BWFE2016-013778-495 CALLE TAMPICO D �NtiI[ICl/
LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT
Contractor:
BUILDING PERMIT
Application Number:
BWFE2016-0137 Owner:
Property Address:
52679 MERIWETHER WAY FARES RUSTOM
APN:
767690030. 55 NE BROADWAY
Application Description:
RUSTOM / BLOCK WALL AT DRIVEWAY ENTRANCE PORTLAND, OR 0
Property Zoning:
Application Valuation:
$4,020.00
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/21/2016
Applicant:
Contractor:
RUCKER MUTH CORP
RUCKER MUTH CORP '
P O BOX 13017
P O BOX 13017
74125 ACADEMY LN EAST
74125 ACADEMY LN.EAST:.
Ic
PALM DESERT, CA 92255
PALM DESERT, CA 92255
(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 7000) of Division 3 of the Business and Professions Code,
and my License is in full force and effect.
License Class: B License No.: 995557
Date: Contra
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).:
(1 I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure isnot 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
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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 wor for hich this permit is issued.
I ave 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 a o become subject to the workers'
compensation laws of California, and agree tha f I should become subject to the
workers' compensation provisions of Section 3 e or Code, I shall forthwith
comply with tho a provisions.
Date: Applica
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 ab information is correct.
I agree to comply with all city and county ordinances and stat aws relating to building
construction, and hereby authorize representatives of this city a pon he
above -m ntio ed property for inspection purposes.
Date: l Signature (Applicant or Agent)
r�f:
FINANCIAL O• •
rrDESCRIPTION `- 4. = w f ACCOUNTFf '"QTY`
AMOUNT 4; "
PAID `'i
PAID`DATE`
BSAS SB1473 FEE 101-0000-20306
0
$1.00
$0.00
PAID.BY �' a METHOD s
x RECEIPT #,. •
CHECK #
CLTD BY.
,
.,
,'
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA:
$1.00
$0.00
DESCRIPTION4k *`
.- ACCOUNT ase'
gQTY,
_ANIOUNTs� x
`PAID
Ai
aPAID'DATE+
WALL/FENCE - FIRST 100 LF
101-0000-42404
0
$47.86
$0.00
• •'' PAID BY
METHOD
_ 't
F = l
RECEIPT #
CHECK #
€ CLTD By,
'DESCRIPTION , a ; ,
4:` ACCOUNT
QTY
,AM()UNT!;PAID
P=
'PAID DATE;
WALL/FENCE - FIRST 100 LF PC
101-0000-42600
0
$60.91
$0.00
` PAID`BY `
METHOD i
- k`, RECEIPT
CHECK #
CLTD BY "
Total Paid for FENCE OR FREESTANDING WALL:
.$108.77
.$0.00
DESCRIPTIONS
�,b. ACCOUNT
QTY
.; AMOUNTPAID
PAID DATE.
u
RET WALL <=12 - FIRST 100 LF
101-0000-42404
0
$47.86
$0.00
PAID BY i
METHOD
#
CHECK #
CLTD BY
E.`
,RECEIPT
.! -DESCRIPTION , '"°
S
.< :ACCOUNT t
P r
.QTY
AMOUNT
i d.
S PAID "
PAID DATE
RET WALL <=12 - FIRST 100 LF PC
101-0000-42600
0
$60.91
$0.00
PAID BY
w METHODS.
F
RECEIPT # z ri ;.
`CHECK
# °
CLTD BY
Total Paid for RETAINING WALL:
$108.77.
$0.00
TOTALS:00
.-
- 1-
.i
. { l.. f.
;. -�. ,• 1.
\• 4 -+ - r
,
,
Description: RUSTOM / BLOCK WALL AT DRIVEWAY ENTRANCE
Type: WALL/FENCE Subtype: CITY STANDARD/PRE- Status: UNDER REVIEW
Applied: 6/21/2016 SKH
APPROVED
Approved:
Parcel No: 767690030 Site Address: 52679 MERIWETHER WAY LA QUINTA,CA 92253
Subdivision: TR 33076-2 Block: Lot: 38
Issued:
Lot Sq Ft: 0 Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $4,020.00 Occupancy Type: Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0 No. Unites: 0
Details: 6LF OF 4', 21LF OF 6' WALL, AND 40LF OF RETAINING WALL AT FRONT DRIVEWAY ENTRANCE [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: Tuesday, June 21, 2016 1:04:34 PM 1 of 2
SYS7Fh1S
.
'ACCO
--AMOUNT
9 ..a
r
:.
`PA
B . ,
..,
`
CLTD,'
.aDESCRIPTION "
, ..
;QTY
�;, _ AMOUNT„
x
PAID ti
AT
IP T C
CHECK # ',
•METHOD t
„PAID BY
SID
c�
WALL/FENCE -FIRST
101-0000-42404
0
$47.86
$0.00
100 LF
WALL/FENCE - FIRST
101-0000-42600
0
$60.91
$0.00
100 LF PC
Total Paid for FENCE OR FREESTANDING WALL: $108.77 $0.00
RET WALL <=12 - FIRST
101-0000-42404
0
$47.86
$0.00
100 LF
RET WALL <=12 - FIRST
101-0000-42600
0
$60.91.
$0:00
-100 LF PC
Total Paid for RETAINING WALL: $108.77 .$0.00
TOTALS:•0
Bin #
Permit #
Project Address: ft&JI n
A. P. Number: 7�7 9G
Legal Description:
Contractor:
Address:
City, ST,
Telephone:,
State Lic. #: �J9Ss'g
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person: NK
Telephone # of Contact Person:
# Submittal
Plan Sets
Structural Calcs,
Truss Cales.
Title 24 Cales.
Flood plain plan
Grading plan
Subcdntactor List
Grant Deed
H.O.A. Approval
IN HOUSE: -
Planning Approval
Pub. Wks. Appr
School Fees,
E
City of La Quin to
Building 8& Safety Division
78-495 Calle Tampico
La Quinta, CA 92253 - (760) 7' 7012
Building Permit Application and Tracking Sheet
(A/ Owner's Name:
.3� Address: 55 AYE,'Sg!AAVWAJ
City, ST, Zip: PMLAt.4)
Telephone: ><»'
Project Description:
Total Permit Fees
�.>.::«•':s.v%;::Y.>;.;:
TYPe:
Occupancy:
"%�%:''<<,' y:<;'»`;;::'r;.,:
.
;.::.Construction
"t;�.`
ProJect type circle one): New Add'n' Alter Repair Demo
�
Sq. FL:
# Stories:
# Units:
p
7ka -27J— ' 7.3
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
'd
Rec'd
TRACKING
PERMIT FEES
Plan Check submitted
Item
Amount
Reviewed, ready for corrections
Plan Check Deposit
Called Contact Person
Plan Check Balance
Plans picked up
Construction
Plans resubmitted
Mechanical
2"" Review, ready forcorrcctions/issue
Electrical
Called Contact Person
Plumbing
Plans picked up
S.M.I.
Plans resubmitted
Grading
Reyiew, ready for correctionsrissue
Developer Impact Fee
Called Contact Person
A.I.P.P.
Date of permit issue
Total Permit Fees
DO
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