BWFE2019-005778-495 CALLE TAMPICO Tihf
4 4 094a
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Permit Type/Subtype: WALL/FENCE/CITY STANDARD/PRE-APPROVED
Application Number:
BWFE2019-0057
Property Address:
51552 AVENIDA MARTINEZ
APN:
773142004
Application Description:
GUERRA / 98LF GARDEN WALL AND (2) PILASTERS
Property Zoning:
Application Valuation:
$7,000.00
n1
Applicant:
LJ
GUERRA, JOSHUA
+
J APR 0 12019
51552 AVENIDA MARTINEZ
LA QUINTA, CA 92253
CITY OF LA QlliKTA
'f DEPARTMENT
DESIGN &DEVELC)PMEt
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).:
MMas owner of the property, or my employees with wages as their sale
lpensation, 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
tsaiAwdid not build or improve for the purpose of sale.).
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
D Owne
CONSTRUCTION "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
Lender's Address:
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/1/2019
Owner:
MEGAN GUERRA
51552 AVENIDA MARTINEZ
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 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: _
rtify that in the performance of the work for which this permit is issued, I
shat! p oy 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: Appllcan1ftAC1.±f:I-
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
MPORTANT: Application is hereby made to the Building Official for a permit subject to
:he conditions and restrictions set forth on this application.
1. Each person upon whose behalf this application is made, each person at whose
-equest and for whose benefit work is performed under or pursuant to any permit
ssued 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
'ollowing issuance of this permit.
2. Any permit issued as a result of this application becomes null and void if work is
iot commenced within 180 days from date of issuance of such permit, or cessation of
Nork for 180 days will subject permit to cancellation.
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
:onstruction, and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
)at Signature (Applicant or Age
Application Number:
BWFE2019-0057
Property Address:
51552 AVENIDA MARTINEZ
APN:
773142004
Application Description-
GUERRA / 98LF GARDEN WALL AND (2) PILASTERS
Property Zoning:
Application Valuation:
$7,000.00
Applicant:
GUERRA, JOSHUA
51552 AVENIDA MARTINEZ
LA QUINTA, CA 92253
Owner:
MEGAN GUERRA
51552 AVENIDA MARTINEZ
LA QUINTA, CA 92253
Contractor:
OWNER BUILDER
Llc. No..
Date: 4/1/2019
Detail: 98 LF OF 6' GARDEN WALL AT SOUTH PROPERTY LINES [CITY STANDARD DETAIL W/ FOOTING OPTION A], AND (2) INDIVIDUAL PILASTERS [CITY
STANDARD DETAIL] WITH ELECTRICAL CONDUIT INSTALLED FOR FUTURE ELECTRICAL WORK. ALL FUTURE ELECTRICAL WILL REQUIRE SEPARATE PERMIT.
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 •/•
DESCRIPTION ACCOUNT
CITY
AMOUNT
WALL/FENCE - EA ADDITIONAL 50 LF
101-0000-42404
0
$16.01
DESCRIPTION
ACCOUNT
CITY
AMOUNT
WALL/FENCE - FIRST 100 LF
101-0000-42404
0
$53.37
DESCRIPTION
ACCOUNT
CITY
AMOUNT
WALL/FENCE - FIRST 100 LF PC
101-0000-42600
0
$66.71
Total Paid for BLOCK WALL: $136.09
DESCRIPTION
ACCOUNT
CITY
AMOUNT
BSAS SB1473 FEE
101-0000-20306
0
$1.00
I Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: 51.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
RECORDS MANAGEMENT FEE
101-0000-42416
0
$10.00
Total Paid for RECORDS MANAGEMENT FEE: $10.00
DESCRIPTION
ACCOUNT
CITY AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0 $5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
4
06%-.x-44 KK)E";
— — — NQ -,i $Lem- wvIll,
.4miz- -- 0
L�
�oc�TlrJ(,, b t�—CIDIJ �
21
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FORNSTRUCTION
ATC `i 1 �JBY
515S2. lWD, MI►ttiNltr'i
isr
FOOTING OPTION "A
A
S
I
t
HEIGHT FROM TOP
OF FOOTING
12" 1 C
l {
T
RE:VERS1:, ----
DIRECTION OF
HOOK ON EVERY
OTHER RF_.6AR
FOOTING OPTION "L"
#•4 HORIZONTAL REOAP.
(USE 90NO BEAM BLOCK)
6" OR 8" BLOCK
#4 HORIZONTAL AT 32" MAX. O.C.
(USE BOND BEAM BLOCK)
SEE TABLE "A"
— FOR REBAR SIZE
AND SPACING
{l OGAI E: Rf F1AR EN C(?N1'ER OI' CI"e 1j
W1. -�
(FI 00TING WIDTH)
SEE TABLE "A"
SEE TABLE 1311
FOR REBAR SIZE -
AND SPACING
(l.Of.A'Er RLEAR IN CENTUt Clip GE2_J
FINISH GRADE
(1) #4 REBAR
L.0NTIN000S Illi
(2) -#4 REBAR
CONTINUOUS ��II
ALL F'O01 INGS ADJACENT TO
SLOPES TO BEAT LEAST 5' TO
DAYLIGHT AS SHOWN BELOW.
CIOi'I OM 4-
0
FOOYING
NOTES:
1) THIS DESIGN DOES NOT ALLOW GRADE DIFFERENTIALS OF
MORE THAN 611 ON OPPOSING SIDES OF THE WALL. THIS IS
NOTA RETAINING WALL.
2) FENCE HEIGHTS ARE REGULATED - CONSULT ZONING
REGULATIONS BEFORE BEGINNING CONSTRUCTION.
3) NO WATER COURSE OR NATURAL DRAINAGE SHALL BE
OBSTRUCTED.
4) GROUT ONLY THE CELLS CONTAINING REBAR. THIS WALL
IS NOT DESIGNED FOR ALL CELLS TO BE GROUTED.
5) ALL REBAR TO BE ASTM SPEC, A615, GRADE 40 MINIMUM.
6) ALL REBAR LAP SPLICES TO BE 24" MINIMUM.
7) ALL MASONRY UNITS TO BE ASTM C•90 GRADE N_
8) REBAR TO BE CENTERED IN MASONRY CELLS.
WESi•ERN RIVCRSIDE COUNTY CODE UNIFORMITY P�R-GRAM
I
FREESTANDING BLOCK WALL_.
'[FOOTING WIDTH?
SEE TABLE "B"
..H,.
HEIGH'f FROM TOP
OF FOOTING
t
1
TABLE "A"
H •
W„
VERTICAL
REINFORCEMENT
3'
17"
#4 @ 48" O.C.
4'
20"
#4 @ 48" O.C.
51
29
#4 @ 48" O.C.
6'
#4 @ 24:" O.G
SEE TABLE 1311
FOR REBAR SIZE -
AND SPACING
(l.Of.A'Er RLEAR IN CENTUt Clip GE2_J
FINISH GRADE
(1) #4 REBAR
L.0NTIN000S Illi
(2) -#4 REBAR
CONTINUOUS ��II
ALL F'O01 INGS ADJACENT TO
SLOPES TO BEAT LEAST 5' TO
DAYLIGHT AS SHOWN BELOW.
CIOi'I OM 4-
0
FOOYING
NOTES:
1) THIS DESIGN DOES NOT ALLOW GRADE DIFFERENTIALS OF
MORE THAN 611 ON OPPOSING SIDES OF THE WALL. THIS IS
NOTA RETAINING WALL.
2) FENCE HEIGHTS ARE REGULATED - CONSULT ZONING
REGULATIONS BEFORE BEGINNING CONSTRUCTION.
3) NO WATER COURSE OR NATURAL DRAINAGE SHALL BE
OBSTRUCTED.
4) GROUT ONLY THE CELLS CONTAINING REBAR. THIS WALL
IS NOT DESIGNED FOR ALL CELLS TO BE GROUTED.
5) ALL REBAR TO BE ASTM SPEC, A615, GRADE 40 MINIMUM.
6) ALL REBAR LAP SPLICES TO BE 24" MINIMUM.
7) ALL MASONRY UNITS TO BE ASTM C•90 GRADE N_
8) REBAR TO BE CENTERED IN MASONRY CELLS.
WESi•ERN RIVCRSIDE COUNTY CODE UNIFORMITY P�R-GRAM
I
FREESTANDING BLOCK WALL_.
'[FOOTING WIDTH?
SEE TABLE "B"
..H,.
HEIGH'f FROM TOP
OF FOOTING
t
1
CHECK WITH THE BUILDING DEPARTMENT TO.
VERIFY IF A BUILDING PERMIT IS -REQUIRED.
WHEN A PERMIT IS REQUIRED, THE FOLLOWING
INSPECTIONS ARE REQUIRED--
1)
EQUIRED:1) FOOTING: EXCAVATION TRENCH CLEAN WITH
STEEL IN PLACE AND SUPPORTED 3" ABOVE AND
AWAY FROM THE SURROUNDING EARTH/DIRT.
2) REBAR/PRE-GROUT: BOND BEAM REBAR AND
VERTICAL REBAR IN PLACE - INSPECTION PRIOR TO
PLACING GROUT,
3) FINAL; AFTER GROUT IS PLACED - PRIOR TO ANY
DECORATIVE CAP PLACEMENT.
-SEE PAGE 2 FOR ADDITIONAL INFORMATION`
DISCLAIMER:
ALTERNATE DESIGNS MAY BE POSSIBLE
WHEN PROVIDED WITH AN ENGINEERED
ANALYSIS. USE OF THIS STANDARD DESIGN
IS AT THE USERS RISK AND CARRIES NO
IMPLIED OR INFERRED GUARANTEE AGAINST
FAILURE OR DEFECTS.
PHONE, (76-0) 777-7125 - 78-49-5 CALLE TAMPIC O
1 A Qi. PINT& [ AI,IFC RN[A 92253
FAX (760) 777-7011 1 uI/q/2u1;1 1 CommUNI-1-y UliVELOPhll,'n1T. PAGE I OPS'
TAE3 E," eV'
"H�•
..W..
VERTICAL
REINFORCEMENT
31
19"
#4 @ 48" O.C.
4'
22"
#4 @ 48" O.C.
51
29
#4 @ 48 O.C.
6'
CHECK WITH THE BUILDING DEPARTMENT TO.
VERIFY IF A BUILDING PERMIT IS -REQUIRED.
WHEN A PERMIT IS REQUIRED, THE FOLLOWING
INSPECTIONS ARE REQUIRED--
1)
EQUIRED:1) FOOTING: EXCAVATION TRENCH CLEAN WITH
STEEL IN PLACE AND SUPPORTED 3" ABOVE AND
AWAY FROM THE SURROUNDING EARTH/DIRT.
2) REBAR/PRE-GROUT: BOND BEAM REBAR AND
VERTICAL REBAR IN PLACE - INSPECTION PRIOR TO
PLACING GROUT,
3) FINAL; AFTER GROUT IS PLACED - PRIOR TO ANY
DECORATIVE CAP PLACEMENT.
-SEE PAGE 2 FOR ADDITIONAL INFORMATION`
DISCLAIMER:
ALTERNATE DESIGNS MAY BE POSSIBLE
WHEN PROVIDED WITH AN ENGINEERED
ANALYSIS. USE OF THIS STANDARD DESIGN
IS AT THE USERS RISK AND CARRIES NO
IMPLIED OR INFERRED GUARANTEE AGAINST
FAILURE OR DEFECTS.
PHONE, (76-0) 777-7125 - 78-49-5 CALLE TAMPIC O
1 A Qi. PINT& [ AI,IFC RN[A 92253
FAX (760) 777-7011 1 uI/q/2u1;1 1 CommUNI-1-y UliVELOPhll,'n1T. PAGE I OPS'
FOO
DESIGN PARAMETERS:
ACTIVE SOIL PRESSURE (PSF) =30
PASSIVE SOIL BEARING (PSF) = 150
COEFFICIENT OF FRICTION = 0.25
ALLOWABLE SOIL BEARING (PSF) =1500
WIND = 80 MPH. EXPOSURE C
SEISMIC:
NA= 1.3. Nv= 1 .6, Z=0.4• SOIL PROFILE=SD
T.
WESTERN R[VtrRSIC)E COUNTY CODE UNIFORMITY PROGRAM
r
a s
- FREESTANDING BLOCK WALL
P[IONE (760) 777-712.5 78-495 CALLA" TAMPIC O
LA QUINTA C:AIJI,-ORNIA 92253
FAX (7601777- 701 1 '0191ea14 r,ussm•a
r
.1
ATOP VIEW
FOOTING
BLOCK
GROUT
STEEL REBAR
REE
PLACE
!LI USTI
SECTION VIEW
6'
MAX
I -
r
I
MIN 24"
REBAR
... __ OVERLAP
BLOCK
(12" X12" OR 16" X 16")
SOLID GROUT
(4) - # 4 REBAR
(ONEAT EACH CORNER)
ALL FOOTINGS ADJACENT TO
SLOPES TO BE AT LEAST' 5' TO
DAYLIGHT AS SHOWN BELOW.
BOTTOM
OF —
FOOTING
FOOTING RE4iAR SHALL
r HAVE MIN. 6" LONG
f [OOK AND A WN.
CONCRETE COVFR OF 3"
CHECK WITH THE BUILDING DEPARTMENT
TO VERIFY IF A BUILDING PERMIT 1S REQUIRED,
WHEN A BUILDING PERMIT IS REQUIRED,
THE FOLLOWING INSPECTIONS ARE ALSO REQUIRED:
1) FOOTING: EXCAVATION TRENCH CLEAN WITH STEEL
IN PLACE AND SUPPORTED 3" ABOVE AND AWAY FROM
THE SURROUNDING THE EARTH/DIRT.
2) REBAR...../P.R.E-G.R......O.UT; VERTICAL REBAR IN PLACE -
INSPECTION PRIOR TO PLACING GROUT.
3) FINAL: AFTER GROUT IS PLACED - PRIOR TO ANY
DECORATIVE CAP PLACEMENT.
DISCLbJMER:
ALTERNATE DESIGNS MAY BE POSSIBLE WHEN PROVIDED WITH
AN ENGINEERED ANALYSIS_ USE OF THIS STANDARD DESIGN IS
AT THE USER'S RISK AND CARRIES -NO IMPLIED OR INFERRED
GUARANTEE AGAINST FAILURE OR DEFECTS.
M
r
O�
LIMITATIONS:
1. PILASTER SPACING SHALL NOT EXCEED 20 FT. WHEN OTHER INFILL FENCING
IS ATTACHED.
2. ONLY OPEN TYPE FENCING (SUCH AS WROUGHT IRON) MAY BE ATTACHED TO
PILASTERS, SOLID TYPE FENCING MAY NQT BE ATT ACHED TO PILASTER.
:3. GATES AND DOORS ATTACHED TO PILASTER ARE LIMITED TO 200# MAX.
WEIGHT AND 4 FT. MAX, WIDTH PER PILASTER.
4.THIS PILASTER DESIGN is INTENDED TO BE USED ONLY AS A FENCING
FEATURE AND IS NOT INTENDED TO SUPPORT ANY OTHER LOADS.
5. FENCE HEIGHTS ARE REGULATED -T CONSULT ZONING REGULATIONS BEFORE
BEGINNING CONSTRUCTION_
6. INSTALLATION OF ELECTRIC CIRCUITS, CONDUITS. OR LIGHTING FIXTURES
REQUIRE ELECTRICAL PERMITS AND INSPECTION.
7. FOOTINGS TO BE PLACED IN UNDISTURBED SOIL OR PROPERLY COMPACTED
AND ENGINEERED FILL.
S. FOR DESIGN PARAMETERS. SEE FREESTANDING BLOCK WALL STANDARD.
WESTERN RIVERSIDE COUNTY CODE UNIFORMITY PROGRAM
4, ag"oG
J.
MASONRY PILASTER
OE b
PHONE (760) 777-7125 78-495 CALLS TAMPICO
LA 2UINTA, CALIFORNIA 92253
FAX (760) 777-7011 10/9/2014 1 COMMUNITY DEVELOPMENT DEPT. PAGE 1OF 1
taQa�fra
CALIFORNIA
PERMIT # 13WIFIDIPOM
PLAN LOCATION:
Project Address: j5 I E� E5 -� 4'
Project Description:
APN
Telephone:
Patio/Porch SF
Email:
Applicant Name:._ 2,14- _
State Lic: City Bus Lic:
Address: 5-)51S�-Z �
State Lic: City Bus Lic:
City, ST, Zip:
Telephone: C] MCI)
Email:2�
Valuation of Project $�
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:
Architect/Engineer Name:
Construction Occupancy:
Address:
Grading:
City, St, Zip
Construction Type: Occupancy:
Telephone:
Bedrooms:
Stories:
# Units:
Email:
State Lic: City Bus Lic:
Property Owner's Name:
New Commercial / Tenant Improvements:
Address: _xjjt,� �J�C�
Total Building SF
City, ST, Zip ��� ���3
Construction Type: Occupancy:
Telephone: -
Email: C' S
U ,/78495 CALLE TAMPICO
LA QUINTA, CA 92253
760-777-7000
OFFICE USE ONLY
#
Submittal
Required
Received
Plan Sets
Structural Calcs
Truss Calcs
Title 24 Calcs
CVWD Fire Flow Letter
Soils Report
Grading Plan (PM10)
Landscape Plan
Subcontractor List
i
Grant Deed
HOA Approval
School Fees
Burrtec Debris Plan
Planning approval
Public Works approval
Fire approval
City Business License
March 26, 2019
To Whom It May Concern,
I am the owner of the home located at 51600 Avenida Martinez La Quinta, CA 92253. My neighbor,
Megan Guerra, is the owner of the property located at 51552 Avenida Martinez La Quinta, CA 92253
am granting her permission to build a block wall on her property, with one side of the wall lining my
property.
Sincerely,
James Cathcart
3�26!�'O19
4s C
FirstAmerican
zc=
wFirstAm"' Property Profile
Property Information
Owner(s): Cathcart Bruce Y / Cathcart Lora M /
Cathcart James Young / Cathcart Maria
Owner Phone: UP Own
Vesting Type: Trust
51600 Avenida Martinez, La Quinta, CA 92253
i
Mailing Address: 44670 Via Catalina, La Quinta, CA 92253
Property Address: 51600 Avenida Martinez, La Quinta, CA 92253
Alt. APN: 773142005
County: Riverside APN: 773-142-005
Map Coord: Census Tract: 045120
Lot#: 20 Block: 113
Subdivision: Santa Carmelita At Vale La Quinta 12 Tract:
Legal: Lot 20 Blk 113 Mb 018/079 Santa Carmelita At Vale La Quinta No 12
.............. —
Property Characteristics
Use: Sfr Year Built/ Eff.: 1978/
Sq. Ft.:
1200
Zoning: Lot Size Ac / Sq Ft: 0.11 / 4792
# of Units:
1
Bedrooms: 3 Bathrooms: 2
Fireplace:
# Rooms: 5 Quality:
Heating:
Central
Pool: Air: Y
Style:
Contemporary
Stories: 1 Improvements:
Parking I #:
Attached / 2
Gross Area: 1640 Garage Area : 440
Basement Area:
_.......... _.._...........
Sale and Loan Information
Sale / Rec Date: / 06/01/1987 *$/Sq. Ft.:
2nd Mtg.:
Sale Price: 1st Loan:
Prior Sale Amt:
Doc No.: 0000168987 Loan Type:
Prior Sale Date:
Doc Type: Deed Transfer Date: 06/01/1987
Prior Doc No.:
0000168987
Seller: Owner Name Unavailable Lender:
Prior Doc Type:
Deed
*$/Sq.Ft. is a calculation of Sale Price divided by Sq. Feet.
Tax Information
Imp Value: $79,193 Exemption Type:
Land Value: $17,190 Tax Year I Area: 2018 / 20-016
Total Value: $96,383 Tax Value:
Total Tax Amt: $1,416.20 Improved: 82%
t
Property Profile 51600 Avenida Martinez, La Quinta, CA 92253 4/1/2019
Page 1 (of 1)
This report is only for the myFirstAm user who applied for it No one else can rely on it As a myFirstAm user, you already agreed to
our disclaimer regarding
third party property
information accuracy You can view it here: www myfirstam com/Security/ShowEULA 02005-2019 First American Financial Corporation and/or its affiliates
All rights reserved
T-vf 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
(7 60) 777-7012
FAX (760) 777-7011
Disclosures & Forms for Owner -Builders Applying for Construction Permits
-IMPORTANTI NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application for a building has been submitted in your name listing yourself as the builder of the property
improvements specified at 1�L S-[' S , p}�•L r nl�
We are providing you with an Owner -Bu r Acknowledgment and Information Verification Form to make you aware of your
responsibilities and possible risk you ma 'cur 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 ACKNOWLEDGM ENT AND VERIFICATION OF INFORMATION
DIRECTIONS: Read and initial each statement below to signify you understand or verify this information.
1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder"
_bu_Hi4ng 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 field 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.
K2understand building permits are not required to be signed by property owners unless they are responsible for the
con etion and are not hiring a licensed Contractor to assume this responsibility.
M3. 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.
4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on
pe is and contracts.
Pb. 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. 1 understand if I am 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.
I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential
tures 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
i ncial 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
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.
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:
IS Z AJEhII tom, H tj yUr I to - -z--
911. 911. 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.
12. 1 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. „/? .0 , j
Signature of property owner � &_� r Date:
Note: The following Authorization ForrhjYrequired 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. f
Scope of Construction Project (or Description of Work): 1 +
Project Location or Address: ,tel SS Z AVENi DA M1412T1 Qe Z -
Name of Authorized Agent <5_11 Tel No 0 —4041
Address of Authorized Agent:
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 require 7 b presented whenthe peri it is issued to verb the rvperty owner's signature.
Property Owner's Signature: Date: