BWFE2015-0021. Al
78495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: BWFE2015-0021
Property Address: 49270 BALADA CT CT
APN: 646290046.
Application Description: BLOCK WALL 69 LF
Property Zoning:
Application Valuation: $3,600.00
Applicant:
EDWARD J STRZELCZYK
P O BOX 7114
LA QUINTA, CA 92248-7114
4 XP
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
JAN 16 2015
CITY OF l (w(�J
ry DEVELOPMENT DEPARTMENT
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 C30, C29 License No.: 439904
Date:
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.).
( ) 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 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 Address:
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/16/2015
Owner:
GUILLERMO SOLITARIA
49270 BALADA CT
LA QUINTA, CA 92253
Contractor:
EDWARD 1 STRZELCZYK
P 0 BOX 7114
LA QUINTA, CA 92248-7114
(760)578-0201
LIC. No.: 439904
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 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.
Date:
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 hereby authorize representatives of this city to enter upon the above-
mentioned property for inspection purposes.
Date: Signature (Applicant or Agent):
Bin #City
Permit #
Project Address:
of La Quinta.
-Building &r Safety Division
P.O. Box 1504, 78-495 Calle Tampico .
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
ner's Name: n
w /
GvV GGCJ
A. P. Number:
Address:YLT a
Legal Description:
Contractor:
Address:G✓
City, ST, Zip:
C� Z telephone:
Project Description:
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City, ST, Zip: &
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:>:.;:<::<>;;r.:«:;::>::;::;iii:•»::>:<zz:::::::>::;:<z:;:.;:.;� ,
State Lie. # :
Arch., Engr., Designer:
City Lie. #:
Address:
City., ST, Zip:
Telephone:
hone:
State Lie. #
Name of Contact Person:
Construction Type: Occupancy:ane •
»<;>:;>;:,>.:xs::»<::>::>.<;;;>>s>sz:>s:.;•:::::.::
"'i"'""' `""'"<"`^'• " `>- ""' Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: --T#—Stories: # Units:
Telephone #,of Contact Person:Estimated
Value of Project: 0 6 • f
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
PIan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan 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
21" Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Dccd
Plans picked up
S.M.I.
II.O.A. Approval
Plans resubmitted
Grading
IN IiOUSE:-
''d Reyiew, 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
FINANCIAL INFORMATION
DESCRIPTION
ACCOUNTQTY
AMOUNT
PAID
PAID DATE
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$1.00
1/16/15
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD.BY
EDWARD J STRZELCZYK
CASH
R3436
MFA
Total Paid for BUILDING STANDARDS ADMINISTRATION BSa
$1.00
$1.00
DESCRIPTION
ACCOUNT. 8
CITY
AMOUNT +
PAID
PAID DATE
WALL/FENCE - FIRST 100 LF
101-0000-42404
0
$47.86
$47.86
1/16/15
PAID BY °
METHOD
RECEIPT #
CHECK #
CLT4D BY
EDWARD J STRZELCZYK
CASH
R3436
MFA
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
WALL/FENCE - FIRST 100 LF PC
101-0000=42600
0
$60.91
$60.91
1/16/15
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
EDWARD J STRZELCZYK
CASH
R3436
MFA
Total Paid forFENCE OR FREESTANDING WALL
TOTALS:0•
$108.77
$108.77
0•
Description: BLOCK WALL 69 LF
Type: WALL/FENCE
Subtype: Status: UNDER REVIEW
Applied: 1/16/2015 MFA
Approved:
Parcel No: 646290046 Site Address: 49270 BALADA CT Ci LA QUINTA CA 92253
Subdivision: TR 21555
Block: Lot: 14
Issued:
Lot Scl Ft: 0
Building Scl Ft: 0 Zoning:
Finaled:
Valuation: $3,600.00
Occupancy Type: Construction Type:
Expired:
No. Buildings: 0
No. Stories: 0 No. Unites: 0
APPLICANT
Details: 69 LF GARDEN BLOCK WALL [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: Friday, January 16, 2015 4:05:03 PM 1 of 2 CR
SYSTEMS
CONTACTS
NAME TYPE
NAME
ADDRES51
CITY
STATE
ZIP
PHONE
FAX
EMAIL
APPLICANT
EDWARD J STRZELCZYK
P O BOX 7114
LA QUINTA
CA
92248-
7114
CONTRACTOR
EDWARD J STRZELCZYK
P O BOX 7114
LA QUINTA
CA
92248-
7114
OWNER
GUILLERMOSOLITARIA
49270BALADACT
LAQUINTA
CA
92253
FINANCIAL
INFORMATION
Printed: Friday, January 16, 2015 4:05:03 PM 1 of 2 CR
SYSTEMS
DESCRIPTION
ACCOUNT
QTY
AMOUNT.
PAID
PAID DATE
. RECEIPT t;.
` CHECK ff .
METHOD
PAID BY
CLTD
DATE
DATE
BOND BEAM
FINAL"
BY
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$1.00
1/16/15
R3436CASH
EDWARD 1
MFA
REVIEWS
RETURNED STATUS REMARKS
REVIEW TYPE REVIEWER
SENT DATE DUE DATE NOTES
STRZELCZYK
Total Paid forBUILDING STANDARDS ADMINISTRATION $1.00 $1.00
BSA:
WALL/FENCE - FIRST
101-0000-42404
0
$47.86
$47.86
1/16/15
R3436
CASH
EDWARD
MFA
100 LF
STRZELQYK
WALL/FENCE - FIRST
101-0000-42600
0
$60.91
$60.91
1/16/15
R3436
CASH
EDWARD J
MFA
100 LF PC
STRZELQYK
Total Paid forFENCE OR FREESTANDING WALL- $108.77 $108.77
TOTALS:
Printed: Friday, January 16, 2015 4:05:03 PM 2 of 2 SYSTEMS
INSPECTIONS
SEQID INSPECTION TYPE
INSPECTOR
SCHEDULED
COMPLETED RESULT REMARKS
NOTES
DATE
DATE
BOND BEAM
FINAL"
FOOTINGS
AOR
PARENT PROJECTS
REVIEWS
RETURNED STATUS REMARKS
REVIEW TYPE REVIEWER
SENT DATE DUE DATE NOTES
Printed: Friday, January 16, 2015 4:05:03 PM 2 of 2 SYSTEMS