BRES2016-0360LICENSED 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.: 802281
Date: Contracto r,.y
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.).
(_) 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 contractors) 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 Na
Lender's Add
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'
com nsation, as provided for by Section 3700 of the Labor Code, for the performance
of th work for which this permit is issued.
Lh
e 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 workerscompensation insurance carrier and policy number are:
Carrier: STATE COMPENSATION INSURANCE FUND Polity Number: 1542839
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 a subject to the
workers' compensation provisions of Sectioq37 of t or de, I shall forthwith
e�;w
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 7rop�eyrtayufor
rethorize representatives of this city ent the
above men ned inspection purposes.
' f
Date: Signature (Applicant or gent):
78-495 CALLE TAMPICO
VOICE (760) 777-7125
LA QUINTA, CALIFORNIA 92253
FAX (760) 777-7011DESIGN
& DEVELOPMENT DEPARTMENT
INSPECTIONS
(760) 777-7153
BUILDING PERMIT
Date: 12/15/2016
Application Number:
BRE52016-0360
Owner:
Property Address:
77921 GREY WOLF TR
RICHARD WARFIELD
APN:
623510016
77921 GREY WOLF TR
—�
Application Description:
WARFIELD / CREATE DOOR AT OUTSIDE ENTRY WAY
LA QUINTA, CA 92253
Property Zoning:
Application Valuation:
$1,500.00
c,
Applicant:
Contractor:
�
E
F CONSTRUCTION INC
F& F CONSTRUCTION INC
m oF&
cD78870
WAKEFIELD CR78870
WAKEFIELD CRLA
QUINTA, CA 92253
LA QUINTA, CA 92253
(760)275-5789
Llc. No.: 802281
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.: 802281
Date: Contracto r,.y
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.).
(_) 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 contractors) 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 Na
Lender's Add
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'
com nsation, as provided for by Section 3700 of the Labor Code, for the performance
of th work for which this permit is issued.
Lh
e 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 workerscompensation insurance carrier and policy number are:
Carrier: STATE COMPENSATION INSURANCE FUND Polity Number: 1542839
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 a subject to the
workers' compensation provisions of Sectioq37 of t or de, I shall forthwith
e�;w
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 7rop�eyrtayufor
rethorize representatives of this city ent the
above men ned inspection purposes.
' f
Date: Signature (Applicant or gent):
Date: 12/15/2016
Application Number:
BRES2016-0360
Owner:
Property Address:
77921 GREY WOLF TR
RICHARD WARFIELD
APN:
623510016
77921 GREY WOLF TR
Application Description:
WARFIELD / CREATE DOOR AT OUTSIDE ENTRY WAY
LA QUINTA, CA 92253
Property Zoning:
Application Valuation:
$1,500.00.
Applicant:
Contractor:.
F & F CONSTRUCTION INC
F & F CONSTRUCTION INC
78870 WAKEFIELD CR
78870 WAKEFIELD CR
LA QUINTA, CA'92253
LA QUINTA; CA 92253
(760)275-5789
------------------------------------------------------
Llc. No.: 802281
--------------------------------------
Detail: RELOCATE COURT YARD DOOR AND ADD LIGHTS PER 2013 CRC CODES
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FINANCIAL INFORMATION
DESCRIPTION ACCOUNT QTY AMOUNT
BSAS SB1473 FEE 101-0000-20306 0 $1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA:' $1.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DEVICES, FIRST 20
101-0000-42403
0
$25.33
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DEVICES, FIRST 20 PC
101-0000-42600
0
$25.33
Total Paid for ELECTRICAL: $50.66
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PERMIT ISSUANCE
101-0000-42404
0
$96.27
Total Paid for PERMIT ISSUANCE: $96.27
DESCRIPTION
ACCOUNT
QTY
AMOUNT
SMI - RESIDENTIAL
101-0000-20308
0
$0.50
Total Paid for STRONG MOTION INSTRUMENTATION SMI: $0.50
DESCRIPTION
ACCOUNTQTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$S.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DOOR/WINDOW, NEW/ALT, FIRST 1
101-0000-42400
0
$101.33
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DOOR/WINDOW, NEW/ALT, FIRST 1 PC
101-0000-42600
0
$115.52
Total Paid for WINDOW/SLIDING GLASS DOOR/FENESTRATION: $216.85
w
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CITY F
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s .a B DING & .,
U1L SAFETy.
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APPROV
ED
TY DEPT
NSr
FOR.CO UCTION
.DAT
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44,
i
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v1_ QUINTA
BUILDING & SAFETY DEPT,
APPR VE®
FOR CONSTRUCTION
Vo &-(LF=..i-t��
V-1
A -P C> 'Zo �J(-r t^ wiK (z)
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
0 PPRVI=®
R CONSUCTION
Bin #
Permit #
Project Address: Z r (
City of La Quinto
Building 8£ Safety Division
78-495 Calle Tampico
La Quinta, CA 92253- (760) 777-701,2
Building Permit Application and Tracking Sheet
_ Owner's Name: 37 �W-�> *tLFP
A. P..Number:
Address: '?_T q I'L9( w V L—C:_ L
Legal Description:
City, ST, Zip:
Contractor:
.r�iYl C
Telephone: •_
Address: C,_S'
Project Description: �I t S ;5 ,6— F W/\J I
City, ST, Zip: Z'Z V4A7L
V_UV IN N IEW
Telehne.
P o
Z
...........................
us. -657) ) IV
State Lic. #
City Lie. #•:
s)x
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
one:
................ ..........
an
Construction tructi n TY e: Occupancy:
P P Y
t _ ,
State a' Lrc#. •
eProJecttYPetcit le one): � N w Add'n AIter Re Repair 0
Name of Contact Person: Jed r STS7L
Sq. Ft.:
# Stories:
#Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rcc'd
TRACKING
PERMIT FEES
Plan Sets'
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plait 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.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'`d Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. 1Yks. Aper (
Date of permit issue
School Fees,
Total Permit Fees
HIDDEN CANYON HOMEOWNERS ASSOCIATION
ARCHITECTURAL AND LANDSCAPE DESIGN REVIEW
APPLICATION FORM
Some amplications. anDrovalinav take uu to 30 days.
Owner's Name: Date: '
Hidden Canyon Address:
Mailing Address: -7 o
Phone: ' Projected Start Date:
E-mail Address: Projected Completion Date:
Detailed Description of Modification:
For Landscape Approvals provide the following information if applicable:
1. A plan with 1/8" = 1'- 0" scale, north arrow.
2. DG color and size or other ground cover information.
3. Stepping stone or paver type, size and color information.
4. Stepping stone size and material type.
5. Latin and common plant names, size and quantity.
6. Show planting plan with five year diameter of proposed plant material.
7. Boulder and or river cobble color and! size. If cobble is used for drainage
purposes, provide drainage information.
8. Lighting manufacturer name and fixture type with bulb wattage.
Contractor's Name:
Contractor's. License Number:
Contractor's Telephone Number:
1
CONDITIONS OF APPROVAL AND DISCLAIMER
1. The applicant agrees that all work performed must be in substantial compliance
with the plans as approved by the ARC. In the event that any work performed
is not in substantial compliance with approved plans, the applicant understands
that he/she may be required to correct, alter, and/or remove the non -conforming
work or improvement(s) as required by the ARC, and will be responsible for any
and all costs associated therewith.
2. No materials may be stored in the street or HOA common areas at any time.
3. Construction hours are: Monday through Saturday 7:OOAM to 5:OOPM
4. Any dirt/debris in the street must be removed and washed clean every day.
5.' The Owner will be responsible for any damage to the common areas (including
streets) caused by the contractor during construction.
PLEASE NOTE THAT THE APPROVAL OF THE PROPOSED PLANS BY THE
ASSOCIATION DOES NOT CHANGE OR ABROGATE THE APPLICANT'S
OBLIGATION TO OBTAIN ALL NECESSARY PERMITS AND/OR COMPLY WITH
ALL APPLICABLE GOVERNMENTAL REGULATIONS, AND IDENTIFY OR
COMPLY WITH INDIVIDUAL PROPERTY LINES.
An architectural deposit of $1,500 is required for projects in the rear yard i.e., pools, spas,
landscaping, room additions, patio covers, barbeque, etc.
Front yard installations i.e., gates, walkways, landscaping, walls, driveways, etc. require a
deposit if $500.00 at the time of submittal for projects under $3000 in cost and $1500 for
projects over $3000. L
The deposit is refundable after the final inspection of the project by a member of the
ARC once it has been determiy that no damage was caused to the common areas.
Agreed & Accepted:
ASSOCIATION USE ONLY"
Date: /P • 7 - /4
Additional C di 'ons of A ro aa11
T our requestoias peen app�ve ely the arc committee via email as submitted. Please
ensure your vendor Wows the FWes of the associations.
Architectural Committee: Date: 10/10/16
( x ) Approved
( ) Denied
Denied/further modifications to design are needed
2