BWFE2015-0074Applicant:
MCI CONSTRUCTION COM
82-746 KYLE DRIVE
INDIO, CA 92203
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: B License No.: 377905
i
ate: I'— b (� Contractor: G .
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 Divisio 'ib
of the Business and Professions Code) or that he or she is exempt therefrom and the
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basis for the alleged exemption. Any violation of Section 7031.5 by any applicant fo 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 Name
Lender's
Contractor:
MCI CONSTRUCTION COMPANY
82-746 KYLE DRIVE
INDIO, CA 92203
(760)799-5106
Llc. No.: 377905 .
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: _
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.
0 u�f c
Dte: I ` ] Applicant:
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 to enter upon the above-
mentioned property for inspection purposes.
te: "' Signature (Applicant or Agent):
(1,
C&
4 Oamrcu
VOICE (760) 777-7125
78-495 CALLE TAMPICO
0 D
FAX
FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253
COMMUNITY DEVELOPMENT DEPARTMENT (760) 777-7153
BUILDING PERMIT
Date: 4/16/2015
Application Number:
BWFE2015-0074
Owner:
Property Address:
77985 AVENIDA MONTEZUMA
TOWER ENERGY GROUP
APN:
773104036
1983 W 190TH ST
Application Description:
JOHN OLSON BLOCK WALL 22LN FT X 6 FT HT
TORRANCE, CA 92253
Property Zoning:
Application Valuation:
$3,000.00
Applicant:
MCI CONSTRUCTION COM
82-746 KYLE DRIVE
INDIO, CA 92203
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: B License No.: 377905
i
ate: I'— b (� Contractor: G .
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 Divisio 'ib
of the Business and Professions Code) or that he or she is exempt therefrom and the
r/X�
basis for the alleged exemption. Any violation of Section 7031.5 by any applicant fo 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 Name
Lender's
Contractor:
MCI CONSTRUCTION COMPANY
82-746 KYLE DRIVE
INDIO, CA 92203
(760)799-5106
Llc. No.: 377905 .
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: _
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.
0 u�f c
Dte: I ` ] Applicant:
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 to enter upon the above-
mentioned property for inspection purposes.
te: "' Signature (Applicant or Agent):
(1,
FINANCIAL INFORMATION
DESCRIPTION
ACCOUNT +
QTY
AMOUNT
PAID
PAID DATE
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid forBUILDING STANDARDS ADMINISTRATION BSA
$1.00
$0.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
WALL/FENCE - FIRST 100 LF
101-0000-42404
0
$47.86
$0.00
PAID BY ':',
METHOD
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
WALL/FENCE - FIRST 100 LF PC
101-0000-42600
0
$60.91
$0.00
PAID BY -
METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid forFENCE OR FREESTANDING WALL-
TOTALS:••
$108.77
$0.00
• ••
Description: JOHN OLSON BLOCK WALL 22LN FT X 6 FT HT
Type: WALL/FENCE Subtype: Status: UNDER REVIEW
Applied: 4/16/2015 PJU
Approved:
Parcel No: 773104036 Site Address: 77985 AVENIDA MONTEZUMA LA QUINTA,CA 92253
Subdivision: SANTA CARMELITA AT VALE LA QUINTA Block: 134 Lot: 24
Issued:
NO 14
Lot Scl Ft: 0 Building Scl Ft: 0 Zoning:
Finaled:
Valuation: $3,000.00 Occupancy Type: Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0 No. Unites: 0
Details: 22 LN X 6 FT HT BLOCK WALL FOR TRASH ENCLOSER TOWER MARKET APPROVED PER PLAN ON ORIGINAL PLANS ISSSUED FOR
MARKET APPROVED PER AJ CITY STANDARDS. PRECISION CONCRETE BLOCK SHALL BE COVERED WITH STUCCO, PAINT, OR TEXTURED
COATING WHERE VISIBLE FROM OUTSIDE THE PROPERTY. 2013 CALIFORNIA BUILDING CODES
Printed: Thursday, April 16, 2015 9:40:43 AM 1 of 2 Cg? -W -SYSTEMS
ADDITIONAL
CHRONOLOGY
CONDITIONS
CONTACTS
NAME TYPE
NAME
ADDRESSI
CITY
STATE
ZIP PHONE
FAX EMAIL
APPLICANT
MCI CONSTRUCTION COMPANY
82-746 KYLE DRIVE
INDIO
CA
92203
CONTRACTOR
MCI CONSTRUCTION COMPANY
82-746 KYLE DRIVE
INDIO
CA
92203
OWNER
TOWER ENERGY GROUP
1983 W 190TH ST
TORRANCE
CA
92253
Printed: Thursday, April 16, 2015 9:40:43 AM 1 of 2 Cg? -W -SYSTEMS
+DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT# CHECK# METHOD PAID BY CLTD
BY
WALL/FENCE - FIRST 101-0000-42404 0 $47.86 $0.00
100 LF
WALL/FENCE - FIRST 101-0000-02600 0 $60.91 $0.00
100 LF PC
Total Paid forFENCE OR FREESTANDING WALL $108.77 $0.00
REVIEWS
REVIEW TYPE REVIEWER SENT DATE DUE DATE RETURNED STATUS REMARKS NOTES
DATE
ATTACHMENTS
Printed: Thursday, April 16, 2015 9:40:43 AM 2 of 2 ��NAAF Ms
1
INSPECTIONS
SEQID
INSPECTION TYPE
INSPECTOR
SCHEDULED
DATE
COMPLETED
DATE -
RESULT
REMARKS
NOTES
BOND BEAM
BLD
FINAL*"
BLD
FOOTINGS
BLD
REVIEWS
REVIEW TYPE REVIEWER SENT DATE DUE DATE RETURNED STATUS REMARKS NOTES
DATE
ATTACHMENTS
Printed: Thursday, April 16, 2015 9:40:43 AM 2 of 2 ��NAAF Ms
1
Qin # .
City of La Quinta
Building 8r Safety Division
Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #iP.O.
2,0
Project Address:O
�� av r10n1�
\ D�
wner's Name: �J
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
Contractor:
Telephone:
hone:
Address:
Project Description: 2
City, ST, Zip:
Telephone:
State Lic. # :
City Lic. #:
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone::•:<.:;:;.:;:.;;;:•;;:.>;>...;;.;>>:<:
,.>:.::•;;<::
...�::.::.:. ::.:....................:::.�
Construction Type: Occupancy:
ADemo
State Lic. #•
•
Project e circle one New Addgn Alter R
J type � )� Repair
Name of Contact Person:
Sq. Ft.:
#Stories:
#Units:
Telephone # of Contact Person:
Estimated Value of Project: Q E) v
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2r' 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:-
'"' Review, ready for correctionsrssue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P,
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees