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BWFE2016-0124LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 70001 of Division 3 of Busi d Professions Code, and my License is in full force and effect. License Class: Bq License No.: 995557 Date./U Contractor. 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 1, 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 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, l" shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if kshould become subject to the workers' compensation provisions of Section 3706 the bor e, I shall forthwith comply with those provisions. Date/' -(C v ( 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 aAstater a ' g'to uildingconstruction, and hereby authorize representatives of tPon tabove-mentioned property for inspection purposes. Date: Signature (Appl VOICE (760) 777-7125 78-495 CALLE TAMPICO D FAX (760) 777-7011. LA QUINTA, CALIFORNIA 92253. COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date:. 6/8/2016 Application Number: BWFE2016-0124 Owner: Property Address: 52679 MERIWETHER WAY FARES RUSTOM APN: 767690030 55 NE BROADWAY Application Description: 427 LF 6' BLOCK WALL -ANGELUS PORTLAND, OR 0 Property Zoning: Application Valuation: $26,000.00 mpqqrqqqR Applicant: Contractor: RUCKER MUTH CORP P 0 BOX 13017 74125 ACADEMY LN EAST ( C (G� PALM DESERT, CA 922SS (760)250-4903 Llc..No.: 995557 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 70001 of Division 3 of Busi d Professions Code, and my License is in full force and effect. License Class: Bq License No.: 995557 Date./U Contractor. 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 1, 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 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, l" shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if kshould become subject to the workers' compensation provisions of Section 3706 the bor e, I shall forthwith comply with those provisions. Date/' -(C v ( 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 aAstater a ' g'to uildingconstruction, and hereby authorize representatives of tPon tabove-mentioned property for inspection purposes. Date: Signature (Appl . ?'+ - r ,x +!: °.'�° 7 r" ... • : `a*N �53 5r x �r.�. a m' 5; Qr . DESCRIPTION; w , A � §NTj'�.. N MO NT �� .. PLj �. 146" BSAS SB1473fEE . 101,0000-20306" :_ 011' _ $2:00 ;. �, $2:00, 6/8/16 iYx�sx rc .�AIDBY���5 �a�METHOD�s ��'RECEIT#k �HEK# I . IAABY . . RUCKER MUTH CORP , CASH .. ' . '_=�R16085 1;TSA ,. Total Paid for BUILDING STANDARDS ADMINISTRATION BSA $2.00 = $2:00 .ESCR�IPTINC "ll4'rs,�'}¢'i:'FC-r,.. 5.�^zmF' i �,11, 01 01 .A^u��'T.kt"v�i\YY "Gt';v; T T' `:. +:'2i{.t . . 3"+�','' Y�3�"a"5,"��•. PAID PiA1D ...�� ca.A000UNT ` 'v5,+ `+�'^ ' ,ttCa�.Iu"ra'3i:c,.,�. ,III� DATE WALL/FENCE - EA ADDITIONAL 50 LF _101=0600' 2404 ,' 0 $72.50" $72.50- . z�" P°i41DfiBY�+�ti ,.rv� , , 7�x k c..,n•,.. :. .*.. M vX+Y,.'?k2?w',z.....� K, METHOD i 5 .. ..... , -, ... Av't..� , Rx�PT ##. t E � X J. B I CL�TD». . RUCKER MUTH:CORP . ' CHECK v°> R16084 1193 TSA F DESCRIPTI ON ACC NTI , 111 ,��z � ID s ,. 1 rNEW _E r M NT p 3 DAT WALL/FENCE _'FIRST SOO LF 6/8/16 ' 101-0000-42404'- 0 '$47.86 ,$47:86 > ���;, �� �'�PA�ID`BY �'' D �rv� � i� I� :�:�, ;�� �• � �. '�.�� �{.� r �' I r IN TSA, RUCKER MUTH CORP' CHECK ". R16084 -4193 ..;��. sal , _,� <z�v�s�:��n�• ,�� .m3 �DES}.C,3R,k;If §PsT.ASIO`i'NL ' IMPOSE =•, ,. x�Si�^A._,.,YyC.�53C:e�:�O`.V'x:U.;�. iN.�T `.r i e7A �3fl�Q''iss�ATi'�SYY,: A AMOb?',NX�?T:. y ��_ � r%[ PID `''�i. �,�.,�.if��m'r:' S �;r �?PAI • WALL/FENCE - FIRST'100 LF'PC 101-0000-42600 0 $60 91 $60.91 ,: -'6/8/16 .PAID Y �' _��a waw *ua ,rig i 1.41 g\ mMET OD w � k � -RECEIP'�CHECK .rM 151 m � a � M&0Ww. , r�- s��w�a�re - RUCKER V UTH CORP . ; -CHECK `. R16084 ` 1193, t TSA . - - Total Paid for FENCE OR•FREESTANDING'WALL $181.27. , , $181.27 ae� mss"r _' x �A�N AMO NT A ODA�7E �CRIRTION R _. k- 3,..P ''��C RET;WALL >12 -,EA ADD. 50 LF , , • 101-0000742404 .' 0 $29 01",$29:01 4 . _' ; ' ,-6/8/16 K PAIOBIf x�'M�ETFlOD RECEIPT # x CHECK '# zx TSA :RUCKER MUTH CORP �' . CHECKR16084,1193; �._ N'Y.cir"i{r -,�t 3"•..:4t- � j; DESCRIPyTIONS a Via. y�r eYSez+ '�' �rACCOUNT �alk..�` `�e:Y�s..:2.:f?� � �ti ,._ R,�'"�. QTyY¢�� �.i �T'3�` s` ?f%v+,vk �', z� x AMOUN�PAID �'X;u�ti .:�.,,,�;.. # �st� 4,0.w;cc��:�2LK�� A OF A f ,,RET WALL>32 '- FIRST 100 LF ., 101-0000-42404 0 $72 52 $72.52 , , , - ' ',6/8/16 • .� P IDBY �:s �, , . '10A. x METHODS' .'r.. rs RECEIRT,# # BECK.# ' CLTOkBY'. "RUCKER MUTH�CORP � � CHECK �:;R16084 1193 •'. TSA, - `� F PAID.•.. `� "TMr. ��� ti .±� ���:a�c�.:���.� �- �s� k �.�,._ .�'�,:� Y .Q,� Ml1NT ?\ID, RET W,,ALLjj>12'--FIRST 1001F PC". 101-0000-42600 0 $60:43 ,` $60.43 6/8/16 ' . M j v • .r -1 'k.. ✓" ��,�.J1rwG',+,'L'�'SKW,�$ 'PAID°BY�����4 METHOD RE@EIPT#" ,CHECK #K SEA _.. CCTD BYE ,rY �K :.� .�?r:4fix. 5Sinr9aYQy�x':o�.,�—. #:?'x RUCKER MUTH CORP. "'�' CHECK „ „ R16084 1193 TSA Total Paid focRETAINING WALL'' $161.96—::. $161.96 e a � Description: 427 LF 6' BLOCK WALL - ANGELUS Type: WALL/FENCE Subtype: CITY STANDARD/PRE- Status: UNDER REVIEW Applied: 6/8/2016 TSA APPROVED Approved: Parcel No: 767690030 Site Address: 52679 MERIWETHER WAY LA QUINTA,CA 92253 Subdivision: TR 33076-2 Block: Lot: 38 Issued: Lot Scl Ff: 0 Building Scl Ft: 0 Zoning: Finaled: Valuation: $26,000.00 - Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 Details: 427 LF OF 6' BLOCK WALL PER ANGELUS STANDARDS S-1.21.0, S-1.11.0, S-1.61.0, S-1.10LQ (5 COLUMNS). 2013 CALIFORNIA BUILDING CODES. DOES NOT INCLUDE 10'6" PILASTERS Printed: Wednesday, June 08, 2016 2:35:33 PM 1 of 2 PWIW SYSTEMS DESCRIPTION. ACCOUNTr CITY . . , AMOUNT PAIQ PAID DATE RECEIPT # CHECK # . METHOD PAID BY CLTD; _. s WALL/FENCE -FIRST 101-0000-42404 0 $47.86 $47.86 6/8/16 R16084 1193 CHECK RUCKER MUTH CORP TSA 100 LF WALL/FENCE - FIRST 103-0000-42600 0 $60.91 $60.91 6/8/16 R16084 1193 CHECK RUCKER MUTH CORP TSA 100 LF PC Total Paid for FENCE OR FREESTANDING WALL: $181.27 $181.27 RET WALL >12 - EA.ADD 101-0000-42404 0 $29.01 $29.01 6/8/16 R16084 1193 CHECK RUCKER MUTH CORP TSA 50 LF RET WALL >12 - FIRST 101-0000-42404 0 $72.52 $72.52 6/8/16 R16084 1193 CHECK RUCKER MUTH CORP TSA 100 LF RET WALL >12 -FIRST 101-0000-42600 0 $60.43 $60.43 6/8/16 R16084 1193 CHECK RUCKER MUTH CORP TSA LF 100 LF PC Total Paid for RETAINING WALL: $161.96 $161.96 INSPECTIONS PARENT PROJECTS . . BOND INFORMATION Printed: Wednesday, June 08, 2016 2:35:33 PM 2 of 2 ., `-f SYSTEMS A