BWFE2015-0259F r
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T444Qums
VOICE (76.0).777- 7125
78-495 CALLE TAMPICO
'
FAX (760) -777-7011
LA QUINTA, CALIFORNIA 92253
COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 8/10/2015
Application Number:
BWFE2015-0259
Owner:
Property Address:
55710 OAK TREE B33
GARY ROZEK
APN:
Application Description:
775231017
ROSEK 9LF OF 6' BLOCK
WALL
3460 COTTAGE GROVE AVE.SE• ca
RAPIDS, C. .
Property Zoning:
/
_
CEDAR IA 52403-1649 i
z
Application Valuation:
$2,000.00
a.) C
�
Q
Applicant:
Contractor: S
G L SCRIVENS CONSTRUCTION
INC
G L SCRIVENS CONSTRUCTION
P O BOX 13302
P O BOX 13302 p V 0
PALM DESERT, CA 92255
PALM DESERT, CA 92255 c it
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. t`
License Class: B License No.: 807645
Date: �d 5 Contractor: 4 -L SC_r1 k/0 -i
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).:
(� 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, 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 Nam
Lender's
(760)837-9918
LIc. No.: 807645
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 thepork for which this permit is issued.
.A4 -1 -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 polity 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: ! l� S Applicant: lS ` SC.I t
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
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 nter upon the above-
mentioned property for inspection purposes.
Date: S ignature (Applicant or Agent):
FINANCIAL INFORmATioN
y �.... _{ .� - t _ e s r fix. �*.>
ti
DESCRIPTION'ft ACCOUNT QTY AMOUNT .� PAID PAID DATE
d
BSAS SB1473 FEE 101-0000-20306 0
$1.00 $0.00
+Jn "JPAMETHOD r RECEIP.:T # CLTD BY.
,r trA s Aa
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA
$1.00 $0.00
ro" r DESCRIPTION'; s'+,+° . g,
. , i - —ACCOUNT - * „;
QTY"
i° AMOUNTe.
;PAID $E%, e�M1
Pi41D: DATE
WALL/FENCE - FIRST 100 LF
101-0000-42404
0
$47.86
$0.00
• r4 1£r PAID:BY ,�, ti _ `
r METHOD
RECEIPT #
'CHECK # s "aa
CLTD BY
t 9 a;
,�$ ;DESCRIPTION , ,.
{q #ACCOUNT A=C{TY.
4 f AMOUNT '-
ss� PAIDPAIDDATE
WALL/FENCE - FIRST 100 LF PC
101-0000-42600
0
$60.91
$0.00
r PAID BY,'t
eco. -G
3r METHOD
,.
"' rt::,:-
RECEIPT #
CHECK M�ii
...
ar CLTD BY.
J
Total Paid forFENCE OR FREESTANDING WALL-
TOTALS:••
$108.77 $0.00
••
`
A
f � ,
S
Description: ROSEK / 9LF OF 6' BLOCK WALL
Type: WALL/FENCE Subtype: Status: UNDER REVIEW
Applied: 8/10/2015 SKH
Approved:
Parcel No: 775231017 Site Address: 55710 OAK TREE B33 LA QUINTA,CA 92253
Subdivision: TR 20717-2 SEE ASSR MB 769 PGS 3134 Block: Lot: 8
Issued:
3536
G L SCRIVENS CONSTRUCTION INC
Lot Sq Ft: 0 Building Scl Ft: 0 Zoning:
Finaled:.
Valuation: $2,000.00 Occupancy Type: Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0 No. Unites: 0
G L SCRIVENS CONSTRUCTION INC
Details: 9LF OF 6' GARDEN WALL FRONT ENTRY GATE AND COURTYARD [CITY SPECIFICATIONS] PRECISION CONCRETE BLOCK SHALL BE
COVERED WITH STUCCO, PAINT, OR TEXTURED COATING WHERE VISIBLE FROM OUTSIDE THE PROPERTY. 2013 CALIFORNIA BUILDING
CODES.
NAME TYPE,
NAME
ADDRESS1 .
CITY-
STATE.
ZIP PHONE ' FAX .j. EMAIL
APPLICANT
G L SCRIVENS CONSTRUCTION INC
P 0 BOX 13302
PALM DESERT .
CA
92255 —
CONTRACTOR
G L SCRIVENS CONSTRUCTION INC
P 0 BOX 13302
PALM DESERT
CA
92255
OWNER
GARY ROZEK
3460 COTTAGE GROVE
AVE. SE.
CEDAR RAPIDS.
I 1
IA
52403 -
1 1649
Printed: Monday, August 10, 2015 3:01:50 PM 1 of 2 x
SYSTEMS
I
FINANCIAL
O RIVIATiON
DESCRIPTION . ' ACCOUNT . _ .% QTY
"AMOUNT
CLTD
PAID + PAID DATE-[, RECEIPT # CHECK # ;; METHOD , „ � ,PAID BYe_' �
BY"
BSAS SB1473 FEE 101-0000-20306 0
$1.00
$0.00
Total Paid forBUILDING STANDARDS ADMINISTRATION
$1.00
-
$0.00
BSA:
Printed: Monday, August 10, 2015 3:01:50 PM 1 of 2 x
SYSTEMS
"' PARENT PROJECTS
Printed: Monday, August 10, 2015 3:01:50 PM 2 of 2
srsirMs
G,
Bin
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City of La Quinta
Building 8T Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address:
6 A' CL
Owner's Name:
A. P. Number:
Address: il0 aT/eG
Legal Description:
City, ST, Zip: 64 9212%S
Contr o
act r•
.
�v
CSO
T I h ne•
ee o P
Address:'74f
d
Project Description:
City, ST, Zip: RDP ' LS►'
Telephone:
-26619-:5
3
State Lic. # : KD—2
City Lic.
Arch., Engr., Designer:
Address:
City., ST, Zip:
<'
CTelephone: on structi n Type: Occupancy:cY
•
State Lic. #:
Project tSPa (circle one): . New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project: �C>CX!5
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Catcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Cales.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2°" Review, ready for-corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:
'"' Reyiew, ready for correctionsrissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
C! TY OF LA QUIN TA
UJ," DI^aC& S It%, F ETY D E PT.
G EE D
FOR CGNSTRUC TION
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DATE 4(o BY 4
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