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BWFE2018-00344 .. 78-445`CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Permit Type/Subtype: Application Number: Property Address: APN: . Application Description Property Zoning: Application Valuation: Applicant: BONNY ITEN 53365 AVEWDA NAVARRO LA QUINTA, CA 92253 �F w DESIGN & DEVELOPMENT DEPARTMENT BUILDING PERMIT VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 WALL/FENCE/CITY STANDARD/PRE-APPROVED Owner: BWFE2018-0034. BONNY ITEN 53365 AVENIDA NAVARRO 53365 AVENIDA NAVARRO 774094017 LA QUINTA, CA 92253 ITEN / 104 LF BLOCK WALL AROUND COURTYARD & BACKYARD $5,000.00 Contractor: OWNER BUILDER Llc. No.: Date: 2/9/2018 -------------------------------------------------------- I -------------------------------------- LICENSED ------------------------------------------------------I------------------------------------ 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 permit cts 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 Vr e did not build or improve for the purpose of sale.). 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 . Contractors' 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 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 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: Carrier:_ Policy Number: _ I certify that in the performance of the work for which this permit is issued, I shaVrnot 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 Sectio of the Labor Code, I shall forthwith comply with those provisions. . Date:/,L/ a O Applicant: WARN I G: 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 cit @r upon the above- mentioned property for inspection purposes. Date: _2fZ / Signature (Applicant or Agent) Date: 2/9/2018 Application Number: BWFE2018-0034 Owner: Prop'etty Address: 53365 AVENIDA NAVARRO BONNY ITEN APN: 774094017 - 53365 AVENIDA NAVARRO Application Description: ITEN / 104 LF BLOCK WALL AROUND COURTYARD & BACKYARD LA QUINTA, CA 92253 Property Zoning: Application Valuation: $5,000.00 Applicant: Contractor: BONNY ITEN OWNER BUILDER 53365 AVENIDA NAVARRO LA QUINTA, CA 92253 LIc. No.: ------------------------------------------------- ------------------------------------------- Detail: 721-F OF 6' GARDEN WALL AROUND7COURTYARD AREA TO INCLUDE TWO PILASTERS W/ LIGHTS, 16LF OF 4' GARDEN WALL AT NORTHE4Sf SIDE FOR PROPANE ENCLOSURE, AND 16LF OF 4' GARDEN WALL AT REAR OF PROPERTY FOR POOL EQUIPMENT ENCLOSURE [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 ACCOUNT QTY AMOUNT WALL/FENCE - EA ADDITIONAL 50 LF 101-0000-42404 0 $15.60 -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: $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 QTY AMOUNT DEVICES, FIRST 20 101-0000-42403 0 $26.01 DESCRIPTION ACCOUNT QTY AMOUNT DEVICES, FIRST 20 PC 101-0000-42600. 0 $26.01 *Total Paid for ELECTRICAL: $52.02 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 y .............. _.._ PERMIT # ISWM9641 PLAN.LOCATION- � Ca ff Project Address: 573365 AJQ�!(dks� Project -Description: Pool, Remodel, Add't, Elect, Plumb, Mech APN Telephone: l� Email: Fire Sprinklers SF State Lic: City Bus Lic: Applicant Name: 1 C Address: 3310 (/Q/dD City, ST, Zip: toZ� Telephone: Email: Cs� D Valuation 'of Project $ Contractor Name: �(,(� jp/ 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: POA[P\JV New Commercial / Tenant Improvements: Address: �� 5 VeM D Total Building SF City, ST, Zip • i 01. 9 Construction Type: Occupancy: Telephone: YP — CQ t /D Email: ( l o ('0M 78495 CALLE TAMPICO LA QUINTA, CA 92253 760-777-7000 , OFFICE•USE ONLY # S r Submittal' �V Req'd -Rec'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 r Public Works approval Fire approval . City Business License S r f t ! 4ti -vf/� 1 'ydrl:_-'p� (�✓\ �r•-"i �lr�' V'�� yp�� r ♦ _ , ' y, l ; ' 0� C4 72-2-5. . C s'r Av #M ft 1) �A �t 1� tr,�4t� FA APPf LA QUIN i r SAFETY DEPT.OVED STRUCTIONBY ry WID ARC =p1LRSTy - b� .vP Woo.S'� ANpA lotOR &LOLV leuxv- � �� . � � ` sem; ._ • •� • � .2 i RY' 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 submitted in your name listing yourself as the builder of the property improvements specified at 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 information. 1. 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 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 b property y p p rty owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. 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. 4. I understand•Contractors are required by law to be licensed and bonded in California and to list their license numbers` on pernuts.and contracts. 'Q_L_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" . 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 risk. financial �7. I understand under California Contractors' State License Law, an Owner -Builder who builds sin le-famil g y resrdenhal 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 the work is performed under contract with a licensed general building Contractor. I- 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. 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- 800-321-CSLB (2752) or www.cslb.ca.gov forlmore information *about licensed contractors. 10. 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 govem Ownei-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 result of a complaint. Your only. remedyagainst 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-' firm is 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 perit. 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 owner's signature. Signature of property owner Date:O1 Note: The following Authorization Form is required to be completed by theproperty 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 ScopPermit for project. 11 P ciC wal' Sco a of Construction Project or Description of Work): : ;04 ��! l O Project Location or Address: Name of Authorized Agent:� 1 Tel No_-"__� Address of Authofized Agent: �57 Z7 5— a l fo 7--ryi,6_4 AK a uf)21C�_ I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above ✓ S 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 wh n the permit is issued to verify the property owner's signature. Property Owner's Signature: p Date: l BONNY [TEN TEL# WORK TO BE PERFORMED AT: 53365 AVENIDA NAVARRO LA QUINTA CA.92253 DATE: 2/ 9/2018 TO WHOM IT MAY CONCERN THIS LETTER IS TO CLARIFY THAT THE PERMIT IM REQUESTING IS AN OWNER BUILDER PERMIT AND VERIFYING THAT BEN BELTRAN IS GOING TO BE THE AGENT ACTING ON MY BEHALF IF THERE IS ANY QUESTIONS OR CONCERNS YOU CAN CONTACT ME OR MY HUSBAND AT THE NUMBER ABOVE OR BEN BELTRAN AT # . THANK YOU CITY OF LA QUINTA SUB-CONTRACTOR LIST JOB ADDRESS _7--`1!> ALOWAt PERMIT NUMBER OWNER? _-I_ kj -BUILDER This form shall be—posted on the iob with the Builcliricl i►ist�ection Card at all times in a conspicuous- place. Only p rsons 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 applicant.. "On File" is not an acceptable response.. _. :. n...s...:... Ct.. .. r�dr /.Glass,(,caCOlttractor;:....•: Statc:Cbntractors:L,cense.;:... Wgrkcrs Cpnhent!o,� Itlsur.� .cc 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) (xxlxxlxx) (xxxx) (xxJxx/xx) RTI WOFK,.IC12) CONCRETt= FRAMING (C 5) "STRU.CT:[;STEL MA SONRY lC ?9) IEiQ� 'PL u.MBIND `(C-36)'::. LlaTH;.PLl�ST[R:.{C 3�) .",• DRYW LLEGTRICAL (C TO) : mej" F3O:OF1NG. (C;=33.1== SFIEET: ETAL' .(C-*z43)' :';..:: (-COpRING lc (6} G..LAZING (C 77). _ S WGG::'D_ 1 (G=X32):' PAINTING (C-.3 .LANQSC�? G(C POOL