BWFE2016-009078-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
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COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: ,
BWFE2016-0090
Property Address:
78785 SANITA DR
APN:
604162017
Application Description:
RODRIGUEZ / 70LF OF 5'/6' BLOCK WALL AT FRONT YARD
Property Zoning:
u
Application Valuation:
$5,500.00
Applicant:
�
EDWARD J STRZELCZYK
that in the performance of the work for which this permit is issued, I
P O BOX 7114
r
LA QUINTA, CA 92248-7114
VOICE (760) 777-7125
FAX (760) 777-7011.
INSPECTIONS (760) 777-7153
Owner: o
I hereby affirm under penalty of perjury one of the following declarations:
RUDY RODRIGUEZ
I have and will maintain a certificate of consent to self -insure for workers'
78785 SAN ITA r
compensation;•as,provided forby Seciion.3700 of the Labor Code, for the performance
LA'QUINTA, CA 92253 n
D
M Ell
u
0CD
is issu d y workers' compensation insurance carrier and polity number -are:
0
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I hereby affirm under penalty of perjury that I am exempt from the Contractor's State •ertify
that in the performance of the work for which this permit is issued, I
Contractor: Z
r
EDWARD 1 STRZELCZYK
PO BOX 7114 - rn
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
LA QUINTA, CA 92248- 14
oth thos provisions.
Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division
;�aa�te,
3 of the Business and Professions Code) or that he or she is exempt therefrom and the
.� S Applicant:
(760)578-0201
�.
Llc. No.: 439904
WARNIN : FAI URE TO SECURE'WORKERS' C PENSATION COVERAGE IS UNLAWFUL,
LICENSED CONTRACTOR'S DECLARATION I WORKER'S COMPENSATION:DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
I hereby affirm under penalty of perjury one of the following declarations:
9 (commencing with Section 7000) of Division 3 of the Business and Professions Code,
I have and will maintain a certificate of consent to self -insure for workers'
and my License is in full force and effect.
compensation;•as,provided forby Seciion.3700 of the Labor Code, for the performance
License Class: B C10 C29 License No.: 439904
of themork forwhich this permit is issued.
�ve and will maintain workers'kcompensation insurance, as required by
Date: l 6 6 Contractor
Seciion 3700 of the Labor Code, for the performance of the work for which this permit
is issu d y workers' compensation insurance carrier and polity number -are:
OWNER -BUILDER CLARATION
Polity Number: .
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State •ertify
that in the performance of the work for which this permit is issued, I
License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any •
loy any personin any manner so asto become subject to the workers'
1cm§p6.0sation
city or county that requires a permit to construct, alter, improve, demolish, or repair
laws of California, and agree that, if I should become subject to the
any structure, prior to its issuance, also requires the applicant for the permit to file a
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
signed statement that he or she is licensed pursuant to the provisions of the
oth thos provisions.
Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division
;�aa�te,
3 of the Business and Professions Code) or that he or she is exempt therefrom and the
.� S Applicant:
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
WARNIN : FAI URE TO SECURE'WORKERS' C PENSATION COVERAGE IS UNLAWFUL,
($500).:
AND SHALL SUBJECT AN;EMPLOYER TOiCRIMINAL PENALTIES AND CIVIL FINES UP TO
(_) I, as owner of the property, or my employees with wages as their sole
ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
compensation, will do the work, and the structure is not intended or offered for sale. .
COMPENSATION; DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
(Sec. 7044, Business and Professions Code: The Contractors' State License Law does not
INTEREST, AND ATTORNEY'S FEES..
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
APPLICANT ACKNOWLEDGEMENT
are not intended or offered for sale. If, however, the building or improvement is sold'
IMPORTANT: Application is hereby made,.to the Building Official for a permit subject to
within one year of completion, the owner -builder will have the burden of proving that
the conditions and restrictions set.forthon this application.
he or she did not build or improve for the purpose of sale.).
I.Each person upon whose behalf this application is made, each person at whose
(.) I, as owner of the property, am exclusively contracting with licensed contractors
request and for•whose'b'enefit•work is,performed under or pursuant to any permit
to construct the project. (Sec. 7044, Business and Professions Code: The Contractors'
issued as a result of this application , the owner, and the applicant, each agrees to, and
State License Law does not apply to an owner of property who builds or improves
shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and
thereon, and who contracts for the projects with a contractor(s) licensed pursuant to
employees for any actor omission related to the work being performed under or
the Contractors' State License Law.).
following issuance of this permit.
(� I am exempt under Sec. . B.&P.C. for this reason
2. Any permitissued as a.result of this application becomes null and void if work is
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
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-mentioD d property for inspection purposes.
Date:e�'� Signature (Applicant or Agentt,�
Description: RODRIGUEZ / 70LF OF 5'/6' BLOCK WALL AT FRONT YARD
Type: WALL/FENCE Subtype: CITY STANDARD/PRE- Status: UNDER REVIEW
Applied: 4/6/2016 SKH
APPROVED
Approved:
Parcel No: 604162017 Site Address: 78785 SANITA DR LA QUINTA,CA 92253
Subdivision: Block: Lot:
Issued:
Lot Sq Ft: 0 Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $5,500.00 Occupancy Type: Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0. No. Unites: 0
Details: 90LF OF 5'/6' BLOCKWALL AND (6) PILASTERS AT FRONT YARD PL. CONDUIT TO EACH PILASTER FOR FUTURE LIGHTS (NEED SEPARATE
PERMIT FOR ELECTRIACL)[ANGELUS SPECIFICATIONS) PRECISION CONCRETE BLOCK SHALL BE COVERED WITH STUCCO, PAINT, OR
TEXTURED COATING WHERE VISIBLE FROM OUTSIDE THE PROPERTY. 2013 CALIFORNIA BUILDING CODES.
N�
GONDITIO ,,.. ,..
FINANCIAL INFORMATION
Printed: Wednesday, April 06, 2016 1:45:51 PM 1 of 2
SYSTEMS. '
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RECEIPT #'
. CHECK # ,'
METHOD
PAID BY,
CLTD
,
BY
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$0.00
Total Paid for BUILDING STANDARDS ADMINISTRATION
$1.00 $0.00
BSA:
DEVICES, FIRST 20
101-0000-42403
0.
$24.17
$0.00
DEVICES, FIRST 20 PC
101-0000-42600
0
$24.17
$0.00
Total Paid for ELECTRICAL: $48.34 $0.00
WALL/FENCE - FIRST
101-0000-42404
0
$47.86'
$0.00
100 LF
WALL/FENCE - FIRST
101-0000-42600
0
$60.91
$0.00
100 LF PC
Total Paid for FENCE OR FREESTANDING WALL: $108.77 $0.00
• 0i
PARENT PROJECTS
BOND INFORMATION
Printed: Wednesday, April 06, 2016 1:45:51 PM 2 of 2
SYSTEMS
lain 4..Qty of, , La QUMa
Building 8z:Safety Division,; '
Permit # A-49S Ca11e:,Tampico
La Quinta, CA 92253:- (760).77,7-7d'12•
Building Permit Application •and Tracking Sheet
Project Address: B- S" JG,�w7 Gv . ��_ Owner's Name d ��
A. P. Number:
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Address:..- lj -- ./�, s tQr✓ l/ 6'
Legal Description:
City, ST, Zi , c:
ty p' •• (J•• � Gi
Contra t' Q Z 1,G
c or: �
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hone:
Telephone:
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Address: �h 1/j
Project- Description:
City, ST, Zip: h�.�. u---
L.`%
Tele hone: '
P D- v
State Lic. # : D
City Lic. #; '
Arch., Engr., Designer:
Address:
City., ST, Zip:
ele h ne:
Telephone: P0
Construction TY Pe: cu an
: c
cY
Lc. #:
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~PrStato e t type (circle one): New Add n Alter Repairair Demo
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Name of Contact Person:
Sq. Ft.:
#Stories:
#Units:
Telephone # of Contact,Person: %�j I>
.- 7i(�
Estimated Value of Project: r1TZ):
•
APPL•ICANT:`DO NOT WRITE.BELOW THIS LINE
N Submittal 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
Title 24 Cales.
Plans picked up
•Construction '
Flood plain plan
Plans:resubmittcd
Mechanical
Grading plan
2nd Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
,Pluinbing
Grant Deed
Plans picked up
S.MA.
H.O.A. Approval
Plans resubmitted
-Grading
IN HOUSE:-
'"! Reyiewi ready for correctionsrissue
Developer Impact Fee
Planning Approval
Called Contact Person
-
A'.-I P.P.
Pub. Wks. Appr
Date of permit issue
School Fees,
"
Total Tcrmit Fees