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BWFE2015-013578-495 CALL E TAMPICO WORKER'S COMPENSATION DECLARATION LA 6UINTA, CALIFORNIA 92253 Application Number: BWFE2015-0135 Property Address: 80268 REDSTONE WY APN: 775220021 Application Description: SIGNATURE @ PGA BLOCK Property Zoning: Application Valuation: $1,431.00 Applicant: ULRICH SAUERBREY 74948 LIVE OAK STREET INDIAN WELLS, CA 92210 c&ht 4 4 Q" COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT JUN 1 N "015 C17YOFLA QUI,NTA VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 6/16/2015 Owner: RREF II CWC LAQ LLC 5927 PRIESTLY DR STE 110 CARLSBAD, CA 92008 Contractor: CALIFORNIA WEST CONSTRUCTION 1 5927 PRIESTLY DRIVE STE 110 CARLSBAD, CA 92008 (760)918-6768 Llc. No.: 927267 LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that I am licensed under provi ions of Chapter I hereby affirm under penalty of perjury one of the following declarations: 9 (commencing with Section 7000) of Division 3 of the Business and P ofessions Code, I have and will maintain a certificate of consent to self -insure for workers' and my License is in full force and effect. License Clas B License No.: 927267 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 Date:' Contractor: 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: OWNER -BUILDER DECLARATIOUProf Carrier: _ Policy Number: I hereby affirm under penalty of perjury that I am exempt fctor's State I certify that in the performance of the work for which this permit is issued, I License Law for the following reason (Sec. 7031.5, Businesss Code: Any shall not employ any person in any manner so as to become subject to the workers' city or county that requires a permit to construct, alter, improve, demolish, or repair compensation laws of California, and agree that, if I should become subject to the any structure, prior to its issuance, also requires the applicant for the permit to file a workers' compensation provisions of Section 3700 of the Labor de, I shall forthwith signed statement that he or she is licensed pursuant to the provisions of the comply with t os provisions. 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 Date: Applicant: 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 ERAG IS UNLAWFUL, WARNING: FAILURE TO SECURE WORKERS' COMPENSATIO(SAND ($500).: AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTI CIVI FINES UP TO I, as owner of the property, or my employees with wages as their sole ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDIO T COST OF compensation, will do the work, and the structure is not intended or offered for sale. COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTIOHE LABOR CODE, (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not INTEREST, AND ATTORNEY'S FEES. 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 APPLICANT ACKNOWLEDGEMENT are not intended or offered for sale. If, however, the building or improvement is sold IMPORTANT: Application is hereby made to the Building Official for a permit subject to within one year of completion, the owner -builder will have the burden of proving that the conditions and restrictions set forth on this application. he or she did not build or improve for the purpose of sale.). 1. Each person upon whose behalf this application is made, each person at whose (_) I, as owner of the property, am exclusively contracting with licensed contractors request and for whose benefit work is performed under or pursuant to any permit to construct the project. (Sec. 7044, Business and Professions Code: The Contractors' issued as a result of this application , the owner, and the applicant, each agrees to, and State License Law does not apply to an owner of property who builds or improves shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and thereon, and who contracts for the projects with a contractor(s) licensed pursuant to employees for any act or omission related to the work being performed under or the Contractors' State License Law.). following issuance of this permit. (_) I am exempt under Sec. . B.&P.C. for this reason 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. 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 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 toy6ilding construction, and hereby authorize representatives of this y(ty entey�}ion t e above mentioned property for inspection purposes. /'tgl Date: Signature (Applicant or Agent) y DESCRIPTION FINANCIAL INFORMATION ACCOUNT QTY AMOUNT PAID PAID DATE BSAS-SB1473.FEE 101-0000-20306 0 $1.00 $0.00 PAID BY. a METHOD RECEIPT # CHECK # CLTD BY Total Paid forBU1LDING STANDARDS ADMINISTRATION BSA $1.00 $0.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE WALL/FENCE - FIRST 100 LF 101-0000-42404 0 $47.86 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE WALL/FENCE - FIRST 100 LF PC 101-0000-42600 0 $60.91 $0.00 PAID BY METHOD RECEIPT # , CHECK # CLTD BY . Total Paid for FENCE OR FREESTANDING WALL TOTALS:0• $108.77 $0.00 i0 •. Permit Details PERMIT N.U.MBER ,.a « .• .BWFE120�15-6135 Cit of laluinta Description: SIGNATURE @ PGA BLOCK WALL Type: WALL/FENCE Subtype: Status: APPROVED Applied: 5/28/2015 MFA Approved: 6/9/2015 BHA Parcel No: 775220021 Site Address: 80268 REDSTONE WY LA QUINTA,CA 92253 Subdivision: Block: Lot: V92 Issued: Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $1,431.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 Details: VILLA #92 SIDE PATIO - 53 LF GARDEN WALL [ORCO SPECIFICATIONS] PRECISION CONCRETE BLOCK SHALL BE COVERED WITH STUCCO, PAINT, OR TEXTURED COATING WHERE VISIBLE FROM OUTSIDE THE PROPERTY. 2013 CALIFORNIA BUILDING CODES. Process 121 __j Applied to Approved FINANCIAL INFORMATION Printed: Tuesday, lune 16, 2015 7:24:52 AM 1 of 2 SYSTEMS • 0 0 0 o � o 0 ' NAME TYPE NAME ADDRESSI CITY STATE ZIP PHONE FAX EMAIL APPLICANT ULRICH SAUERBREY 74948 LIVE OAK STREET INDIAN WELLS CA 92210 (760)918-6768 ulrichs@uslandlink.co m CONTRACTOR CALIFORNIA WEST CONSTRUCTION 1 5927 PRIESTLY DRIVE STE 110 CARLSBAD CA 92008 1 1 (760)918-6768 1 LBELLOSO@CALWESTC 1OMMUNITIES.COM OWNER RREF II CWC LAQ LLC 5927 PRIESTLY DR STE 110 CARLS BAD CA 92008 (760)918-6768 FINANCIAL INFORMATION Printed: Tuesday, lune 16, 2015 7:24:52 AM 1 of 2 SYSTEMS Permit De0ail5 City 0- La a inta [PERMITUNID SEQID INSPECTION TYPE INSPECTOR ER COMPLETED DATE RESULT REMARKS NOTES 0 CLTD DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT # BWFEj2Q15-0135 METHOD PAID BY 0 FOOTINGS BLD BY BSAS SB1473 FEE 1 101-0000-20306 0 o SEQID INSPECTION TYPE INSPECTOR SCHEDULED DATE COMPLETED DATE RESULT REMARKS NOTES 0 CLTD DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY 0 FOOTINGS BLD BY BSAS SB1473 FEE 1 101-0000-20306 0 $1.00 $0.00 Total Paid for BUILDING STANDARDS ADMINISTRATION $1.00 $0.00 BSA: 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 o SEQID INSPECTION TYPE INSPECTOR SCHEDULED DATE COMPLETED DATE RESULT REMARKS NOTES 0 BOND BEAM BLD BURT HANADA 6/9/2015 6/9/2015 6/9/2015 APPROVED 0 FINAL" BLD 0 FOOTINGS BLD BOND INFORMATION ATTACHMENTS Printed: Tuesday, June 16, 2015 7:24:52 AM 2 of 2 SYST:MS LLLT:AJSA�J REVIEW TYPE REVIEWER SENT DATE DUE DATE RETURNED DATE STATUS REMARKS NOTES NON-STRUCTURAL - 1 WK BURT HANADA 6/9/2015 6/9/2015 6/9/2015 APPROVED BOND INFORMATION ATTACHMENTS Printed: Tuesday, June 16, 2015 7:24:52 AM 2 of 2 SYST:MS