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BWFE2017-0200LICENSED 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:140528101254086939 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 buects the applicant to a civil penalty of not more than five hundred dollars ($500).: C) 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure isnot 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 o sh did not build or improve for the purpose of sale.). moi, as owner of the property, am exclusively contracting with licensed contractors to 11 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 C tractors' State License Law.). -- am exempt under Sec. . B.&P.C. for this reason 11deY D —/-3/Z Obvne 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 Llc. No.::CONw:140528101254086939 WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury oneof the following declarations: I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 37DO of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain workers' -ompensation 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: Polity Number:Cl _ yl certify that in the performance of the work for which this permit is issued, l shall not employ any person in any manner so as to become subjectto the workers' compensation laws of California, and agree>ihat, if I should become subject to the workers' compensation provisions of Sectior 3700 of the Labor Code, I shall forthwith comply with those provisions. . pplic`ant.T�` WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE 15 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 t5is application. 1. Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is perfocmed 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 Cita of La Quinta, its officers, agents, and employees for any act or omission related tathe 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. 1 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 represencatives of this city to enter upon the above- mentioned property for inspection purposes. DaDa e1/& / J-i:-ALatorr f"Annlir nr GoantF C` VOICE (760) 777-7125 78-495 CALLE TANJPICO , , 0 . D FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 10/13/2017 Permit Type/Subtype: WALL/FENCE/CITY STANDARD/PRE-APPROVED Owner: Application Number: BWFE2017-0200 HILAR 10 VALLE Property Address: 508QO CALLE QUITO 50800 CALLE QUITO APN: 770102002 LA QUINTA, CA 92253, Application Description: VALLE / BLOCK WALL Property Zoning: o 10 Application Valuation: $3,000.00 0( uJ c , o Applicant: Contractor: I HILAR 10 VALLE OWNER BUILDER L z 50800 GALLE QUITO 50800 CALLE QUITO o LA QUINTA, CA 92253 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.::CONV:140528101254086939 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 buects the applicant to a civil penalty of not more than five hundred dollars ($500).: C) 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure isnot 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 o sh did not build or improve for the purpose of sale.). moi, as owner of the property, am exclusively contracting with licensed contractors to 11 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 C tractors' State License Law.). -- am exempt under Sec. . B.&P.C. for this reason 11deY D —/-3/Z Obvne 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 Llc. No.::CONw:140528101254086939 WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury oneof the following declarations: I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 37DO of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain workers' -ompensation 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: Polity Number:Cl _ yl certify that in the performance of the work for which this permit is issued, l shall not employ any person in any manner so as to become subjectto the workers' compensation laws of California, and agree>ihat, if I should become subject to the workers' compensation provisions of Sectior 3700 of the Labor Code, I shall forthwith comply with those provisions. . pplic`ant.T�` WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE 15 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 t5is application. 1. Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is perfocmed 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 Cita of La Quinta, its officers, agents, and employees for any act or omission related tathe 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. 1 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 represencatives of this city to enter upon the above- mentioned property for inspection purposes. DaDa e1/& / J-i:-ALatorr f"Annlir nr GoantF 1 Mj` Date: 10/13/2017 Application Number: BWFE2017-0200 Owner: Property Address: " 50800 CALLE QUM HILARIO VALLE APN: 770102002 50800 CALLE QUITO Application Description:. VALLE / BLOCK WALL LA QUINTA, CA 92253 Property Zoning: Application Valuation: $3,000.00 Applicant: Contractor: HILARIO VALLE OWNER BUILDER 50800 CALLE QUITO 50800 CALLE QUITO LA QUINTA, CA 92253 LA QUINTA, CA 92253 Llc. No.:.:CONV:140528101254086939 Detail: 150LF OF 6' GARDEN WALL AT NORTH AND WEST PROPERTY LINE AND AROUND DRIVEWAY WITH GATES AND 4 PILLASTERS AT SOUTHWEST CORNER FOR RV AND NORTH WEST CORNER 4 ENTRANCE[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 A14D ANY FENCING SHALL BE LANDSCAPED, HAVE A SUITABLE PERMANENT IRRIGATION SYSTEM, AND BE CONTINUOUSLY MAINTAINED BY THE PROPERTY OWNER. 2016 CALIFORNIA BUILDING CODES. FINANCIAL INFORMATION DESCRIPTION.c .;; ,,, ACCOUNT QTY AMOUNT' WALL/FENCE - EA ADDITIONAL 50 LF 101-0000-42404 0 $15.60 DESCRIPTION ACCOUNT i 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 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 ENHANCEM=NT FEE:$5.00 TOTALS:4: t TOM f44 " - 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 y ur name listing y urself as the guilder of the property improvements specified at '� � 4 a � `��---/��jr 4 Z7 We are providing you with and er- it er Acknowledgment d�inforni�a,aRo�nn Veri kation 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. l 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. A/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. I understand as an "Owner -Builder" I am the responsible party of record on the permit. I enders and 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. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on rrruts and contracts. g`s understand if I employ or otherwise engage any persons, other than California licensed Contract:)rs, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered a " under state and federal law. Y n employer" �. 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 risk. subject ire to serious financial 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 strictures does not exceed four within any calendar year, or all of t>ke 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 owner(s) that result from any latent construction defects in the workmanship or materials. —�k 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. 10. I am aware of and consent to an Owrier-Builder building permit applied for in my name, and understand that I am the party legally; and financially res onsible for propos d construction activity at the following address: i l . I agree that; as the party legally and financially responsible for this proposed construction activity, I wi11 abide by all applicable laws and requirements that govern Owner -Builders as.well as employers. ty 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 remedy againstunlicensed Contractors may be in civil court. Itis 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 maybe 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 presented when the permit is issued to verify the property owner's signature. Signature of prop Ch' o e l �f Date: / }v Note: The following Authorization Form is required to be cotnpleted 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 Permit 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 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 is required to be presented when the permit is issued to verify the property owners.signaiure. Property Owner's Signature: Date: Bin# . City of La Quinta Building & Safety Division r ` Permit# 78-495 Calle Tampico aW BCJ�La Quinta, CA 92253 - (760) 777-7012 ' uilding Permit Application and Tracking Sheet Project Addiess: 5 0.0 1D Owner's Name? 14 A.P. Number i Address:.-) Ci (iE Legal Description: City; ST–Zip: Contractor: ✓ l Telephone:, _ Address: Project DescriptSon:j I lJ City, ST, Zip: Telephone: State Lic. #: City Lic M Arch, Engr., Designer: Address: City, ST, Zip: Telephone: Construction Type: Occupancy: State Lic. #:Proj. Type New Add Alter Repair Demo Name of Cont� SgFt:#Stories # Units: Tele hone of Con—i:1 P � ` "E _ Estimated:Value_of P>•oject:J APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'd TRACKING PERMITFEES 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 J Mechanical: Grading Plan 2nd Rev, Ready for corrections / Electrical Subcontractor List Called Contact Person Plumbing. Grant Deed Plans Picked Up S.M.I. HOA Approval Plans Resubmitted Grading M-HOUSE 3rd Rev, Ready for corrections / Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Apps Date of permit issue School Fees Total Permit Fees v