BWFE2017-021178-495 ALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
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DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Permit Type/Subtype: WALL/FENCE/CITY STANDARD/PRE-APPROVED
Application Number: BWFE2017-0211
Property Address: 53880 AVENIDA MENDOZA
APN: 774173067
Application Description: ACOSTA / 29LF BLOCK WALL AT FRONT COURTYARD
Property Zoning:
Application Valuation: $2,900.00
Applicant: r[NO
CRISTINA ACOSTA53880 AVENIDA MEN60ZA2 17
LA QUINTA, CA 92253 L I
CITY OF LA QUINTA
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 70001 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
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
s b'ects 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
A.Pe did not build or improve for the purpose of sale.).
(e&`J, I, 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
actors'State License Law.). '
I am exempt under Sec. . B.&P:C. for this reason
Date: — 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: 11/15/2017
Owner:
CRISTINA ACOITA
53880 AVENIDA MENDOZA
LA QUINTA, CA 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 certificace 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
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:
Carri Policy Number:
Lcertify that in the performance ofthe 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. '�
Date: // l
�/ 5 `��/Ap7licant:
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 FGR IN SECTION, 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT: Application is hereby made to tie Building Official for a permit subject to
the conditions and restrictions set forth on the application.
1. Each person upon whose behalf this appbcation is made, each person at whose
request and for whose benefit work is perforned under or pursuant to any permit issued
as a result of this application, the owner, andlthe 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 fie work being performed under or
following issuance of this permit.'
2. Any permit issued as a result of this appli,:ation 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 cancellatioi.
I certify that 1 have read this application and s -ate that the above information is correct.
I agree to comply with all city and county ordi lances and state laws relating to building
construction, and hereby authorize represent:,tives of this city to enter upon the above-
mentioned property for inspection purpose�
Date://—/5-
ate: / .JSignature (AppZ nt �r Agent--/%
Q
Date: 11/15/2017
Application Number: BWFE2017-0211 Owner:
�P%peft Address: "' 1 53880 AVENIDAAAENDOZA CRISTINA ACOSTA
APN: 774173007 - 53880 AVENIC•A MENDOZA
Application Description: ACOSTA / 29LF BLOCK WALL AT FRONT COURTYARD LA QUINTA, CA 92253
Property Zoning:
Application Valuation: $2,900:00
Applicant: Contractor:
CRISTINA ACOSTA OWNER BUILCER
53880 AVENIDA MENDOZA
LA QUINTA, CA 92253
Lic. No.:
Detail: 29.1-F AT FRONT COURTYARD [ORCO SPECIFICATIONS 1.2] 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 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: $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
r
i
PERMIT 1#
l�� PLAN LOCATION
Project Address: vCU v Project Description: Pool, Remodel, Add't, Elect, Plumb, Mech
APN 4:
Address: Qs� - �s �1
Conditioned Space SF
City, St, Zip l �-, kr-0
Applicant Name: *7rAw,,Jz.
Telephone: 6® .. �Q -- ljS
Patio/Porch SF
Address: `j 34gqDen
Fire Sprinklers SF
A
City, ST, Zip: fa,
Telephoner 11 —r 5-7
Email:
Valuation of Project S ` G� 66
Contractor Name: a- 6
New SFD Construction:
Address: Qs� - �s �1
Conditioned Space SF
City, St, Zip l �-, kr-0
Garage _SF
Telephone: 6® .. �Q -- ljS
Patio/Porch SF
Email:4� �SC��� �,i �r
Fire Sprinklers SF
State Lic: qg6 City Bus ic:
krch/trig Name:
Construction Type: Occupancy:
%ddress:
Grading:
'ity, St, Zip
Construction Type: Occupancy:
Telephone:
Bedrooms:
Stories:
#Units:
.mail:
;tate Lic: City -Bus Lic:
.roperty Owner's Name: fi
New Commercial J Tenant Improv,.ements:
,ddress: 3gt'�Total
Building SF
'ity, ST, Zip V t �-� 7i7i5
Construction Type: Occupancy:
elephone: Lt
mail:
78495 CALLE TAMPICO
LA QUINTA, CA 92253
760-777-7000
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MAX WALL MAX DIP 4. TOP! OF LEVEL NATURAL GRADE
HEIGHT FOOTING PT ROD SPACING = - OR. COMPACTED SUBGRADE
6' CMU SPACING Oj o - . `' `
T''... 3'-0' 5.. CONT. CONCRETE SETTING PAD -
9 MIN
6'-0* 10'-8' O.C. 6'-0' O.C. 6. THICKEN CONCRETE SETTING PAD
TO.PROVIDE. 3' MIN COVER
6'-8" 8'-8' D.C. 4'-8" O.C. AROUND PT'ROD AND: NUT; AS _
'RED'), WHERE,PT,ROD DOES
NOT ALIGN W/ DIF FOOTING
1 -4' 7. .,UNE OF. DIP FTG. BEYOND
MIN
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CONCRETE ..�
FBI EtFVATION 9. VERTICAL. REINF V4/„ STD . HOOK
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= OVER 6'=0' HIGH. USE'(t);4
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3 " COUPLER AND //OR POST,
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t 0, .REFER TO GSN AND TYPICAL
SETBACK DETREQUIREMENTS AND ITEMS
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N ' FLOOD .WALL OR' OTHERWISE -1
z 10 SURCHARGED,;UNO
a �` 12 MIN C. PLACE.FIRST BLOCK INTO. WET u
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NO SCALE _ -
SEAL
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PROTECT: PROTO II STANDARD PLANS
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WIND EXPOSURE CAT 110 MPH
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Q PLAN CHECK 07-17
LA QUINTA, CA
REV DESCRIPTION !DATE
TITLE: TYPICAL DETAILS
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PROT&IlTM WALL SYSTEMS
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RIM .RCICKENGINEERING
41800 CASCADES. COURT ATTN: GARY OTTO
I.S.
9030 W. CHEYENNE AVE. STE 210
LAS VEGAS, NV 89129
TEMECULA, CA 92591 PH#. (951)6943793
WWW.PhOTO2.COM garyo �Pro1D`u•COM
PIt 702 838 6311
PATENTED S•794.921 &8.431,797. a 7.188, &6=044 i4s4,fqq 97,461,44
PROT041 WALL SYSTEMS MAY ONLY BE INSTALLED BY APPROVED AND CERTIFIED It
o No., Cfi9.6'1:6'
DLP. 6/30/t.8
02-06-17, . f
CIVIL
No: STD, ���
T -df 4 4.4"
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 Construction Permits
IMPORTANT! NOTICE TO PROPERTY. OWNER
Dear Property Owner:
An application for a building peisrut has been s bcriitte m our na lis tin y urself the iuilder of the property
improvements specified at ;�o C_�
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 cainot 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 informatien.
�. I understand a frequent practice of unlicensed persons is to have the property owner obtasr 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 Ly an unlicensed person
and his or her employees while working on' my property. My homeowner's insurance may not protide 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.
CL -N2- 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. P
3. I understand as an "Owner -Builder" I am the responsible party of record on the permit. I undersand that I may protect
myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or ler name instead of my
own.
4.1 understand Contractors are required by law to be licensed and bonded in California and to list their lice
permits and contracts. license numbers on
.�5: I understand -if I employ or otherwise engage any persons, otherthan 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.
�6. 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. 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 fire work is performed
under contract with a licensed general building Contractor.
6C-_'8. I understand as an Owner -Builder if I sell the property for which ".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. f
9. 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-
%80.0-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors.
V 10.1 am aware of and consent to an Owner -Builder building permit applied for in my name, and inderstand 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 acrivity, 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 pubic. 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 firm .s 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 resented when the permit is issuee to verify the
owner's signature. /% / /7 _ property
Signature of property owner �� �C� 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 OFAGENT TO ACT ON PROPERTY OWNER'S BERALF
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 obtF-in 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
I declare under penalty of perjury that I am the property owner for the. address listed above and I person -ally filled out the abo
information and certify its accuracy. Note: A copy of the.owner's driver's ve
license, form notarization, or ether verification
acceptable lathe agency is required to be presented when the permit isissued to verify the property owaer s signature.
Property Owner's Signature: Date:
CITY OF LA QUINTA SUB -CONTRACTOR. LIST _
JOB ADDRESS_ 2.�C7 -..PERMIT NUMBER G, OWNER _ _ �BUiLDEI
This 'form ;hall bepostedon- the ioi.) with -the Building (nshection Ca
rd nt all -rimes in a -conspicuous -.place. Only persons appearing on this list or their employees are authorized to work
on this job. Any changes to this list must betapproved 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 applicant.. "On File" is not an acceptable response.,
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License Number
Exp. Date
Carrier Name
Policy Number
Exp. Date
License Number
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(xx/xx/xx)
(e.g. A, B, C-8)
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(xx/xx/xx)
(e.g. State Fund, CalComp)
(Format Varies)
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