BWFE2016-0117•t,
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application Description:
Property Zoning:
Application Valuation:
BWFE2016-0117
54640 AVENIDA RUBIO
TAtyl
4 VOICE (760) 777-7125
D
FAX (760) 777-7011
COMMUNITY DEVELOPMENT DEPARTMENT. INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 5/23/2016
Owner:
JEFFREY WILLIAMSON
774272007
JEFFREY WILLIAMSON / BLOCK WALL
$5,500.00
Applicant:
RAY M DUFF
13130 SANTA YSABEL
DESERT HOT SPRINGS, CA 9224b
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 Professio s Code,
and my License is in full force and effect.
License Class: C29, C27, C-8. B License No., 47
D — Contour:
V OWNER -BUILDER D RATION
I hereby affirm under penalty of perjury that I a 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't
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 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
Lender's Address:
, 92253
131 ANTI YS%LBEY 3 20 i 0
DES -`HOT PRINGS CA 9240""
(760) 29-6904
LIC.
N .;.satu2lkA'ldlitiDEVELOPM
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.
¢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 polity 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 as to become subject to the workers'
compensation laws of California, and agree that, if I should become subject to the
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with those provisions.
SIP I .. ppliccan�t'.
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 9706 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 hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
Dates !!�Signature:(Applicant`'o�Agent)
Description: JEFFREY WILLIAMSON / BLOCK WALL
Type: WALL/FENCE Subtype: CITY STANDARD/PRE- Status: UNDER REVIEW
Applied: 5/23/2016 RSE
APPROVED
Approved:
Parcel No: 774272007 Site Address: 54640 AVENIDA RUBIO LA QUINTA,CA 92253
Subdivision: SANTA CARMELITA VALE LA QUINTA Block: 269 Lot: 18
Issued:
UNIT 25 .
Lot Scl Ft: 0 Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $5,500.00 Occupancy Type: Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0 No. Unites: 0
Details: 98LF OF 6' GARDEN SIDE YARD [PROTO 2 CITY SPECIFICATIONS] PRECISION CONCRETE BLOCK SHALL BE COVERED WITH STUCCO,
PAINT, OR TEXTURED COATING WHERE VISIBLE FROM OUTSIDE THE PROPERTY. 2013 CALIFORNIA BUILDING CODES.
_ -
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Printed: Monday, May 23, 2016 12:14:35 PM 1 of 2
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a. AMOUNT
&
"PAID
PAID DATE.
r; RECEIPT #
' CHECK #,;
METHOD
PAID BY
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BSAS SB1473 FEE
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
i .$0..00
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Printed: Monday, May 23, 2016 12:14:35 PM 2 of 2 _ sysrrMs
FINANCIAL INFORMATION
°.DESCRIPTION,: °> ACCOUNT, � �.< ,:. :-
°+�" AMOUNTi 'PAID DATE;
" < , __:,VAIsD ,... 6
BSAS SB1473 FEE 101-0000-20306 0
$1.00
$0.00
h'PAID BY JY 1 b ; METHOD)'»°'s RECEIPT #+ $
"'r CHECK # CLTU BY
x '<;
Total Paid for BUILDING.STANDARDS ADMINISTRATION. BSA:' $1.00 $0.00
tl� 'DESCRIPTION:-,&
F `'ACCOUNT`x' z ;
QTY
$ AMOUNT
PAIDPAID:
DATE ;
a
,: _
:.
WALL/FENCE - FIRST 100 LF
101-0000-42404
0
$47.86
$0.00
'` PAID'BY k
a :.
METHOD r� i
'„, RECEIPT4i a,
ZCHECK # � '
CLTD BY
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AMOUNTa :— X
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PAID
ID, ,
+PAID DATE
igDESCRIP,TION .w :
,'
WALL/FENCE — FIRST 100 LF PC
101-0000-42600
0
$60.91
:P "S''' 4 $* �• S «`3X Xr:,
r PAID✓BY
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# � �
CHECK #
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Total Paid for FENCE OR FREESTANDING WALL: .$108.77 $0.00
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CITY OF LAQUINTA
BUILDING &•SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DA
mm�
Bin #
Permit #
+ 6- I V7
Project Address: SLibli ✓�
City of La Quinta
Building U Safety Division
787495. Calle•Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
JB Owner's Name:
A. P. Number:
Address: s���iO A !/F_
Legal Description:
City, ST, Zip: X-8 I%IC/r
Contractor:'
o. J
S �v
Telephone:
Address: 3 / U .
J) .,J r 1 s 3z' `
Project Description: 5 L /✓h t�%J=
Cit ST, Zi
ao
Ffu
TeleP hone U 2
� S 7— 277
6
:ciN
S �� y
State Lie. # : 6-7/— '741
City Lie. #;
Arch., Engr,, Designer:
!V /
Address:.
City., ST, Zip: .
hone:
_1ele
Cn tructi n TY Pe: Oc iP cY=
Lie.
P'Pe (circle one)•New' Add'n Alt' 'Repair
Demo
ty er
Name of Contact Person:Sq.
Ft.:
#Stories:
#Units:
Telephone # of Contact Person:
Estimated Value oOC)
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
Submittal
Req'd
Red'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted .
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check.Deposit
Truss Calcs.
Called Contact Person
Plan, Check I321ance
Title 24 Cates.
Plans picked up
Construction '
Floodplain plan
Plans resubmitted
Mechanical
Grading plan.
2" Review, ready for corrections/issueElectrical
Subcontactor List
Called Contact -Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A.-Approval
Plans resubmitted
Grading
IN HOUSE:- .
3r!Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees,
Total Permit Fees