BWFE2016-0104111
Applicant:
M O,MASONRY INC
45093 COEUR D'ALENE DRIVE
INDIO, CA 92201
• 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.
License Class: C29 License No.: 920321�/�/�
tactor: V ' \ ('/ �/O1Q2 1�' (21 Lk
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 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:
/D a
q 0 0 777-7125
F ) 77-7011
��, j • IN N (7 777-7153
Y L 2016
C�rya 5/2/2016
Pit
Contractor:
M 0 MASONRY INC
45093 COEUR D'ALENE DRIVE
INDIO, CA 92201
(760)574-3313
Llc. No.: 920321
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:�� O��[� 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 ($100,000). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT: Application is hereby made to the Building Official for a permit subject to .
the conditions and restrictions set forth on this application.
1. Each person upon whose behalf this application is made, each person at whose.
request and for whose benefit work is performed under or pursuant to any permit
issued as a result of this application , the owner, and the applicant, each agrees to, and
shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and
employees for any act or omission related to the work being performed under or
following issuance of this permit.
2. Any permit issued as a result of this application becomes null and void if work is
not commenced within 180 days from date of issuance of such permit, or cessation of
work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
Date: Signature (Applicant or Agent)
w.
as:--�>r r:.��F -s ��3, 7•$�.a�ar .,r. sxi'R-�-fid t,.:. '.va�.:¢Y� .x .ih
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M O MASONRY -INC CHECK 1115180 1365 MFA
.Total Paid for BUILDING STAN DARDS'ADMINISTRATION'BSA: $1:00. $1.00
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AID,
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cPAIDhE�r
WALL/FENCE EA,ADDITIONAL 50 LF
°101-0000-42404
0
$43.50
$43.50.
5/2/16 .
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MCI MASONRY INC
CHECK
R15180
1365
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PAID DATE-
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WALL/FENCE,-'FIRST 100 LF :
Aol-'0000-42404
0
$47.86
$47.86
5/2/16.
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WALL/FENCE -;FIRST 100 LF PC ;
101=0000-42600
0
$60.91
$60.91
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METODU
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a sR�CEIPT #�
CHECK #CLTDsBY
M O MASONRY INC ..
CHECK
'1115180 ._`..:.
1365
MFA
Total'Paid for: FENCE•ORTREESTANDING WALL: $152.27 ,` $152.27
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PAID {
PAID`DATE
- RET WALL<=1'2-:EA-ADD 50 LF"
101=0000-42404 '
0
$29.00
$29.00
5/2/16
"12s.�rF
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.RECEIPT..'r'`
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M'O MASONRY INC
CHECK
1115180
1365
MFA
r ���� DESCRIPTION �:
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�z;PAID Y
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PAID>DATE
xa,�k e.f:,.. T.'::
WALL <=12 = FIRST 100 LF
101-0000-42404
0...
$47.86
$47.86
5/2/16
FRET
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PAID BY r
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M.O MASONRY INC
•CHECK:.
R15180
1365
MFA
I% .r.C.'PRC....,u:�L
ION
DESCRIPTIONS,
�, ,ACCOUNT ,r
TY
-g ` ' "AMOUNT n
„u :.r
n �.;:
�..,,., =_., 00
,� •,
..
'PAID
PA1D{DATE>
$60.91
5/2/16.
RE.T WALL <=12 -'FIRST 100•LF PC .
301-0000-42600
'0"
.$60.91
��_, 5 4>., ''�`•.c„'x'4 i,E #mss 0 �;�
': 4 f PAIDBYk
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METHOD.,
CLTD BY
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a :RECEIPT#gs
CHECK r#Z
"7 M O MASONRY INC
CHECK
1115180 •
..
1365
MFA
Total'Paid for RETAINING WALL;' $137:77 $137.77
w.
Permit Details PERMIT NUMBER
` City of La Quinta BWFE201V0104
Description: TRADITION / BLOCK WALL / 3761F
Type: WALL/FENCE Subtype: CITY STANDARD/PRE- Status: ISSUED
Applied: 5/2/2016 MFA
APPROVED
Approved: 5/2/2016 MFA
Parcel No: 770370009 Site Address: 53750 DEL GATO DR LA QUINTA,CA 92253
Subdivision: TR 28867 Block: Lot: 108
Issued: 5/2/2016 MFA
Lot Sq Ft: 0 Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $16;000.00 Occupancy Type: Construction Type:
Expired: 10/29/2016 MFA
No. Buildings: 0 No. Stories: 0 No. Unites: 0
ADDRESSI
Details: 172 LF BLOCK RETAINING WALL AND 204 LF GARDEN WALL[CITY SPECIFICATIONS] THIS PERMIT FOES NOT INCLUDE THE
INSTALLATION OR CONSTRUCTION OF THE FOUNTAIN/WATER FEATURE WALL AT THE SIDE YARD. PRECISION CONCRETE BLOCK
SHALL BE•COVERED WITH STUCCO, PAINT, OR TEXTURED COATING WHERE VISIBLE FROM OUTSIDE THE PROPERTY. 2013 CALIFORNIA
BUILDING CODES.
I __j Applied to Approved
I= Approved to Issued
u .+
CHRONOLOGY
CONDITIONS
CONTACTS
NAME TYPE
NAME
ADDRESSI
CITY:
STATE
ZIP
'PHONE
FAX
EMAIL
APPLICANT
M 0 MASONRY INC
45093 COEUR WALENE
DRIVE
INDIO
CA
92201
CONTRACTOR
M 0 MASONRY INC
45093 COEUR WALENE
DRIVE
INDIO
CA
92201
OWNER
ALAN & DONNA KINSEL
1001 NW LOVEJOY ST
#PH3
PORTLAND
OR
97209
FINANCIAL INFORMATION
Printed: Monday, May 02, 2016 8:27:04 AM 1 of 2 ,
SYSTEMS
PARENT PROJECTS
ATTACHMENTS
Printed: Monday, May 02, 2016 8:27:04 AM 2 of 2 ,. srsTr:Ms
CLTD
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID BY
BY
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$1.00
5/2/16
R15180
1365
CHECK
M O MASONRY INC
MFA .
Total Paid for BUILDING STANDARDS ADMINISTRATION
$1.00 $1.00
BSA:
WALL FENCE - EA-
AADDITIONAL
101-0000-42404
0
$43.50
$43.50
5/2/16
R15180
1365
CHECK
M.0 MASONRY INC
MFA
ADDITIONAL50 LF
WALL/FENCE -FIRST
101-0000-42404
0
$47.86
$47.86
5/2/16
R15180
1365
CHECK
M 0 MASONRY INC
MFA
100 LF
WALL/FENCE - FIRST
101-0000-42600
0.
$60.91
$60.91
5/2/16
R15180
1365
CHECK
M O MASONRY INC
MFA
100 LF PC
Total Paid for FENCE OR FREESTANDING WALL: $152.27 $152.27
RET WALL <=12 - EA
101-0000-42404
0
$29.00
$29.00
5/2/16
R15180
1365
CHECK
M O' MASONRY INC
MFA
ADD 50 LF
RET WALL <=12 - FIRST
101-0000-42404
0
$47.86
$47.86
5/2/16
R15180
1365
CHECK
M 0 MASONRY INC
MFA
100 LF
RET WALLF -FIRST
101-0000-42600
0
$60.91
$60.91
5/2/16
R15180
1365
CHECK
M 0 MASONRY INC
MFA
100 LF P
L PC
Total Paid for RETAINING WALL: $137.77 $137.77
TOTALS:i4 $291.04
PARENT PROJECTS
ATTACHMENTS
Printed: Monday, May 02, 2016 8:27:04 AM 2 of 2 ,. srsTr:Ms
Bin #
City of La Quinta
Building 8f: Safety Division
78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
66 Building Permit Application and Tracking -Sheet
Permit #
Project Address: ��� �2
Owner's Name:
A. P. Number:
Address:
Legal Description: �5LOCJ(_
City, ST, Zip:
Contractor:
f`
Telephone:
one:
Address: 4r,
Project Description:'
,
City, ST, Zip: �n i" o 2zZD1
r
LLr ui.
e h '
Telephone: Po . 3
l v-
S y 3 3
L� -a- G L
State Lie. #: CN 2-0 2—k
City Lie. #;
f o LE C T
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
P o .
Construction ucti
on TYP e: Occupancy:
W Y:
[\!lam
.
State Lie. #•
DemoProJect type circle one Add'n AlterRe air
Name of Contact Person: D2C-A J.""
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: Q aQ I 3
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Reed
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Cheek Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2nd 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:-
'rd 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
.,•�:�*x ..
A
ME
CITY OF L' \ QUINTA
BUILDING & SAFETY DEPT.
APPR(:)VED
FOR CONSTRUCTION
D. < < BY
if
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I BDI2086
APPPOKD M:
o
/+, fw. C e La putnfa
P -11 -in -y Grading Plan 2
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ca. rn.z.s '
n. rc r+vad->s re rx�/ms.
CITY OF L' \ QUINTA
BUILDING & SAFETY DEPT.
APPR(:)VED
FOR CONSTRUCTION
D. < < BY
if