BWFE2016-0222Applicant:
M CASTILLO'S CONCRETE CO
P0BOX 5
COACHELLA, CA 92236
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: C-8. C29 License No.: 881611
Date:':�004 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 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:
VC
DQ
QCT 3 2015
Owner:�Ry OF 1A QUIPITA
OOSJtUON MKO PMENT DEPARTPAENT
Contractor:
M CASTILLO'S CONCRETE CO
P0BOX 5
COACHELLA, CA 92236
(760)398-9227
Llc. No.: 881611
(760)777-7125
(760)777-7011
(760) 777-7153
10/25/2016
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.
" AL— 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. Miworkers' compensation insurance carrier and policy number are:
Carrier: MIDWEST EMPLOYERS CASUALTY COMPANY Policy Number:
BN U W C0134789
_ 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.
Dater- Applic t
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.
CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is correct.'
I hereby affirm under penalty of perjury that there is a construction lending agency for 1 agree to comply with all city and county ordinances and state laws relating to building
the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). construction, and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
Lender's Name: ' '\
Date: I& — KI -16 Signature (Applicant or Agent):
Lender's Address: �
p
'
Date: 10/25/2016,
Application Number:
BWFE2016-0222
Owner:
Property Address:
81150 ELSWORTH PL
JIMMY FILLER
APN:
767670007
Property Zoning:
Application Valuation:
$3,487.00
Applicant:
Contractor:
M CASTILLO'S CONCRETE CO
M CASTILLO'S CONCRETE CO ..
POBOX5 •
I
P0BOX 5
COACHELLA, CA 92236
COACHELLA, CA 92236
(760)398-9227
------------------------------------------------------
----------------------------------------
LIC. No.: 881611
Detail: 41LF OF 6' EQUIPMENT WALL [CITY SPECIFICATIONS] PRECISION CONCRETE BLOCK
SHALL_ BE COVERED WITH STUCCO, PAINT, OR TEXTURED
COATING WHERE VISIBLE
`
r
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
r,
jll
.71
m V� ((-(Loa
z 0
zm
CD> >
< -M-'O fn
-4cc): < 0
M C::
�510 0 Z 4-0
z rn
>
V*/ A
'o 4
&K,
cll�
4 1 9047'
35
N sa
t
Gpcj
. RC ED
Le
. E26:80 SO- PK)ao- LeD
T 00 LIGHTm2C-3
co
F -R
S OV , , B
-n, test p
2Y,ISS-rUDS@ 16.'O'C Wt
ft-21
jt4SULANION (T(p.)
LANDING
Co.
.0 0p 1 Arc,
0 AFC,
Lso Y
/--N /
Bin #
City of La Quill to
Building & Safery Division
_ 78-495 Calle Tampico
La Quinta, CA 92253 • (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: Lot 11 A Elsworth PI. Madison Club
owner's Name: James & Carol Filler
A. P. Number:
Address:
Legal Description:
City, ST, zip:
Contractor: M Castillo's Concrete Co.Telephone:
:iS'} 'F. �jini,i�ii�i>'ri>' :?..:::.•.,:.
Address: 45116 Commerce St.
Project Description:
City, ST, Zip: Indio, CA 92201
..�-... -.-.
Telephone: (760)398-9227
_�i?J I::`;`:'6nN??'kJ�.`i:�?i!.�.�'i<S
. , ;; ;;.A>:.;<t.;.; _
1 11
Build 6 high by 8 wide block wall
State Lic. # : 881611
City Lie. #.-LIC-01 0239
5^
I.
Arch., Engr., DesignerIon
Address:
City, ST, Zip:
Telephone:
's._r:v;;;.'•r <:>;
:�.u:�?:.�:�:�•>:�:.s4tt:.3°<v�?:�>:s:<�.Construction
\...
Type: New Occupancy: Residence
State Lie. 41:
Project a circle one New Add'n Alter Repair Demo
Name of Contact Person:Matias, Castillo B.
Sq. Ft.: 41 Ift
#Stories:
# Units:
Telephone # of Contact Person: (760)398-9227
Estimated Value of Project: So
APPLICANT: DO NOT WRITE BELOW THIS LINE
11
Submittal
Rcq'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.
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2°' Review, ready for corrcelions/issue
Electrical
Subcontaclor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
$.M.[.
H.O.A. Approval
Plans resubmitted
Grading
1N HOUSE:-
'`9 Review, ready for corrections/issue
Developer Impact Tee
Planning Approval
Called Contact Person
A.I.1'.P.
Pub. Ms. Appr
Date of permit issue
School Fees,
Total Permit
.r 1160%#Fm I V CLJ
OCT 25 2016
CITY OF LA OUINTA
COMMUNITY DEVELOPMENT