BWFE2016-0254LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 {commencing with Section 7000) of yt11DaEmfex!empt
a Business and Professions Code,
and my License is in full force and effe
License Class: C29 /License No.:
Date �"v "�4 Contra
OWNER-BRATION
I hereby affirm under penalty of perjufrom 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.).
(_) 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 Na
Lender's Add
(760)413-4030
Llc. No.: 966567
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 t work for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by
ion 3 00 of the Labor Code, for the performance of the work for which this permit
i issued. My workers' compensation insurance carrier and policy number are:
Carrier: NATIONAL LIABILITY AND FIRE INSURANCE COMPANY Policy Number:
A9WC601673
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 Sectio 00 of the Labor Code, I shall forth ith
comply with th•�ossee pr visions.
Date: Z 2 /Z Applican
WARNING: FAILURE TO SECURE WOR RS' 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 stat ws relating to building
construction, and hereby authorize representatives ofthis ci t enter upon the
above-ment'.oneedddpperty for inspection purposes.
IV
: � —
DateneL / Signature (Applicant or Agent
1
78-495 CALLE TAMPICO
� Q�i D
VOICE (760) 777-7125 .
LA QUINTA, CALIFORNIA 92253
FAX (760) 777-7011DESIGN
& DEVELOPMENT DEPARTMENT
INSPECTIONS
(760) 777-7153
BUILDING PERMIT
/ 6
Application Number:
BWFE2016-0254
Owner:
Property Address:
44125 CAMINO LAVANDA
PAUL VILLANUEVA
O t—, o
APN:
604180052
44125 CAMINO LAVANDA
C7 N d w
Application Description:
VILLANUEVA / 20LF OF V BLOCK WALL IN BACK YARD
LA QUINTA, CA 92253
Property Zoning:
G�3' CD
Application Valuation:
$1,800.00
w
LLI U i
Applicant:
Contractor:
�
L M MASONRY
L M MASONRY
C=3
74074 ASTER
74074 ASTER
PALM DESERT, CA 92260
PALM DESERT, CA 92260
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 yt11DaEmfex!empt
a Business and Professions Code,
and my License is in full force and effe
License Class: C29 /License No.:
Date �"v "�4 Contra
OWNER-BRATION
I hereby affirm under penalty of perjufrom 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.).
(_) 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 Na
Lender's Add
(760)413-4030
Llc. No.: 966567
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 t work for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by
ion 3 00 of the Labor Code, for the performance of the work for which this permit
i issued. My workers' compensation insurance carrier and policy number are:
Carrier: NATIONAL LIABILITY AND FIRE INSURANCE COMPANY Policy Number:
A9WC601673
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 Sectio 00 of the Labor Code, I shall forth ith
comply with th•�ossee pr visions.
Date: Z 2 /Z Applican
WARNING: FAILURE TO SECURE WOR RS' 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 stat ws relating to building
construction, and hereby authorize representatives ofthis ci t enter upon the
above-ment'.oneedddpperty for inspection purposes.
IV
: � —
DateneL / Signature (Applicant or Agent
1
Date: 12/29/2016
Application Number:
BWFE2016-0254
Owner:
Property Address:
44125 CAMINO LAVANDA
PAUL VILLANUEVA
APN:
604180052
44125 CAMINO LAVANDA .
Application Description:
VILLANUEVA / 20LF OF 6' BLOCK WALL IN BACK YARD
LA QUINTA, CA 92253
Property Zoning:
Application Valuation:
$1,800.00
Applicant:
Contractor:
L M MASONRY
L M MASONRY
74074 ASTER
74074 ASTER
PALM DESERT, CA 92260
PALM DESERT, CA 92260
(760)413-4030
Llc. No.: 966567
------------------------------
Detail: 201-F OF 6' GARDEN WALL AT BACK YARD AT PATIO [CITY SPECIFICATIONS] PRECISION CONCRETE BLOCK SHALL BE COVERED WITH STUCCO, PAINT,
OR TEXTURED COATING WHERE VISIBLE.
DESCRIPTION
FINANCIAL INFORMATION
ACCOUNT QTY
AMOUNT
WALL/FENCE - FIRST 100 LF
101-0000-42404 0
$50.67
DESCRIPTION
ACCOUNT' QTY
AMOUNT
WALL/FENCE - FIRST 100 LF PC
• 101-0000-42600 0
$63.33
Total Paid for BLOCK WALL:
$114.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
BSAS SB1473 FEE
101-0000-20306
0
$1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA:
$1.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0.
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
Bin ## "
City of La Quilita
Building a Safety Division
P rnut ## 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-701,2
Building Permit Application and Tracking Sheet
Project Address: �ZS� 0,I-M Inv L-11i1i4 Owner's Name: f:: ALf L- YV) Wt 11,4 V f t £
A. P. Number:
Address: 61LI'—
Legal Description:
City, ST, Zip: L-0-- Coq
Contractor: L b9' n� G7
�'Y1 0
57
Telephone:
,;<.;.;.<•.7_-q.::
Address: 7 !/ 7
Project Description: �G4C K l✓19LL
City_ST,Zip: &PA(,M 1��/S1r/1
-2-
Telephone: 7 6 O/ 3 i]
D
-
2b
State Lic. #
City Lic. #;
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
one:
�State
aneY
Occupancy:
Construction Type: 5D K :
Lic. #•
ProJ'ect type circle one • New Add'n Alter Repair Demo
0
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
P
timated Value of Project: t�0
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
Submittal
Req'd
Rcc'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cales.
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
2°" Review, ready for corrections/issue
Electrical .
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
II.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'"! Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks_ Appr
Date of permit issue
Scholl Fees,
Total Permit Fees
/4—
tA
a.:
,o
n
S.,q
4 . rt / . v r w "*-)
,_Y_ / !j -r -i r�
I L)
I
4,-
Doo j.-t—
CITY OF LA QUINTA
BL.F'ILDING & SAFETY DEPT.
APPR(DVED
FOR CONSTRUCTION
DATE -VIA, I t(O -BY