BWFE2017-001678-495 CALLE TAMPICO 4-: �VOICE (760) 777-7125
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011
DESIGN '& DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT,
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.
fLicensee Claass: B./C33. C53. C-9. C30, C20:'C36�C21 License No.: 581636
Date:- //// 7 Contract
OWNER-BUILDER'DECLARATION .
I hereby affirm under penalty of perjury that l 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)'oe that he or sheJs 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,n&e 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.r of
apply to an owner of property 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 with1icensed 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)Jicensed pursuant to
the Contractors' State License Law.).
(_J I am exempt under Sec. B.&P.C. forthisreason
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:
.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'
77
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 policy number are:
Carrier: STATE COMPENSATION INSURANCE FUND Policy Number: 9087965
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 be 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
employe es:for any act or omission related to the work being performed under or
following issuance of.this permit.
2. Any permit issue&as a result of this•application becomes null and void if work is
riot 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
a bove- mentionedy roperty for inspection purposes.
Dat�'Z T Signature (Applicant or Agent t)' -'
Date: 2/6/2017
Application Number:
BWFE2017-0016
Owner:
Property Address:
53825 AVENIDA RAMIREZ
ANDREW SIPOVAC IT
APN:
774161018
Property Zoning:
Application Valuation:
$10,000.00
`C�lCMD
Applicant:
Contractor:
SIPOVAC CONSTRUCTION
INC
SIPOVAC CONSTRUCTION;:
W
72651 THEODORA LANE
72651;THEODORA LANE
PALM DESERT, CA 92H.0
PALM DESERT, CA 92260 m ay
(760)567-2347 y
Uc. No.: 581636 m
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.
fLicensee Claass: B./C33. C53. C-9. C30, C20:'C36�C21 License No.: 581636
Date:- //// 7 Contract
OWNER-BUILDER'DECLARATION .
I hereby affirm under penalty of perjury that l 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)'oe that he or sheJs 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,n&e 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.r of
apply to an owner of property 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 with1icensed 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)Jicensed pursuant to
the Contractors' State License Law.).
(_J I am exempt under Sec. B.&P.C. forthisreason
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:
.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'
77
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 policy number are:
Carrier: STATE COMPENSATION INSURANCE FUND Policy Number: 9087965
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 be 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
employe es:for any act or omission related to the work being performed under or
following issuance of.this permit.
2. Any permit issue&as a result of this•application becomes null and void if work is
riot 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
a bove- mentionedy roperty for inspection purposes.
Dat�'Z T Signature (Applicant or Agent t)' -'
Application Number:
BWFE2017-0016
Property Address:
53825AVENIDA kAMIREZ
APN:
774161018
Application Description:
SIPOVAC RESIDENCE / BLOCK WALL
Property Zoning:
Application Valuation:
$10,000.00
Applicant:
SIPOVAC CONSTRUCTION
INC
72651 THEODORA LANE
PALM DESERT, CA92260
Owner:
ANDREW SIPOVAC
Contractor:
SIPOVAC CONSTRUCTION INC
72651 THEODORA LANE
PALM DESERT, CA 92260
(760)567-2347
Llc. No.: 581636
Date: 2/6/2017
Detail: 155 LF COMBINATION WALL (ORCO SITE-SPECIFIC SPECIFICATIONS) + 75 LF GARDEN WALL AT 6'0" HEIGHT (CITY SPEC) + 25 LF GARDEN WALL @ 5'0"
HEIGHT (CITY SPEC) + 20 LF @ 4'0" HEIGHT (CITY SPEC). + (2) PILASTERS (CITY SPEC) 275 TOTAL LF OF WALL. PRECISION CONCRETE BLOCK SHALL BE
COVERED WITH STUCCO, PAINT, OR TEXTURED COATING WHERE VISIBLE FROM OUTSIDE THE PROPERTY. PER 2016 CALIFORNIA BUILDING CODES
• • f [t r
DESCRIPTION ;' 'T•'
. ACCOUNT.
QTY
AMOUNT
RETAINING/COMBINATION WALL EA SOLF
101-0000-42400
0
$60.80
DESCRIPTION
ACCOUNT..
QTY
AMOUNT
WALL/FENCE - EA ADDITIONAL 50 LF
"• 101`-0000 42404
0
$60.80
DESCRIPTION' ` °
` ACCOUNT
QTY
AMOUNT
WALL/FENCE - FIRST.100 LF
101-0000-42404, R
0
$50.67
DESCRIPTION .
,.ACCOUNT,,:
QTY
AMOUNT
WALL/FENCE -FIRST 100 LF,PC.
101-0000-42600;
0
$63.33
Total Paid for BLOCK WALL:
$235.60
DESCRIPTION`
ACCOUNTQTY
AMOUNT
BSAS SB1473 FEE . [ ' _ ' r
101-0000-20306 :`
0
$1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA:
$1.00
DESCRIPTION " •
ACCOUNT' • w
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE ,
{
502=0000-43611
0
$5.00
Total Paid forJECHNOLOGY. ENHANCEMENT FEE:
$5.00
4
•
Bin #
Permit #78495
U N 1� -
Project Address: S
M
Qfv'. of La Quin to
Building. &r Safety Division
Calle Tampico
La Quit ta, CA 92253 - (760) 777-701,2
Building Permrt,Appllcation i ' d Trackilig.Sheet
gZ Owner's Name:
A. P. Number:Address:.
�
Legal Description: -
City, ST, Z* �
Contractor: ctor: a
-
T h ne:
Tele- 0
P.
Address:.
�.
Projectpescription:.S
City, ST, Zip:
_ . ?
-
:O cicr
Telephone:
ne-
7
-
State Lic. # :
City Lic. #:
Arch.,'Engr., Designer:
Address:
City, ST, Zip:
Telephone: h
one:
"Construction Type: Occupancy:
cY:
t
Sa te Lic. #:.
0ect type • ProJ circle one •
.Add n Alter Repair. Demo
Name of Contact Person:
S
Sq. Ft::.
#Stories:
# Units:
Telephone # of Contact P�L,o-6
i�
Estimated,Valeerson: '
of Project. OD.O
# Submittal
.Plan
APPLICANT: DO NOT-PAITE BELOW THIS,=LINE
Req'd Rcc'd TRACKING PERMIT TEES
2
Sets
�'
Plan Cheek:subinitted
Jtcm '
Amount
Structural Calcs.
Reviewed, ready for. corrections
Plan Check Deposit
Truss Calcs.
Called;Contacf Pcrson . "
[Plan Check Balance.
Title 24 Calcs.
Plans-picked up
Construction '
Flood plain plan
Plans resubmitted
Mechanical
Grading plan.
2-." Reviciv, ready. for correclionsrissue
Electrical ; .
Subcontactor List
Called ContactPcrson
Plumbing
Gran( Dced
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading ,
IN.IiOUSE:-
Rcyiew, ready for correctionstissue
Developer.Impact Fee
Planning Approval .
'
Called Contact Person "
A.I.P.P.
Pub. Ms. Appr
Date of permit issue
School Pecs,
Total Permit Fees