builder of the property
improvements specified at 5.5e iS
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 c>=nnot execute this notice
unless you, the property owner, obtain the prior approval of the permitting authority.
DIRECTIONS: Read and initial each statement below to sign you understand or verify this information.
1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder"
b •i ing permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as
an wner-Builder, may be held liable and -subject to serious financial risk for any injuries sustained -:)y 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.
1t2- I understand building permits are not required to be signed by property .owners unless they are responsible for the
ructiori 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.
pet4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on
s and contracts.
5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value
of construction is at least five hundred dollars ($500), including labor and materials I may be "
under state and federal law. y co>tsrdered an employer
N6. I understand if I am considered an "employer" under state and federal law, I must register wish the state and federal
go rnment, withhold payroll taxes, provide workers' compensation disability insurance; and cont-bute to' unemployment
compensation for each "employee." I also understand my failure to abide by these laws may subject :ne to.serious financial
risk.
7. I understand under.California Contractors' State License Law, an Owner -Builder who builds single-family residential
stn tures 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. °
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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
fin cial or personal injuries 'sustained by any subsequent owner(s) that result from any latent construction defects in the
workmanship or materials.
9. I understand I may obtain more information regarding my obligations as an."employer" from the Internal Revenue
Se ice, 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. ,
10. I am aware of and consent to an Owner -Builder building permit. applied for in my name, a
nd understand that I am the
p legally, anf financia 1 responsible for proposed construction activity at the ' following address:
S.3g%S Nv '
,11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will_ abide by all
ap able laws and requirements that govern Owner -Builders as.well as employers.
112. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I
haprovided 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, 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 presentedd when the permit is issued to verify the property
owner's signature.
i
Signature of property owner Date: 'S
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
Permif 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 ds required to bepresented when the permit is issued to verify the property owner's signature.
Property. Owner's Signature: Date:
12-284
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