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BWFE2019-0007T4ty/ 4 VOICE (760) 777-7125 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT FAX (760) 777-7011 INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 1/14/2019 Permit Type/Subtype: WALL/FENCE/CITY STANDARD/PRE-APPROVED Owner: Application Number: BWFE2019-0007 a DERRYBERRY-QVIN G AN Property Address: 53531 AVENIDA CARRANZA 53531 AVENIig CARRAI APN: 774115013 LA QUINT, CA f 251' - rr Application Description: DERRYBERRY / 160LF OF BLOCK WALL INSIDE PL 7 >_J I/ Property Zoning: �- Application Valuation: $4,200.00 Ham.•C Applicant: Contractor: DERRYBERRY KEVIN G AND SHERI L OWNER BUIp �' CL? 53531 AVENIDA CARRANZA LA QUINT, CA 92253 Llc. No.: LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 {commencing with Section 70001 of Division 3 of the Business and Professions Code, and my License is in full force and effect. License Class: License No.: Date: Contractor: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($na: CA aSowner 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 hg r� did not build or improve for the purpose of sale.). 10_) 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 ptractors' State License Law.). r_ l am exempt under Sec. B.&P.C. for this reason Date: I- l e-f - I ( 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.• WORKER'S COMPENSATION DECLARATION I herebVirm under penalty of perjury one of the following declarations: I haV,e 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: er �tify 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. � Grp ...�--►/ Date: Y - e 4j- Applicant: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBIECTAN 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. Date: Signature (Applicant or Agent): Lender's Add Application Number: BWFE2019-0007 Property Address: 53531 AVENIDA CARRANZA APN: 774115013 Application Description: DERRYBERRY / 160LF OF BLOCK WALL INSIDE PL Property Zoning: Application Valuation: $4,200.00 Applicant: DERRYBERRY KEVIN G AND SHERI L 53531 AVENIDA CARRANZA LA QUINT, CA 92253 Date: 1/14/2019 Owner: DERRYBERRY KEVIN G AND SHERI L 53531 AVENIDA CARRANZA LA QUINT, CA 92253 Contractor: OWNER BUILD 1H111111i:[7F Detail: 160LF OF BLOCK WALL INSIDE NORTH AND EAST PROPERTY LINE. [CITY SPECIFICATIONS] PRECISION CONCRETE BLOCK SHALL BE COVERED WITH STUCCO, PAINT, ORTEXTURED 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 INFORMATION DESCRIPTION ACCOUNT QTY AMOUNT WALL/FENCE - EA ADDITIONAL 50 LF 101-0000-42404 0 $32.02 DESCRIPTION ACCOUNT QTY AMOUNT WALL/FENCE - FIRST 100 LF 101-0000-42404 0 $53.37 DESCRIPTION ACCOUNT QTY AMOUNT WALL/FENCE - FIRST 100 LF PC 101-0000-42600 0 $66.71 Total Paid for BLOCK WALL: $152.10 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 TOTALS: K' Evi nu De ,e e y b e SCR Ll �- La .4 chi v 7W e4wL l3tOf C- 21A.-O oca7 CITY OF LA QUINTA BUILDING & SAFETY DEPT. APPROVED FOR CONSTRUCTION T44t 4 4 Q" 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 submitted in your name listing yourself as the builder 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 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. 1 . 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 lield 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. 2. I understand building permits are not required to be signed by property owners unless they are responsible for the co truction 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 that I may protect elf from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. A 4, I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on 'ts and contracts. 5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value OTAY construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. WY6. I understand if I am considered an "employer" under state and federal law, I must register with the state and federal g vernment, 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. stF7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential ictures 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. $. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any tancial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. �I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue e, 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. 0. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the p legally and financially responsible for proposed construction activy at the following address: 5 9S3 J �� � "-Cv 4) � Z �] Z// AJ7� GJ -01. I agree that, as the party legally ar d financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner -Builders as well as employers. 1 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 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 t: the agency responsible for issuing the perptit, Note: A copy, other verification accep able tr the aA } is' aired to� owner's signature. ' Signature of property owner npleted and signed by the property owner and returned to f7(e property owner's driver's license, form notarization, or presented when the permit is issued to verify the property Date: Note: The following Authorization Form is requiredi4e 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. f Scope of Construction Project (or Description of Work): Project Location or Address: f e0t­ Name of Authorized Agent: XX02 A)i Tel No 760- 11491 r Address of Authorized Agent: j c 1 I declare under penalty of perjury that I the prope owner for the address listed above and I personally filled out the above information and certify its curacy. Not py of t owners river's license, form notarization, or other verification acceptable to the agency isgo resented wen the r�nit is issued to verify the property owner's signature. za 0ai4tra GEIM f1b, DLSFRT — Project Address: -55 J-3 APN #: Applicant Name:i�j�/L� &%,, �„� Address:�g�_7 City, ST, Zip: zDacll Telephone: 9 �9� X p .9 L Email: PERMIT # VWf Y 1�0I q - 0tq PLAN LOCATION: Project Description: Pool, Remodel, Add't, Elect, Plumb, Mech M b VJ, of Project $ (� r Contractor Name: New SFD 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 Telephone: Bedrooms: Stories: # Units: Email: State Lic: ---------------- City Bus Lic: Property Owner's Name:` IL�IrI � L l f P Commercial /Tenant Improvements: Address: 5-3 Total Building City, ST, Zip SF Construction Type: Occupancy: Telephone: Email: 78495 CALLE TAMPICO LA QUINTA, CA 92253 760-777-7000