BSPN2017-001778-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BSPN2017-0017
Property Address: 54100 AVENIDA RAMIREZ
APN: 774212005
Application Description: GERTSMAN RESIDENCE / SPECIAL INSPECTION FOR BLOCK WALL
Property Zoning:
Application Valuation:
Applicant:
BILL AITKEN
54080 AVE NIDA RAM IREZ
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.:
Dat
t 777
Coctor:
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 i
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 or she 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 cont�actor(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 Na
Lender's
® VOICE (760) 777-7125
VOICE
77-7011
INSPE& ONS ��60 7 J- 153
s�J-
JUN 01 20/pate- 6/ /2017
PaHI�LINM�" NOF QUINTA
481 W 23RD AVE tQ fir^f7T
VANCOUVER BC CANADA 5Y,
ENT
Contractor:
LIC. 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
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
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 a provisions. _
I
r
Date:_[ •� 0,;�" o1Appl1cant:6/ '14
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 property for inspection purposes. .1)
Application Number: BSPN2017-0017
Property Address: 54100 AVENIDA RAMIREZ
APN: 774212005
Application Description: GERTSMAN RESIDENCE / SPECIAL INSPECTION FOR BLOCK WALL
Property Zoning:
Application Valuation:
Date: 6/1/2017
Owner:
PHIL GERTSMAN
481 W 23RD AVE
VANCOUVER BC CANADA VSY, H5 92203
Applicant: Contractor:
BILL AITKEN
54080 AVENIDA RAMIREZ
LA QUINTA, CA 92253
Llc. No.:
-------------------------------------------------------------------
Detail: WOOD FENCE FELL DOWN. THE RETAINING WALL WAS NOT PERMITTED.
I
DESCRIPTION
FINANCIAL INFORMATION
ACCOUNT QTY
AMOUNT
SPECIAL INSPECTION
101-0000-42404 0
$76.00
Total Paid for COMPLIANCE SURVEY/SPECIAL INSPECTION:
$76.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
1 $S.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
Bin #
City of LA Quints
Building &r Safety Division
U �� 78-495 Calle Tampico.
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
1 "'lot
Project Address: 00 (�Ue�,JdzCy pme�l Z
Owner's Name: ph.i l �ev tSMC.Jv
A. P. Number:
Address: to '10
Legal Descriptiq
rmnnortml
City, ST, Zip: (J GeOY d P, S I. (JA U r—g u i/er G
Telephone: P
hone: GOT � %
3
Address: J `Y 6 (� �Ue��d� ��MeriZ
Project Description:
City, ST, Zip:
Telephone: q .cl l i .
...........................
•
r0 - -_ /
0 1P t4
State Lic. # :u 5 Ou3
City Lica
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
one:
State Lic. #•............................................
Name of Contact Person:
Con tru ' T
s ctt n
o e: Occupancy:
Type:
Project type (circle one): New Add'n Alter Repair Demo
Sq. FL: # Stories: #Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'.d
TRACKING
PERMIT FEES
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
Mechanical
Grading plan
2"" Review,' ready for correctionsfissue
Electrical
Subcontactor. List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
MOA., Approval
Plans resubmitted
Grading
IN HOUSE:-
'"' Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
WP.O. Box 1504 7
LA QUINTA, CALIFORNIA 92247-1504 BUILDING �dt SAFETY DEIARTMENT _
78-49S CALLE TAMPICG y -"► s� .. _
.. , , .,... s, r4 !4, �.. ,�_ - (760) 777-7012 e'-'
LA QUINTA, CALIFORNIA 92253 x .�• a r`i, r , , i gA7t (760) T77-7011
. PROPERTY OMWERIS'PACKAGE _ v
Disclosures & Forints for Owner -Builders Applying for Construction- Permits
,URI VRl/Lill 'Nr ~`•,J i a 7:. -� -. r_ 1' •--r .! .,.. �� -.. i': -�. .. 1. �.• '_ .L1.._ .
NOTICE TO PROPERTY OWNER - e• ? .. i 5 r:.z .. �' L`
Dear Property Owner.
An application for aIding mn
Pambas been submitted in your,mme listing yourself as the builder'of ttie 'Iimprovemer
,
apecsfiedat MvewidA Rise 17—.,R a/c�1'e��" � '
We are Pmvtdng you wiK an Owner -Builder Acknowledgumtand Information verification Fmm to make -
�ponAilit s and posAle risk you may incur by bmiag tins P "d .issued in 34m name as the "'.:" a asvatee of your I :., _ , e'
Owns Bolder. We will not issue a building permit until YOU have read, Initialed your understanding of cutch, I
wed, and rdmmed this form b a at oro• o�dal address indicated. Aa a U.
gent of the owim cannot c�omoe titin mtioe
unless you. 8u P� � obtain the prior approval of the Pamittgg authority�'�
OWNER'S ACKNO%_UMGMLNT AND VERIFICATION OF INFORMATION
DIREC?7OA M Read and umiak each statmmt below to sign&."m mi kmand or ver#' this usf :.r.
t 4 . alniatrart
a fc; ue persons,is to have'the property'owner obtain as `tOsvner-8 ~'
building permit that crtmeoudy implies that the property owner is pmvidmg his or het own labor and material petsomally. J.
is
an Owner -Builder, may be held liable and subject to serious fimm-61 risk for any injuries sustained by an >m>;aaad pe s
and his or brr employees whsle working on my property. My homeowners insurmce may nut
' provide coverage for those
injuries. I am willfully acting as an Owner BusYdet and am aware of On litrsits of my insur ice covaegefor injuries to worlcera - ---�
on my property' _ _ . _ _ - - ---_ f
2. I understand balding pemrrts are not required to be signed by.ptoperty' owners imless they an` foi the
Lr',x
and ate not Wring a bce>md COnaaGtOr to =nzne this responsMity. , . ,, �_ t , , .. . _.. _ ' • `r.
i3- I uinderstmd as an `Owner -Builder" I am the responsWe party of rroord oro tie I u '
myself from potectial financial risk by hh' I a fioeased Coattacii and ba I mry protect
Own. _ _ Ynlj , lit m his or he; mine mstsad of aq 4
4.1 understand Contractors are required bylaw to be hoensed and bonded in California and to
pinvits and contracts lid their license mmibers wiz .
5. I understand ifl employ or otberwviw engage nay Persona, other than California licensed Contractors, and the 6�1 value -
of my oons>Hetion is at Least five hundred dollars VOW), including labor and maoerials, I may be considered an';ernploycrw.;
Hader state and federal law.
0_16. I understand if I am considered an "employes" undo state and federal law; I nnrattregistm with tie state and federal
govern withhold Payroll taxes, provide workers' compensation disability incursaoe, and comnbuoe to to f .
motion for earls "employee." I also um�ind my failure to abide by there laws subject me to serious financial
4kU 7. I understand under California Cosmactors' State License I^ an Owner -Builder who builds single-fiFOY residential, r w, T
,
sores cannot legally bu &.them with the intent -to offer them for sale, -unless all work -is perioaned by lieaased
1 subcontractors and the number of structures does not'exc ccd four within any calendar year, or all of the work is performed
under centrad with a licensed general building Coatracear. _
a
WP.O. Box 1504 7
LA QUINTA, CALIFORNIA 92247-1504 BUILDING �dt SAFETY DEIARTMENT _
78-49S CALLE TAMPICG y -"► s� .. _
.. , , .,... s, r4 !4, �.. ,�_ - (760) 777-7012 e'-'
LA QUINTA, CALIFORNIA 92253 x .�• a r`i, r , , i gA7t (760) T77-7011
. PROPERTY OMWERIS'PACKAGE _ v
Disclosures & Forints for Owner -Builders Applying for Construction- Permits
,URI VRl/Lill 'Nr ~`•,J i a 7:. -� -. r_ 1' •--r .! .,.. �� -.. i': -�. .. 1. �.• '_ .L1.._ .
NOTICE TO PROPERTY OWNER - e• ? .. i 5 r:.z .. �' L`
Dear Property Owner.
An application for aIding mn
Pambas been submitted in your,mme listing yourself as the builder'of ttie 'Iimprovemer
,
apecsfiedat MvewidA Rise 17—.,R a/c�1'e��" � '
We are Pmvtdng you wiK an Owner -Builder Acknowledgumtand Information verification Fmm to make -
�ponAilit s and posAle risk you may incur by bmiag tins P "d .issued in 34m name as the "'.:" a asvatee of your I :., _ , e'
Owns Bolder. We will not issue a building permit until YOU have read, Initialed your understanding of cutch, I
wed, and rdmmed this form b a at oro• o�dal address indicated. Aa a U.
gent of the owim cannot c�omoe titin mtioe
unless you. 8u P� � obtain the prior approval of the Pamittgg authority�'�
OWNER'S ACKNO%_UMGMLNT AND VERIFICATION OF INFORMATION
DIREC?7OA M Read and umiak each statmmt below to sign&."m mi kmand or ver#' this usf :.r.
t 4 . alniatrart
a fc; ue persons,is to have'the property'owner obtain as `tOsvner-8 ~'
building permit that crtmeoudy implies that the property owner is pmvidmg his or het own labor and material petsomally. J.
is
an Owner -Builder, may be held liable and subject to serious fimm-61 risk for any injuries sustained by an >m>;aaad pe s
and his or brr employees whsle working on my property. My homeowners insurmce may nut
' provide coverage for those
injuries. I am willfully acting as an Owner BusYdet and am aware of On litrsits of my insur ice covaegefor injuries to worlcera - ---�
on my property' _ _ . _ _ - - ---_ f
2. I understand balding pemrrts are not required to be signed by.ptoperty' owners imless they an` foi the
Lr',x
and ate not Wring a bce>md COnaaGtOr to =nzne this responsMity. , . ,, �_ t , , .. . _.. _ ' • `r.
i3- I uinderstmd as an `Owner -Builder" I am the responsWe party of rroord oro tie I u '
myself from potectial financial risk by hh' I a fioeased Coattacii and ba I mry protect
Own. _ _ Ynlj , lit m his or he; mine mstsad of aq 4
4.1 understand Contractors are required bylaw to be hoensed and bonded in California and to
pinvits and contracts lid their license mmibers wiz .
5. I understand ifl employ or otberwviw engage nay Persona, other than California licensed Contractors, and the 6�1 value -
of my oons>Hetion is at Least five hundred dollars VOW), including labor and maoerials, I may be considered an';ernploycrw.;
Hader state and federal law.
0_16. I understand if I am considered an "employes" undo state and federal law; I nnrattregistm with tie state and federal
govern withhold Payroll taxes, provide workers' compensation disability incursaoe, and comnbuoe to to f .
motion for earls "employee." I also um�ind my failure to abide by there laws subject me to serious financial
4kU 7. I understand under California Cosmactors' State License I^ an Owner -Builder who builds single-fiFOY residential, r w, T
,
sores cannot legally bu &.them with the intent -to offer them for sale, -unless all work -is perioaned by lieaased
1 subcontractors and the number of structures does not'exc ccd four within any calendar year, or all of the work is performed
under centrad with a licensed general building Coatracear. _
a
Us. I undereand as an -$udder if I sell the picpaty for which this per it is issoed. I may be held habb for airy
financial or pumal injuria sustained by soy •subsequent ownet(s) that result from any latera eonsauction defects D► the
workmanship or materials.' _.
9. I,understand I roay obtaici more information regarding my obligations u an "%coploye from the Totem! Revenue's y '
Service, the United States Small Business Administration, the California Depubnlf it of Benefit Payrner ts. and the Caiifomia ` • .
Division of Industrial Accidents. I also understand I may contact the California Contraceora'Stow License Board (CSW) at 1- ,
8110-321-CSLB (2752)•or waw cdh a_gov for amre information about lied contractors.
Y
10. I am aware of and consent to an Owner Builder buriding permit applied for in my narrc, and understand brat I am the
i jt 1eg� �
/,30
0 d -An i�r t for proposed ooason:etion activity at the following address:
/ff �+✓iw' Cr GG Derr Z
11. I agibe that, as the party leplly and famcially responsible for this proposed conmuction activity. I va abide by alt,
applicable laws and tcgwem n% that govern Owns -Builders u,%Tll as ftn*yers. , : 1•' ` _ ' :. t . _ ` '.''
U+ 12. I agree to notify the isstxr of this form immediately of any additions, deletions, or cbanges to nay of the inf nnatioa I '•
have PWvidod a this form Lkmed contractors are regulated by laws "good to protea the public. If * oontraa w' -,
someone who don not have a lioeas the Coatrsccois' State license Boird maybe unable to assist you with any 5nsacial loss
you may sustain eia result of a o=Piamt Your only moody against.—I Coatractois may be i n civil opt' It is also .
important for you to understand tient if as oalioeosed Contractor or employee of that individual or firm is injured nrhr7e 4=idvg }
on your Pro&rty. ya may be held liable for,damaga. If you obtain a pew* as Owner4hiffda and wish to hire Cmandors,
you will be irspoanble for-VUify* whether or not those Comcacsom are propedy liaased and the status of wadtew K '
compensation 6trreaaa oovetage.
I Before ben • + 'a _ .� e ti., . � ,• is - • -� •� tP•l.t �, • �, _, . ,
rlding permit can be tasned,Ythis form mast tie completed and slgaed by the Property owner and r wried to -
the agency responsible for WuIng the permit. Nota A copy of the property owom's Giver's Ilcexs feral satahaSou, or f
Other' verif&afiou accrptabie b the Wwr Is required to be presented whesn &e pemxit is isstcad to vero the pr
, °Perty
Signature of w7n
.��. t .• - _ ... `Qf')P� d x''09 ••,Y/tC: { _z ,,. -c � � � � ! ,
Note: TIrejo#ow%*g"hmitation Form is req�d to be eoVIeted o dwpropeoy mmesonly when leer atiP g - i
an agent of the prop" 'vewze, to ap*for a consbuetlon pewit for the Ownet-Brdlder.
'�- AUTHORIZAITON OF AGF,NT TO ACT ON PROPERTY OWNER'S BEHALF
Euclud mg the Notice to Property Owner, the execution of which I understand is 6
the following person(s) to ad as my agengs) to apply for. si and file the docu b ' I he new DwMeze `
Permit for my project. �' �y to obtain an Oaaa Bm'ldar
Scope of Construction Project (or Description of Woritk' C" ('` e c
strO-t
tel
ProjectLocation or Address: J?/ /d a A u et q a G' Pts.r-\C
me ofAdthwiiedAgeitt: _ ,Or?d 1 zl �
Tel Noy
Na.+ti
Address of Authorized Agent: -&W o ?o AyaQ , a.'�P
I declare underpenahy of perjutry that I era the' owaa fac the addtess listed above and I personally 6IIed out the above r.s.�
information end certify its accuracy: Note: A copy of the owner i drivrr's lieease, foray notmizQtjam or other vai out the t »
acceptable to the agency is requir ed to be prae ed when the it ' Lsaued o m* the property owner's signature.
PMPPm►o.$-Signamn:. , 4s i,f ate �' �3d%7A, r : - k
r ti. e �'.E� PS?i. `►'�j Yr+�•� .: , ern 4. - _.