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BWFE2016-0214Applicant: SERGIO PERNES 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: C36, A. C33, C10 License No.: 936147 Date: ��� �� Contractor: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that.l ani 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 Name: Lender's VOICE (760) 777-7125 FAX (760) 777-7011 AS—INSPECTIONS (760) 777-7153 . DDatk=w10/4/2016 n 2A424 ( ' .I ID' ANZA- ­ D � ' r �A'922531 78-495 CALLETAMPICO C-7- iZ J =r LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT E i L BUILDING PERMIT BWFE2016-0214 Owner: _ApplicationNumber: Property Address: 53040 AVENIDA MENDOZA SERGIO CAF -A FIN: 774063002 53040 AVEP Application Description: CARRANZA RESIDENCE / BLOCK WALL LA QUINTA, ` Property Zoning: Application Valuation: $3,750.00 Applicant: SERGIO PERNES 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: C36, A. C33, C10 License No.: 936147 Date: ��� �� Contractor: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that.l ani 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 Name: Lender's VOICE (760) 777-7125 FAX (760) 777-7011 AS—INSPECTIONS (760) 777-7153 . DDatk=w10/4/2016 n 2A424 ( ' .I ID' ANZA- ­ D � ' r �A'922531 C-7- iZ J =r ryv JCD PiA E i Contractor: y L_ STATEWIDE SERVICES INC 36947 COOK -ST STE 104 PALM DESERT 9-2211 (442)666-8858 Llc. No.: 936147 E PL 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,9k for which this permit is issued. 42,6 I have and will maintain workers' compensation insurance, as required by ecti n 3700 of the Labor Code, for the performance of the work for which this permit 'S issued. My workers' compensation insurance carrier and policy number are: Carrier: BENCHMARK INSURANCE COMPANY Polity Number: CST5007723 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:g1 �L/—�� 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 eQtey u�on the above-mentioned property for inspection purposes. 7)� (Date: 1f/—y-Z RZ Signature (Applicant orAgent ):� LtJ�h Date: 10/4/2016 Application, Number: BWFE2016-0214 Owner: Property Address: 53040 AVENIDA MENDOZA SERGIO CARRANZA APN: 774063002 53040 AVENIDA CARRANZA Application Description: CARRANZA RESIDENCE / BLOCK WALL LA QUINTA, CA 92253 Property Zoning: Application Valuation;;. $3,750.00 Applicant: Contractor: SERGIO PERNES STATEWIDE SERVICES INC DBA STATE WIDE PL ` 36947 COOK ST STE 104 PALM DESERT, CA 92211 (442)666-8858 Llc. No.: 936147 Detail: REPLACE 6 FT X 50 LF GARDEN WALL AT REAR YARD [CITY SPECIFICATIONS] PRECISION CONCRETE BLOCK SHALL BE COVERED WITH STUCCO, PAINT, OR TEXTURED COATING WHERE VISIBLE FROM OUTSIDE THE PROPERTY. PER 2013 CALIFORNIA BUILDING CODES } DESCRIPTION ACCOUNT QTY AMOUNT' WALL/FENCE - FIRST 100 LF 101-0000-42404 0 $50.67 DESCRIPTION ACCOUNT QTY. AMOUNT WALL/FENCE - FIRST 100 LF PC 101-0000-42600 0 $63.33 Total Paid for BLOCK WALL: $114.00 DESCRIPTION ACCOUNT QTY AMOUNT BSAS SB1473 FEE 101-0000-20306 0 $1.00 L/A CA Iain 1i City of Ia `Quin to ' Building 8t Safety Division - Permit 78-495 Calle Tampico 4 I �p La Quinta, CA 92253 - (76d) 777-701.2 = 'Building Permit Application and Tracking Sheet _Project Address: 53 040 AJ. c -Owner's Name:" " alpv 15 AAZ-& A. P. Number. Address: �3�i� • l'c��l{ �� CA, Legal Description: City, ST, Zip: Contractor: j E - Telephone: ele hone: Address:41 R S _ / project Description:, ............. City, ST, Zip eW 47-2211 LOU, Lo4 u, Tele h ne• P o . • .I 6.� f State Lic. # : l City Lie. Arch., Engr., Designer: Address: • . City;QST, Zip: e Telephone: h one: • Con tructi s on Type: •Oecuane Occupancy:, Sta toLic . # Pr ect tYPa(circle one • New Add'n' Alter Repair Demo oJ (:Name:of Contact Persona fA� PG�� Sq. Ft.: # Stories: #Units: +Telephone# of Contact Person::Estimaied_y_aIue of Project:D. Ov APPLICANT: DO NOT WRITE BELOW THIS LINE • s # Submittal Req'd ' Rec'd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item , Amount , Structural Calcs. Reviewed, ready for corrections Plan Check Deposit . Truss Calcs. - Caned Contact Person Plan Check Balance Title 24. Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2"d Review, ready for corrections/issue Electrical SubcontactorList Called Contact Person Plumbing Grant Dced t Plans picked up S.M.I. Ii.O.A. Approval Plans resubmitted Grading IN ROUSE:- Reyiew, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.LP.P. { ;^ Pub. Wks. Appr Date of permit issue - School Fees,'. + ` Total Permit Fees' Sergio Carranza 53040 Avenida Mendoza R La Quinta, CA 92253 Independent ContractAgreement THIS GENERAL PROFESSIONAL SERVICES AGREEMENT (hereinafter, "Agreement"), made and entered into effective on October 3, 2016 between and among Sergio Carranza, hereinafter "The Owner", and StateWide Services, Inc. "The Contractor". RECITALS WHEREAS, Sergio Carranza has retained the services of Contractor to conduct Block Wall Construction, frame out to close existing window, drywall, paint and stucco at residence located at 53040 Avenida Mendoza, La Quinta, CA 92253. TERMS AND CONDITIONS In consideration of the covenants and agreements therein contained, and other good and valuable consideration, the parties hereto agree as follows: 1. The Project. Sergio Carranza agrees to retain the services of the contractor to furnish services which includes project described above. 2. Contract Price/Payment Terms. Subject to the terms of this Agreement, the "Contract Price" no to exceed $3,750. vmap" 00"'� rivll Z'