BWFE2015-000654105 Avenida Madero
BWFE2016-0006
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 Licen a is in full force and effect.
License Clas4_/icencp No.::LIC-000,*
Date: / / If / / --' Contrauror: L/ 'r
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.).
(1 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:Z (L_ Owner: 6_ L/
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
Lender's
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 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:
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 her y authorize representatives of this city to enter upon the above-
mentioned pr ert or ipsp22tion purposes.
a
Date: Signature (Applicant or Age
O. i
VOICE (760) 777-7125
78-495 CALLE TAMPICO
D
LA QUINTA, CALIFORNIA 92253
FAX (760) 777-7011
COMMUNITY DEVELOPMENT DEPARTMENT
INSPECTIONS
(760) 777-7153
BUILDING PERMIT
Date: 1/8/2015
Application Number:
BWFE2015-0006
Owner:
Property Address:
54105 AVENIDA MADERO
LARRY SMITH
APN:
774192016
53670 AVENIDA VELASCO
Application Description:
40LF GARDEN WALL AT FRONT
PROPERTY LINE
LA QUINTA, CA 92253
Property Zoning:
Application Valuation:
$3,000.00
Applicant:
ORTEGA MASONRY
Contractor:
ORTEGA MASONRY
0 OUTSIDE CITY LIMITS
F7:1
0 OUTSIDE CITY LIMITS
LA QUINTA, CA 92253
LA QUINTA, CA 92253
(760)912-1730
Llc. No.::LIC 0004031
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 Licen a is in full force and effect.
License Clas4_/icencp No.::LIC-000,*
Date: / / If / / --' Contrauror: L/ 'r
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.).
(1 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:Z (L_ Owner: 6_ L/
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
Lender's
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 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:
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 her y authorize representatives of this city to enter upon the above-
mentioned pr ert or ipsp22tion purposes.
a
Date: Signature (Applicant or Age
Ia
DESCRIPTION_
INFORMATIONFINANCIAL
ACCOUNT QTY
AMOUNT
PAID
PAID DATE
BSAS SB1473 FEE
101-0000-20306
0
$1.00 .•
$1.00
1/8/15
PAID BY
METHOD
RECEIPT#"
CHECK #
CLTD BY
ORTEGA MASONRY
DEBIT
R3339
AOR
Total Paid forBUILDING STANDARDS ADMINISTRATION BSA
$1.00
$1.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
WALL/FENCE - FIRST 100 LF
101-0000-42404
0
$47.86
$47.86
1/8/15
PAID BY
METHOD-- _ _.
RECEIPT #
CHECK #
CLTD BY
ORTEGA MASONRY
DEBIT
113339
AOR
DESCRIPTION
ACCOUNT
QTY
-".AMOUNT
PAID
PAID DATE
WALL/FENCE - FIRST 100 LF PC
101-0000-42600
0
j $60.91
$60.91
1/8/15
PAID BY •
METHOD.,- `•w,
r
RECEIPT #
CHECK #
CLTD BY
ORTEGA MASONRY
DEBIT
` —113339
AOR
Total Paid for FENCE OR FREESTANDING WALL
TOTALS:0•
$108.77
$108.77
0•
w r e-✓`
sq 1015-
14 1
.a .
0
6
fli v
mI
Description: 40LF GARDEN WALL AT FRONT PROPERTY LINE
Type: WALL/FENCE Subtype: Status: ISSUED
Applied: 1/8/2015 AOR
Approved: 1/8/2015 AOR
Parcel No: 774192016 Site Address: 54105 AVENIDA MADERO LA QUINTA,CA 92253
Subdivision: SANTA CARMELITA VALE LA QUINTA Block: 258 Lot: 5
Issued: 1/8/2015 AOR
UNIT 24
Lot Sq Ft: 0 Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $3,000.00 Occupancy Type: Construction Type:
Expired: 7/7/2015 AOR
No. Buildings: 0 No. Stories: 0 No. Unites: 0
STATE
Details: 40LF OF 5' GARDEN WALL AT FRONT PROPERTY LINE [ANGELUS SPECIFICATIONS] PRECISION CONCRETE BLOCK SHALL BE COVERED
WITH STUCCO, PAINT, OR TEXTURED COATING WHERE VISIBLE FROM OUTSIDE THE PROPERTY. 2013 CALIFORNIA BUILDING CODES.
Printed: Thursday, January 08, 2015 9:08:18 AM 1 of 2 C
SYS TEti1S
CONTACTS
NAME TYPE
NAME
ADDRESSI
CITY
STATE
ZIP
PHONE
FAX
EMAIL
APPLICANT
ORTEGA MASONRY
0 OUTSIDE CITY LIMITS
LA QUINTA
CA
92253
CONTRACTOR
ORTEGA MASONRY
0 OUTSIDE CITY LIMITS
LA QUINTA
CA
92253
OWNER
LARRY SMITH
53670 AVENIDA
VELASCO
LA QUINTA
CA
92253
Printed: Thursday, January 08, 2015 9:08:18 AM 1 of 2 C
SYS TEti1S
Printed: Thursday, January 08, 2015 9:08:18 AM 2 of 2 CRVAI
SYSTEMS
INSPECTIONS
SEQID
INSPECTION TYPE
INSPECTOR
CLTD
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID BY
,..
BOND BEAM
BY
BY
WALL/FENCE - FIRST
101-0000-42404
0
$47.86
$47.86
1/8/15
R3339
DEBIT
ORTEGA MASONRY
AOR
100 LF
WALL/FENCE - FIRST
101-0000-42600
0
$60.91
$60.91
1/8/15
R3339
DEBIT
ORTEGA MASONRY
AOR
100 LF PC
Total Paid for FENCE OR FREESTANDING WALL, $108.77 $108.77
TOTALS:•• i• .77
Printed: Thursday, January 08, 2015 9:08:18 AM 2 of 2 CRVAI
SYSTEMS
INSPECTIONS
SEQID
INSPECTION TYPE
INSPECTOR
SCHEDULED
DATE
COMPLETED
DATE
RESULT
REMARKS
NOTES
FOOTINGS
AOR
BOND BEAM
FINAL"
Printed: Thursday, January 08, 2015 9:08:18 AM 2 of 2 CRVAI
SYSTEMS
Bin #
Permit #
'f W G9,o S •
City of La Q uin to .
Building &r Safety Division
P.O. Box 1504, 78-495 Calle Tampico .
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Project Address: 0-S'.-
,I
Owner's Name: v
A. P. Number:
Address: ('
Legal Description:
City, ST, -Zip: [,
LZ
Contractor:
-
Telephone:
:>R.
Address: d
V
Project Description: 02
City, ST, Zip:.MIPIZZ
Telephonc:7 d' 712 Z2 I
State Lic. # : Z- Z d
City Lie. #;
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
:......•:<>>; •;:;::;
Construction Type: Occupancy:
State Lic #:
w Add'n Alter Repair
Demo ect tyPa circle one : Ne
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone #,of Contact Person:
Estimated Value of Project:
# Submittal Req'd
APPLICANT: DO'NOT WRITE BELOW THIS LINE
Rec'd 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
2°" Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
M.O.A. Approval
Plans resubmitted
Grading
IN IiOUSE:-
'rd Review, ready for correctionstissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees