BWFE2017-027878-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Permit Type/Subtype:
Application Number:
Property Address:
APN:
Application Description:
Property Zoning:
Application Valuation:
Applicant:
CARLOS ACEVES
78390 VIA DIJON
LA QUINTA, CA 92253
44.Q9,ht& .
DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
WALL/FENCE/CITY STANDARD/PRE-APPROVED
BW FE2017-0278
78390 VIA DIJON
604600026
ACEVES RESIDENCE/ BLOCK WALL
$1,200.00
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.
�mpe
ner of the property, or my employees with wages as their sole
n, 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 contractor(s) licensed pursuant to
the Contractors' State License Law.).
(_) I am exempt under Sec. eason
Date: !y,'�p qL_ 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 Name:
Lender's Address:
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Gate: ,1'2�(' 8/2017
Owner: _
CARLOSAL VES DEC 201?
78390 VI pA DIJON
LA QUINTA, CA �2353QFLAQUIN7A
COt1'1UhJNpEVELOF;vfENTpEFARTf,}E;yT
Contractor:
OWNER / BUILDER
Llc. No.:
WORKER'S COMPENSATION DECLARATION
ereby affirm under penalty of perjury one cf the following declarations:
I have and will maintain a certifica-e of consent to self -insure for workers'
mpensation, as provided for by Section 37CO of the Labor Code, for the performance
the work for which this permit is issued.
I have and will maintain workers' ompensation insurance, as required by
ction 3700 of the Labor Code, for the perfo -mance of the work for which this permit
issued. My workers' compensation insuran:e carrier and policy number are:
rrier: _ Policy Number: _
I certify that In the performance of the work for which this permit is issued, I
all not employ any person in any manner sc as to become subject to the workers'
mpensation laws of California; and agree tl-at, if I should become subject to the
)rkers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
mply with those provisions.
ite: Applicant:
ARNING: FAILURE TO SECURE WORKERS' CC MPENSATION COVERAGE IS UNLAWFUL,
JD SHALL SUBJECT AN EMPLOYER TO CRIMI JAL PENALTIES AND CIVIL FINES UP TO
VE HUNDRED THOUSAND DOLLARS ($100,0610). IN ADDITION TO THE COST OF
)MPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
TEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNCWLEDGEMENT
(PORTANT: Application is hereby made to tie Building Official for a permit subject to
e conditions and restrictions set forth on th s application.
L. Each person upon whose behalf this application is made, each person at whose
quest and for whose benefit work is perforned under or pursuant to any permit
ued as a result of this application , the owner, and the applicant, each agrees to, and
all defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and
nployees for any act or omission related to fie work being performed under or
Ilowing Issuance of this permit.
Z. Any permit issued as a result of this appli:ation becomes null and void if work is
it commenced within 180 days from date of issuance of such permit, or cessation of
irk for 180 days will subject permit to cancellation.
ertify that I have read this application and sate that the above information is correct.
agree to comply with all city and county ord nances and state laws relating to building
nstruction, and hereby authorize represent: tives of this city to enter upon the
ove-mentioned property for inspection purposes
ite: 12-244-7 Signature (Applicant or Agent): ,
Date: 12/28/2017
Application Number: BWFE2017-0278
Owner:
Property Address: 78390 VIA DIJON
CARLOS ACEVES
APN: 604600026
78390 VIA DIJON
Application Description: ACEVES RESIDENCE / BLOCK WALL
LA QUINTA, CA 92253
Property Zoning:
Application Valuation: $1,200.00
Applicant:
Contractor:
CARLOS ACEVES
OWNER / BUILDER
78390 VIA DIJON
LA QUINTA, CA 92253
----------------------------------------------------------------------------------------------
Llc. No.:
Detail: 70 LF OF 5' GARDEN AND 82 LF OF 5' RETAINING WALL AND (4) PILASTERS. ADD ELECTRICAL TO PILASTERS. 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.CONTIN000SLY MAINTAINED BY THE PROPERTY OWNER.
2016 CALIFORNIA BUILDING CODES.
r
FINANCIAL INFORMATION
DESCRIPTION
ACCOUNT
QTY
AMOUNT
RETAINING/COMBINATION WALL EA 50LF
101-0000-42400
0
$31.20
DESCRIPTION
ACCOUNT
QTY
AMOUNT
WALL/FENCE - EA ADDITIONAL 50 LF
101-0000-42404
0
$31.20
DESCRIPTION
ACCOUNT
QTY
AMOUNT
WALL/FENCE - FIRST 100 LF
101-0000-42404
0
$52.01
DESCRIPTION
ACCOUNT
QTY
AMOUNT
WALL/FENCE - FIRST 100 LRPC
101-0000-426000
$65.02
Total Paid for BLOCK:WALL: $179.43
DESCRIPTION
ACCOUNT
QTY
AMOUNT
BSAS SB1473 FEE
101-0000-20306
0
'$1.00
Total Paid for. BUILDING STANDARDS ADMINISTRATIOAV 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
TOTALS: $247.4s
I
Contractor Name:
,v
GE'M gf,hr rarst.r:x..__............
PERMIT #
PLAN LOCATION:
Project Address:3�U V` r/�);
Project Description: Pool, Remodel, Add't, Elect, Plumb, Mech
APN M
Patio/Porch SF
Email:
Fire Sprinklers SF
State Lic: City Bus Lic:
Applicant Name: S .
2
Address:
`3 VM _
City, ST, Zip:
Telephone:
_ U
Email:
Valuation of Project $ ✓L�f/C/. 0!O
Contractor Name:
New SVD 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:
i
Property Owner's Name:
New Commercial / Tenant Improvements:
Address: A ��
Total Building SF
City, ST, Zip
Construction Type: Occupancy:
Telephone:
Email:
/64y5 CALLE IAMPICO
LA QUI NTA, CA 92253
760-777-7000
OFFICE USE ONLY
Submittal
Req'd
•Ree'd
Plan Sets
Structural Calcs
Truss Calcs
1:
Title 24.Calcs
a
Soils Report
Grading Plan (PM 10)
Landscape Plan
Subcontractor List
Grant Deed
HOA Approval
School Fees
Burrtec Debris Plan
{
Planning approval
Public Works approval
Fire approval
City Business License
F�
8�DD
rpS
1
x
-m-
n
�
z
i
Y £
(
N
�.
2s
F�
- _ ---' -- ------- - -
£m`�
r C
>s
T.z x
N m,
FRONTY -RD: DES:1
7"* vt*A sopm
t& AP4017a
1
x
-m-
n
i
- _ ---' -- ------- - -
£m`�
r C
>s
T.z x
N m,
FRONTY -RD: DES:1
7"* vt*A sopm
t& AP4017a
PartiallyJ�ICEtl1'EC"7`E71ii i"QXvJi�1TI`XlktB�F
Approved X._. s -.=r.` J. w pcuied_.:
totetlitiori'sfir nppr9va'I orrea8e�ns fordenihl Your request has been approved with th
x--�- - ---- -^ M--
4 fAlowin
: .
modifications: Please see'attached . Plba§. e ensureY our vendor follows the rul
3.,S of the associatio'
.
ignaiurzs 4Jew am Dd#arda
Boird ofD.iresrurs ApPro�nal:
_ .. ... .... .... . .
,! f
LA. 4 UIN.TA DEL ORO C!OM.NIUNITY ASSOCIA!.:� N
'ARC14IT8(1'UP.-k-LrLA.X[)SCAPF; REQUEST
NEIGHBOR, ACKNOWLEDGEMENT
A .i.2...—_...,d+'�. rt�[ �Y.� ►OY iW � i 6d''
y;r
TUIT QUM&
P.O. Box 1504
LA QUINTA, CALIFORNIA 92247-1504
78-495 CALLE 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 subrnitted in your name listing yourself as the tuilder 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 carrot execute this notice
unless you, the property owner, obtain the prior approval of the permitting authority.-
OWNER'S
uthority:
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
DIRECTIONS: Read and initial each statement below to signs you understand or verify this informatioe.
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.
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.
&V. 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 lex name instead of my
0
understand Contractors are required b law
q y to be licensed and bonded in California and to list heir license numbers on
permits and contracts.
u95nderstand if I employ or otherwise engage any persons, other than California licensed Contractus, and the total value
f
omy construction is at least five hundred dollars ($500), including labor and materials I may be "•
under state and federal law. ` Ye comdered an .employer
understand if I am considered an "employer" under state and federal law, I must register wit-' the state and federal
overnment, 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
risk. to.serious financial
�ders�nd under California Contractors' State License Law, an Owner -Builder who builds single-family residential
structures cannot legally build them withthe 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.
understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any
f
nancral or personal injuries 'sustained by any subsequent owner(s) that result from any latent construction defects' in the
kmanshi or materials.
-9. I understand I *mayobtain more informs «
hon 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 I-
800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors.
0'ZW
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 govern Owner -Builders as.well as employers.
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:
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:.. �/ �J vV v ,q _•
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'slicense, form notarization, or other verification
acceptable to the agency is require the permit is issued to verify the propertyowners signature.
Property Owner's Signature: Date: < Z /.Z V -Z