BLCK (14-0917)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 14-00000917
Property Address: 54160 AVENIDA MENDOZA
APN: 774-223-008-15 -000000-
Application description: WALL/FENCE
Property Zoning: COVE RESIDENTIAL
Application valuation: 1650
Tu!t444"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
REYNOLDS MATTHEW A
54160 AVENIDA MENDOZA
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/23/14
Contractor:
Applicant: Architect or Engineer: STRZELCZYK, EDWARD J. D
P.O. BOX 7114
LA QUINTA', CA 92248 JON
(760)347-0399 r
Lic. No.: 439904
Girtof LA Q04TA
FIN.
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LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect._ Ihave and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: B Cl C29 Licen : 439904 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
�teer.by
aintractor: 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
OWNER -BUILDER DECLARATION insurance carrier and policy number are:
affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier EXEMPT Policy Number EXEMPT
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to _ I certify that, in the performance of the work for which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner so as to become subject to the workers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I should become ubject to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3700 of the Labor Code, I sorthwi omply with those provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by fir"
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars IS5001.: at—wpplicant:
(_ 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
7 7 -
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The WARNING: FAILURE TO SECURE WC6R ERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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.). APPLICANT ACKNOWLEDGEMENT
(_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application.
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed 1 . Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License Law.)• whose benefit work is performed under or pursuant to any permit issued as a result of this application,
(_ 1 I am exempt under Sec. , B.&P.C. for this reason the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
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 Address:
LQPERMIT
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 th�c;; upon the above-mentioned proprty tDaeignature
(Applicant or Agentl:
Application Number . . . . . 14-00000917
Permit . . . WALL/FENCE PERMIT 2013
Additional desc . .
Permit Fee . . . . 47.19 Plan Check Fee
.00
Issue Date . . . . Valuation . . .
. 1650
Expiration Date . . 12/20/14
Qty Unit Charge Per
Extension
1.00 47.1900 LS MISC WALL, FIRST 100 LF
47.19
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Special Notes and Comments
BLOCK PER ANGELUS STANDARDS & APPROVED
PLANS. 66 LN FT X 6 FT HT.2013
CALIFORNIS BUILDING CODES.) PRECISION
CONCRETE BLOCK SHALL BE COVERED WITH
STUCCO, PAINT, OR TEXTURED COATING WHERE
VISIBLE FROM OUTSIDE THE PROPERTY.
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Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
PLAN CHECK, WALLS
60.06
Fee summary Charged Paid Credited
Due
---------------------------------------------------------
Permit Fee Total 47.19 .00 .00
47.19
Plan Check Total .00 .00 .00
.00
Other Fee Total 61.06 .00 .00
61.06
Grand Total 108.25 .00 .00
108.25
LQPERMIT
Bin fr
City of La Quinta
-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
Permit #
^ ^
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Project Address:
Owner's Name:
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
Contractor: V2 -
Telephone
{ >
Address:Project
i
Description:
City, ST, Zip: ,--
Structural Calcs.
Tele hone:
;'.s>:; :;':::;:::
Reviewed, ready for corrections
State Lic. # :
City Lie. #t
Arch., Engr., Designer:
Truss Cala.
Address:
City., ST, Zip:
Tele
Telephone:
P
Construction Typ Occupancy
New Add'n Alter Repair DemoProJect type circle o
State Lic. #:
...........................
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone #,of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#t
Submittal
Rcq'd
Recd
TRACKING
PERMIT FEES.
Plan Sets
PIan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cala.
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 correctionslissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Decd
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:
'"' Review, ready for correctionsrassue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees