BWFE2015-0220f maw
78-495 CALLE TAMPICO •
LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
VOICE (760).777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/16/2015
Application Number:
BWFE2015-0220
Owner:
Property Address:
51701 AVENIDA JUAREZ
STEPHANIE 1ENSEN
APN:
Application Description:
773113014
JENSEN RESIDENCE BLOCK WALL REPA
0 LF Q
51701 AVENIDA JUAREZ
LA QUINTA, CA 92253
Property Zoning:
Application Valuation:
$1,500.00
2015
[=INTA
Applicant:
Contractor:
ORTIZ MASONRY
COMMUNfTYDEVELOPMEMDEPARTMEM
ORTIZ MASONRY
68-195 TACHEVAH DRIVE
68-195 TACH EVAH DRIVE ,
CATHEDRAL CITY, CA 92234
CATHEDRAL CITY, CA 92234
(760)408-8791
Llc. No.: 784762
---------------------------------------------------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjurythat 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.: 784762
CDate: l_,P' J�I 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, 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
Lender's Address:
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:_ 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: / l� _Applicant:
AQa.ZQ—
WARNING: FAILURE TO tSECURE WORKERS' COMPENSATION CO ERAGE 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: l (o' J s t Signature (Applicant or Agent)
,
DESCRIPTION `
INFORMATIONFINANCIAL
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE.
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$1.00
6/16/15
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
ORTIZ MASONRY
CHECK
MR184
7232
MFA
Total Paid forBUILDING STANDARDS ADMINISTRATION BSA
$1.00
$1.00
DESCRIPTION -
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
WALL/FENCE - FIRST 100 LF
101-0000-42404
0
$47.86
$47.86
6/16/15
PAID BY
METHOD
RECEIPT # •
CHECK #
CLTD BY
ORTIZ MASONRY
CHECK
MR184
7232
MFA
DESCRIPTION
ACCOUNT
QTY;
AMOUNT
PAID
PAID DATE
WALL/FENCE - FIRST 100 LF PC
101-0000-42600
0
$60.91
$60.91
6/16/15
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
ORTIZ MASONRY
CHECK
MR184
7232
MFA
Total Paid forFENCE OR FREESTANDING WALL-
TOTALS:0•
$108.77
$108.77
0•
Description: JENSEN RESIDENCE BLOCK WALL REPAIR 30 LF
Type: WALL/FENCE Subtype: Status: ISSUED
Applied: 6/16/2015 MFA
Approved: 6/16/2015 MFA
Parcel No: 773113014 Site Address: 51701 AVENIDA JUAREZ LA QUINTA,CA 92253
Subdivision: SANTA CARMELITA VALE LA QUINTA Block: 25 Lot: 4
Issued: 6/16/2015 MFA
UNIT 2
ZIP
Lot Sq Ft: 0 Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $1,500.00 Occupancy Type: Construction Type:
Expired: 12/13/2015 MFA
No. Buildings: 0 No. Stories: 0 No. Unites: 0
68-195 TACHEVAH
DRIVE
Details: 30 LF OF 6' GARDEN WALL AT PROPERTY [CITY SPECIFICATIONS] PRECISION CONCRETE BLOCK SHALL BE COVERED WITH STUCCO,
PAINT, OR TEXTURED COATING WHERE VISIBLE FROM OUTSIDE THE PROPERTY. 2013 CALIFORNIA BUILDING CODES.
CHRONOLOGY
CONDITIONS
NAME TYPE
NAME
ADDRESSI
CONTACTS
CITY
STATE
ZIP
PHONE
FAX
EMAIL
APPLICANT
ORTIZ MASONRY
68-195 TACHEVAH
DRIVE
CATHEDRAL
CITY
CA
92234
(
CONTRACTOR
ORTIZ MASONRY
68-195 TACHEVAH
DRIVE
CATHEDRAL
CITY
CA
92234
(
OWNER
STEPHANIE JENSEN
51701 AVENIDA JUAREZ
LA QUINTA
I CA
92253
(
PINANCIAL INFORMATION
Printed: Tuesday, June 16, 2015 12:39:34 PM 1 of 2 J
SYSTEMS
BOND INFORMATION
ATTACHMENTS
Printed: Tuesday, June 16, 2015 12:39:34 PM 2 of 2
' ?SYS7EnAS
CLTD
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID BY
,
BY
BSAS 581473 FEE
101-0000-20306
0.
$1.00
$1.00
6/16/15
MR184
7232
CHECK
ORTIZ MASONRY
MFA'
Total Paid forBUILDING STANDARDS ADMINISTRATION
$1.00
$1.00
BSA:
WALL/FENCE - FIRST
101-0000-42404
0
$47.86
$47.86
6/16/15
MR184
7232
CHECK
ORTIZ MASONRY
MFA
100 LF
WALL/FENCE -FIRST
101-0000-42600
0
$60.91
$60.91
6/16/15
MR184
7232
CHECK
ORTIZ MASONRY
MFA
100 LF PC
Total Paid forFENCE OR FREESTANDING WALL
$108.77-
$108.77
TOTALS:0•
i• .77
INSPECTIONS
SEQID
INSPECTION TYPE
INSPECTOR
SCHEDULED
COMPLETED
RESULT
REMARKS
NOTES.
DATE
DATE
BOND BEAM
BLD
FINAL"
BLD
FOOTINGS
BLD
BOND INFORMATION
ATTACHMENTS
Printed: Tuesday, June 16, 2015 12:39:34 PM 2 of 2
' ?SYS7EnAS
Bin #
City of La Quinta
Building &r Safety Division
O P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: I -�p I ✓�r,,d` aeaia'Z-
Owner's Name:
A. P. Number:
Address: 45 'Z o 1 / wLV� �olo� Tt ya.VeZ
Legal Description:
City, ST, Zip: Lz- a A,-�r. C'I . 22 S 3
Contractor: U Y L f
iMat Ut!t
Address:Ci S Vk L L --R- V ii%K-
Project Description: 3 v �,o�k V -c, 11
City, ST, Zi
Y P 2,Ava C► C V 3��
-7
Telephone: 6 0
U
L
'Fu cc
5 m
State Lie. # : �% r4—h to`L
City Lie.
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone: P
o e.•
Con tr
s ucti Type: e• ane
Occu
Y P Occupancy:
Lie. •
State #.
Project type (circle one): New Add'n Alter Re a' Demo
P
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: -7 + v% cZj"1
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
11
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cales.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2°4 Review, ready for corrections/issue
Electrical
Subeontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I. .
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
"d 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
P
v
s
S
S
471
40
P
II
h
d
rN,
0
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