BWFE2017-017278-495 CALLE TAMPICO C� 0 D
LA QUINTA, CALIFORNIA 92253" DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number:
BWFE2017-0172
Property Address:
51840 AVENIDA RUBIO
APN:
773162005
Application Description:
GOMEZ / 50LF GARDEN WALL AT REAR YARD
Property Zoning:
Application Valuation: ,
$20,000.00
Applicant:
SILVIA GOMEZ
51840 AVENIDA RUBIO
LA QUINTA, CA 92253
SEP 18 2017
LI CITY OF LA QUINTA
OMMUNITYN�VELOENT DEQ
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 a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
(1 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 I 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 Nan
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/18/2017
Owner:
SILVIA GOME.'-
51840 AVENIDA RUBIO
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 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 workere 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 those provisions.
Date:
Applicant:
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRPOINAL 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 ACENOWLEDGEMENT
IMPORTANT: Application is hereby made to the Building Official for a permit subject to
the conditions and restrictions set forth onthis 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, aid the applicant, each agrees to, and shall
defend, indemnify and hold harmless the 0ty of La Quinta, its officers, agents, and
employees for any act or omission related -:o 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 Fssuance 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 cadinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter upon the above-
mentioned property for inspection purposes.
Date: Signature (Applin nt or Agent):
Lender's Address:
Date: 9/18/2017
Application Number: BWFE2017-0172 Owner:
Property Address: 51840 AVENIDA RUBIO SILVIA GOME'_
APN: 773162005 51840 AVENIDA RUBIO
Application Description: GOMEZ / 50LF GARDEN WALL AT REAR YARD LA QUINTA, CA 92253
Property Zoning:
Application Valuation: $20,000.00
Applicant: Contractor:
SILVIA GOMEZ' OWNER BUILDER
51840 AVENIDA RUBIO
LA QUINTA, CA 92253
LIc. No.:
---------------------------------------------------------- ----------------------------------
Detail: 501-F OF 6' HIGH GARDEN WALL AT REAR PROPERTY LINE[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.
t
DESCRIPTION
FINANCIAL
ACCOUNT QTY
AMOUNT
WALL/FENCE - FIRST 100 LF
101-0000-42404 0
$50.67
DESCRIPTION
ACCOUNT QTY
AMOUNT
WALL/FENCE - FIRST 100 LF PC
101-0000-42600 0
$63.33
Total Paid for BLOCK WALL:
$114.00
-DESCRIPTION
ACCOUNT
QTY
AMOUNT
BSAS SB1473 FEE
101-0000-20306
0
$1.00
Total Paid for BUILDING STANDARDS ADMINISTRATLON BSA:
$1.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE:
$5.00
Description: GOMEZ / 50LF GARDEN WALL AT REAR YARD
Type: WALL/FENCE Subtype: CITY STANDARD/PRE- Status: ISSUED
Applied: 9/18/2017 AMA
APPROVED
Approved: 9/18/2017 AMA
Parcel No: 773162005 Site Address: 51840 AVENIDA RUBIO LA QUINTA,CA 92253
Subdivision: SANTA CARMELITA VALE LA QUINTA Block: 34 Lot: 20
Issued: 9/18/2017 AMA
UNIT 2
NAME
Lot Sq Ft: 0 Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $20,000.00 Occupancy Type: Construction Type:
Expired: 5/30/2018 DCL
No. Buildings: 0 No. Stories: 0 No. Unites: 0
SILVIA GOMEZ
Details: 50LF OF 6' HIGH GARDEN WALL AT REAR PROPERTY LINE[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
CHRONOLOGY
CONDITIONS
CONTACTS
DESCRIPTION ACCOUNT QTY AMOUNT
NAME TYPE
NAME
ADDRESSI CITY
STATE
ZIP PHONE FAX
EMAIL
APPLICANT
SILVIA GOMEZ
51840 AVENIDA RUBIO LA QUINTA
CA
92253 (760)980-6867
100 LF
CONTRACTOR
OWNER BUILDER
(760)980-6867
OWNER
SILVIA GOMEZ
51840 AVENIDA RUBIO LA QUINTA
CA
92253 (760)980-6867
FINANCIAL
INFORMATION
CLTD
DESCRIPTION ACCOUNT QTY AMOUNT
PAID
PAID DATE RECEIPT # CHECK # METHOD PAID BY
BY
WALL/FENCE - FIRST
101-0000-42404 0 $50.67
$50.67
9/18/17 R28006 00001 DEBIT SILVIA GOMEZ AMA
100 LF
Printed: Friday, January 27, 2023 1:31:55 PM 1 of 3
WsYsrEMS
Printed: Friday, January 27, 2023 1:31:55 PM 2 of 3
WSYSiEMS
SEQID
INSPECTION TYPE
INSPECTOR
SCHEDULED
D
CO7DATE
RESULT
REMARKS
NOTES
CLTD
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID
10/25/2017
10/25/2017
APPROVED
BY
WALL/FENCE - FIRST
101-0000-42600
0
$63.33
$63.33
9/18/17
R28006
00001
DEBIT
SILVIA GOMEZ
AMA
100 LF PC
REINSPECTION.
BOND BEAM
DCL
12/1/2017
12/1/2017
Total Paid for BLOCK WALL: $114.00 $114.00
BSAS SB1473 FEE
101-0000-20306
1 0
$1.00
$1.00
9/18/17
R28006
00001
DEBIT
SILVIA GOMEZ
AMA
Total Paid for BUILDING STANDARDS ADMINISTRATION $1.00 $1.00
BSA:
TECHNOLOGY
502-0000-436110
$5.00
$5.00
9/18/17
R28006
00001
DEBIT
SILVIA GOMEZ
AMA
ENHANCEMENT FEE
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00 $5.00
Printed: Friday, January 27, 2023 1:31:55 PM 2 of 3
WSYSiEMS
SEQID
INSPECTION TYPE
INSPECTOR
SCHEDULED
D
CO7DATE
RESULT
REMARKS
NOTES
DATE
FOOTINGS
DCL
10/25/2017
10/25/2017
APPROVED
- INSTALL RETAINING CMU BLOCKS AND
BOND BEAM
DCL
11/2/2017
11/2/2017
NOT READY
BOND BEAM BARS, THEN CALL FOR
REINSPECTION.
BOND BEAM
DCL
12/1/2017
12/1/2017
APPROVED
- REAR EAST PL WALL. SEE ATTACHED
PICTURE.
Printed: Friday, January 27, 2023 1:31:55 PM 2 of 3
WSYSiEMS
ATTACHMENTS
Attachment Type CREATED OWNER DESCRIPTION PATHNAME SUBDIR
ETRAKIT ENABLED
IMAGE 12/1/2017 DUANE CLAYTON BOND BEAM.JPG BOND BEAM.JPG
0
Printed: Friday, January 27, 2023 1:31:55 PM 3 of 3
WsYsrEMS
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City of La Quinta
Building & Safety Division
78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
�F@*Building Permit Application and Tracking Sheet
Permit#
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P\�§:jeSt Address SILO
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Owner's Name:
1'
A.P. Number
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Address: 5-71
9-0 t4V"JaL Aeo
Legal Description:
City, ST, Zip:
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Contract:
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Telephone' v ^�
Address:
Project Description'
City, ST, Zip:
a -4 JhZ 4.1 -
Telephone:
State Lic. #:
City Lic #:
Arch, Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Construction Type:
Prcj. Type New Add'n
Occupancy:
Alter Repair Demo
)game of -Contact: ( Ute, ` e
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SgFt'� ��
#Stories
#Units:
Telephoneof on act:,b
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Estimated- al e- � oject:�
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Ree'd
TRACKING
PERMiF FEES
Plan Sets
Plan Check Submitted
Item
Amount
Structural Cales
Reviewed, ready for corrections
Plan CE.eck Deposit:
Truss Calcs
Called Contact Person
Plan Clieck Balance:
Title 24 Calcs
Plans Picked Up
Constn..ction:
Flood Plain Plan
Plans Resubmitted
Mechamical:
Grading Plan
2nd Rev, Ready for corrections /
Electrical:
Subcontractor List
Called Contact Person
Plumbi-ig:
Grant Deed
Plans Picked Up
S.M.I.
HOA Approval
Plans Resubmitted
Grading
IN-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 Pzrmit Fees
r3„s
Tihf 4 4 - QUIA 261
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��c
L) g 11.f� rc r Lase i
We are providing you with an Owner -Builder Acknowledgmen 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 understa=ding 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 signs 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"
uildrng 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.
. 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.
A� 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.
4I understand Contractors are required by law to be licensed and bonded in California and to list heir license numbers on
euts and contracts.
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.
I understand if I am considered an `.`employer" under state and federal law, I must register w th the state and federal
govemment, 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.
I understand under California Contractors' State License Law, an Owner -Builder who builds Ein . gleTfarnily 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 the work is performed
under contract with a licensed general building Contractor.
A'
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 b bse subsequent owner
Y an Y suq (s) that result from any latent construction defects in the
workmanship or materials.
I understand [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.
¢19rI 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:
Al
11. 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 govern Owner -Builders as mell as employers.
�2.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 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 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 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 property owner Date: 1 )�
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
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 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 theproperty owners signature.
Property Owner's Signature: Date: