BWFE2018-004778-495 CALLE TAMPICO D 'i VOICE (760) 777-7125
FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT INSPECTIONS (760).777-7153
BUILDING PERMIT
Date: 2/28/2018
Permit Type/Subtype:
Application Number:
Property Address:
APN:
Application Description
Property Zoning:
Application Valuation:
Applicant:
EUSEBIO PAVON
51460 AVENIDA VALLEJO
LA QUINTA, CA 92253
WALL/FENCE/CITY STANDARD/PRE-APPROVED
BWFE2018-0047
51460 AVENIDA VALLEJO
773084011
PAVON / 26LF GARDEN WALL AT SOUTHWEST PL
$950.00
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CITYOFLAQUINTA
COMMUNITY DEVELOPMENT DEPARTMENT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that 1 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:
EUSEBIO PAVON
51460 AVENIDA VALLEJO
LA QUINTA, CA 92253
Contractor:
OWNER BUILDER
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:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State
Carrier: Policy Number: _
n'5 certify that in the performance of the work for which this permit is issued, I
License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
sha not employ any person in any manner so as to become sub'ect to the workers'
city or county that requires a permitto construclter, improve, demolish, or repair any
compensation laws of California, and agree that, if I should a subject to the
structure, prior to its issuance, also requires the' pplicant for the permit to file a signed
workers' compensation provisions of Section 3700 of the r ode, I shall forthwith
statement that he or she is licensed pursuant to the provisions of the Contractor's State
comply with those provisions.
License Law (Chapter9 (commencing with Section 7000) of Division 3 of the Business
�-7
and Professions Code) or that he or she is exempt therefrom and the basis for the
Date: G Applicant:
alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
ects the applicant to a civil penalty of not more than five hundred dollars ($500).:
WARNING: FAILURE TO SECURE WORKERS' CO SATION COVERAGE IS UNLAWFUL,
1, as owner of the property, or my employees with wages as their sole
AND SHALL SUBJECT AN EMPLOYER TO CR! NAL PENALTIES AND CIVIL FINES UP TO
compensation, will do the work, and the structure is not intended or offered for sale.
ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
(Sec. 7044, Business and Professions Code: The Contractors' State License Law does not
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, .
apply to an owner of property who builds or improves thereon, and who does the work
INTEREST, AND ATTORNEY'S FEES.
himself or herself through his or her own employee's, provided that the improvements
are not intended or offered for safe. If, however, the building or improvement is sold
APPLICANT ACKNOWLEDGEMENT
wi n one year of completion, the owner -builder will have the burden of proving that he
IMPORTANT: Application is hereby made to the Building Official for a permit subject to
AfAe did not build or improve for the purpose of sale.).
the conditions and restrictions set forth on this application.
I, as owner of the property, am exclusively contracting with licensed contractors to
1. Each person upon whose behalf this application is made, each person at whose
construct the project. (Sec. 7044, Business and Professions Code: The Contractors' State
request and for whose benefit work is performed under or pursuant to any permit issued
License Law does not apply to an owner of property who builds or improves thereon,
as a result of this application', the owner, and the applicant, each agrees to, and shall
and who contracts for the projects with a contractor(s) licensed pursuant to the
defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and
Con actors' State License Law.).
employees for any"act or omission related to the work being performed under or
I am exempt under Sec. B.&P.C. for this
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
2
Date: j Owner:
for 180 days will subject permit to cancellation.
CONSTRUCTION1151DING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency.for
correct.
I certify that I have read this application and state that the above inforWn
I agree to comply with all city and county ordinances and state laws rbuilding
the performance of the work for which this permit•is issued (Sec. 3097, Civ. C.).
construction, and hereby authorize representatives of this cit above -
Lender's Name:
Lender's Address:
mentionedpropertyfor inspection purposes.
Dat- 227'1 Signature (Applicant or A ent):
Date: 2/28/2018
Application Number: BWFE2018-0047 Owner:
Property Address: 51460 AVENIDA VALLEJO EUSEBIO PAVON
APN: 773084011 51460 AVENIDA VALLEJO
Application. Description: PAVON / 26LF GARDEN WALL AT SOUTHWEST PL LA QUINTA, CA 92253
Property Zoning:
Application Valuation:. $950.00
Applicant:. Contractor:
EUSEBIO PAVON OWNER BUILDER
51460 AVENIDA VALLEJO
LA QUINTA, CA 92253
Lic. No.:
---------------------------------------=----------------------------------------------------
Detail: 27LF OF 5' GARDEN [ANGELUS 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.
DESCRIPTION
FINANCIAL INFORMATION
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
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
t.
PERMIT #
PLAN LOCATION:
Project Address: j'-q&o k c
City, St,Zip yAC, . � cS
roject Description: Pool, Remodel, Add't, Elect, Plumb, Mech
APN.#:
Patio/Porch SF
Email: .� J 1 Z yyJC�.,y- ® , _ C�
Fire Sprinklers SF
Applicant Name: l� Vwe.1� ��O Y_�
Telephone:
Address:
City, ST, Zip:
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Telephone: llam'! 0, b
Email: ,�_y. �Ma� d4 m
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Valuation of Project $ Q
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Contractor Name:
New SFD Construction:
Address:.[.
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Conditioned Space SF
City, St,Zip yAC, . � cS
Garage SF.
Telephone:G ��
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Patio/Porch SF
Email: .� J 1 Z yyJC�.,y- ® , _ C�
Fire Sprinklers SF
State Lic: City Ea Lic:
Telephone:
Arch/Eng Name:
Construction Type: Occupancy:
Address:.
Grading:
City, St, Zip
Ac.,
Telephone:
Bedrooms:
Stories:
# Units:
Email:
Telephone:
State Lic: City Bus Lic:
Property Owner's Name:
l`U45P— ko E��'xDY_\
New Commercial / Tenant Improvements:
Address: ,
��AOCK-k
Ac.,
Total Building SF .
City, ST, Zip U�
D� a
Construction Type: Occupancy:
Telephone:
Email:i°
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(J 78495 CALLE TAMPICO
LA QUINTA, CA 92253
760-777-7000
OFFICE USE ONLY
#
Submittal
Req'd
-Rec'd
Plan Sets
"It.
#
Submittal
Req'd
-Rec'd
Plan Sets
Structural Calcs
r +
Truss Calcs
v
Title 24 Calcs
Soils Report
Grading Plan (PM 10)
Landscape.Plan
Subcontractor List
Grant Deed
HOA Approval
j`
,
School Fees
Burrtec Debris Plan
Planning approval
Public Works approval
Fire approval
City Business License
�-V�o CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
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DATE�_gY
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LA QUINTA, CALIFORNIA 92247-1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
(760)777-7012
FAX (760)_777-7011
PROPERTY OWNER'S PACKAGE
Disclosures & Forms for Owner -Builders Applying for Construction Permits
IMPORTANT! NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application for. a building pchr»t has been submitted in your name listing yourself as the builder of the property
improvements specified at
We 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 signs you understand or verify this information. '.
b1. 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.
�L2. 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.
3. I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand thatI may protect
myself from potential financial risk by hiring a.licensed Contractor and havingthe e
own p rnut filed in his or her name is of my
a4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on
permits 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.
6. I understand if I arri 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.
�EP7. f understand under California Contractors' State License Law, an Owner -Builder who builds single-family g y residentialstructures 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.
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.
9. I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue
eMce, the United States Small.Business Administration, the California Department of Benefit Payments, and the California
Yn?
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 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:
agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all
applicable laws and requirement$. that govern Owner -Builders as.well as eitiployers.
61v 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 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 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
the agency responsible for issuing the per ' , a
other verification acceptable to thea Cy i&_r4Q
owner's signature. i' I/
Signature of property owner
pnT and signed by the property owner and returned to
Wentoed
perty owner's driver's license, form notarization, or
be. when the permit is issued to verify the property'.
Date: 2 — w L
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 fora 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 the property owners signature.
Property Owner's Signature: Date: