BWFE2016-024978-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: BWFE2016-0249
Tty, D / VOICE (760) 777-7125
a FAX (760) 777-7011
DESIGN & DEVELOPMENT DEPARTMENT SPE NS 760)
BUILDING PERMIT
Property Address:
53507 VIA MALLORCA
APN:
777390010
Application Description:
TOMREI RESIDENCE / BLOCK GARDEN WALL
Property Zoning:
Application Valuation:
$1,000.00
Applicant:
BRIAN WESTLAKE LANDSCAPE INC
P 0 BOX 5175
LA QU I NTA, CA 92248
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing with Section 70001 of Division 3 of the Business and Professions Code,
and my License is in full force and effect.
License Class: C27 License No.: 857801
r.
f
G- Contractor:
OWNER ER DECIRATION
I hereby affirm under penalty of perjury that I a exempt from the Contractor's State
License Law for the following reason (Sec. 703 5, Business and Professions Code: Any
city or county that requires a permit to construct, after, 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.).
(1 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 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
Pat DEC192��6ESIDENCE _
53507 VIAMALLORCA
DNDQUINTA
DEVELOPMENT DEPARTMENT.
Contractor:
BRIAN WESTLAKE LANDSCAPE INC
P 0 BOX 5175
LA QUINTA, CA 92248
(760)250-2924
Llc. No.: 857801
777-7153
016
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 policy number are:
Carrier: AMERICAN ZURICH INSURANCE COMPANY 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 bpcome subject to the
workers' compensation provisions of Section 3700 of the or Code, I shall forthwith
comply with those provisions.
Date: /� / Applicant:
WARNING: FAILURE TO SECURE ERS' CO ENSATION COVERAGE IS UNLAWFUL,
AND SHALLSUBJECT AN EMPLOYER TO CRIMI A 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 r ating to building
construction, and hereby authorize representatives of this city to r upon the
above-mentioned property for inspection purposes.
D _ (9 Signa ure-(At pplrcant
Date: 12/19/2016
Application Number: BWFE2016-0249 Owner:
Property Address: 53507 VIA MALLORCA TOMEI RESIDENCE
APN: 777390010 53507 VIA MALLORCA
Application Description: TOMREI RESIDENCE / BLOCK GARDEN WALL LA QUINTA, CA 92253
Property Zoning:
Application Valuation: $1,000.00
Applicant: Contractor:
BRIAN WESTLAKE LANDSCAPE INC BRIAN WESTLAKE LANDSCAPE INC
P 0 BOX 5175 P 0 BOX 5175
LA QUINTA, CA 92248 LA QUINTA, CA 92248
(760)250-2924
Llc. No.: 857801
---------------------------------------------------------------------------------------------
Detail: 65' LF OF 6' GARDEN BLOCK WALLS ALONG SIDE YARDS AND COURT YARD [CITY SPECIFICATIONS] PRECISION CONCRETE BLOCK SHALL BE COVERED
WITH STUCCO, PAINT, OR TEXTURED COATING WHERE VISIBLE FROM OUTSIDE THE PROPERTY. 2013 CALIFORNIA BUILDING CODES.
FINANCIAL INFORMATION
DESCRIPTION ACCOUNT
CITY
AMOUNT
WALL/FENCE - FIRST 100 LF 101-0000-42404
0
$50.67
DESCRIPTION ACCOUNT
CITY
AMOUNT
WALL/FENCE - FIRST 100 LF PC 101-0000-42600
0
$63.33
Total Paid for BLOCK WALL: $114.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
BSAS SB1473 FEE
101-0000-20306
0
$1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
Bin //
Permit # /
El� V.
Project Address:
Qty of La QUinto
f ' Building a Safety Division
, %^�,�-!, 78-495 Caffe Tampico
La Quinta, CA 92253 (760) 777 701,2
Building Permit Application and Tracking Sheet
Q G�LLU t Cq Owner's Name:
A. P. Number:
Address:
Legal Description:
City, ST, Zip: L !n Cc, S
'
Contractor:Tele
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P oe ZMENEM
Address:
Project Description:
City, ST, Zip: (�,() `%1,I-e-1 CGl67
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Teleh
Pone:
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State Lic. # : 7
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City Lie. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
h
Telephone:
one:
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..........................
Construction Type: e: Occupancy:aneY
:
t i #
State a L c.
Alter Repair. r Demo
0Pa(cir le ne)• New Add'nroJect hP
Name of Contact Person:r
Sq. Ft.:
# Stories:
# Units:
/ ''\\
Telephone # of Contact Person: 7& 3 2Sc)? q Z y
Estimated Value of Project: j (�
# Submittal
APPLICANT: DO NOT WRITE BELOW THIS LINE
Req'd Rcc'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 Balance.
Titic 24 Cafes.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2°" Revicw, ready for corrcctions/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
II.O.A. Approval
Plans resubmitted
Grading
IN ROUSE:-
3,! Reyiciv, ready for corrcctions/issuc
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. \Vks. Appr
Date of permit issue
School Fees,
.
I
Total Permit Fees