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BWFE2015-0016L,t 78-495 CALLE TA;v1PIC-O . LA QUINTA, CALIFORNIA 92253 Application Number: BWFE2015-0016 Property Address: 80020 CHAMPIONS WAY APN: 775370016 - Application Description: x+110 LF OF COMBO WALL Property Zoning: Application Value ' n: $6,875.00 Applicant: ULRICH SAUERBREY 74948 LIVE OAK STREET INDIAN WELLS, CA 92210 Twr 4 1wQ" COMMUNITY DEVELOPMENT DEPARTMENT 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 i full force and effect. License Class B License No.: 927267 Date: S Contractor. OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt froLtho tractor's State License Law for the following reason (Sec. 7031.5, Business atractor's 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 Name Lender's Ad VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 1/28/2015 Owner: LQR GOLF 1 BUSH ST STE 1100 SAN FRANCISCO, CA 0 Contractor: CALIFORNIA WEST CONSTRUCTION 1 5927 PRIESTLY DRIVE STE 110 CARLSBAD, CA 92008 ;760)918-6768 Llc. No.: 927267 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�k for which this permit is issued. G► 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 subj t to the workers' compensation provisions of Section 370 of the Labor e, I all forthwith comply with yhose provisions. Dater Z Applicant: WARNIN : FAILURE TO SECURE WORKERS' COMPENSATION (ND RAGE IS NLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIESCIVIL FIN S UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITIO THE T 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 ar:d 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 uilding construction, and hereby authorize representatives of this c' y to enter n t e above- mentione roperty for inspection purposes. d - Dat, �b Signature (Applicant or Agent)l FINANCIAL INF ORMATION D`ESGRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid for BUILDING STANDARDS ADMINISTRATION BSA $1.00 $0.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE WALL/FENCE - EA ADDITIONAL 50 LF 101-0000-42404 of $62.36 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE WALL/FENCE - FIRST 100 LF 101-0000-42404 0 $47.86 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE WALL/FENCE - FIRST 100 LF PC 101-0000-42600 0 $60.91 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid for FENCE OR FREESTANDING WALL $171.13 $0.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RET WALL <=12 - EA ADD 50 LF 101-0000-42404 0 $14.50 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RET WALL <=12 - FIRST 100 LF 101-0000-42404 0 $47.86 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RET WALL <=12 - FIRST 100 LF PC 101-0000-42600 0 $60.91 .$0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid for RETAINING WALL $123.27 $0.00 40 $0.00 Description: 110 LF OF COMBO WALL ADDITIONAL Type: WALL/FENCE Subtype: Status: APPROVED Applied: 1/12/2015 SKH Approved: 1/28/2015 SKH Parcel No: 775370016 Site Address: 80020 CHAMPIONS WAY LA QUINTA,CA 92253 Subdivision: TR 29421 Block: Lot: 110 Issued: Lot Scl Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $6,875.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 Details: 110 LF OF COMBO WALL PER APPROVED DETAIL. 2013 CALIFORNIA BUILDING CODES. Printed: Wednesday, January 28, 2015 10:06:13 AM 1 of 3 CR� SY.C7FM.S ADDITIONAL CHRONOLOGY CHRONOLOGY TYPE STAFF NAME ACTION DATE COMPLETION DATE NOTES 1-13-15 RECEIVED DETAIL, NO LA QUINTA SIGNATURES OR STAMPS PER PLANS ALREADY APPOVED FOR SIGNATURE E-MAIL STEPHANIE KHATAMI 1/12/2015 1/12/2015 DEVELOPMENT ONLY. 1-14-15 LOCATED PREVIOUS WALL PERMIT FOR WALL DETAIL APPROVED FOR THE SIGNATURE ONLY. RECEIVED APPLICATION AND PLANS FROM ULRICH, WAITING PLAN CHECK SUBMITTAL STEPHANIE KHATAMI 1/8/2015 1/8/2015 FOR WALL DETAIL. CAN'T ISSUE UNTIL PUBLIC WORKS RECEIVED APPROVES THE TRACT MAP. CONDITIONS CONTACTS NAME TYPE NAME ADDRESSI CITY STATE ZIP PHONE FAX • EMAIL APPLICANT ULRICH SAUERBREY 74948 LIVE OAK STREET INDIAN WELLS CA 92210 ulrichs@uslandlink.co m Printed: Wednesday, January 28, 2015 10:06:13 AM 1 of 3 CR� SY.C7FM.S NAME TYPE " NAME ADDRESSI CITY STATE ZIP PHONE FAX EMAIL CONTRACTOR CALIFORNIA WEST CONSTRUCTION 1 5927 PRIESTLY DRIVE CARLSBAD CA 92008 STE 110 OWNER LQR GOLF 1 BUSH ST STE 1100 SAN FRANCISCO CA 0 FINANCIAL INFORMATION CLTD DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY BY BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00 Total Paid forBUILDING STANDARDS ADMINISTRATION $1.00 $0.00 BSA: WALL/FENCE - EA 101-0000-42404 0 $62.36 $0.00 ADDITIONAL 50 LF 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 $171.13 $0.00 RET WALL <=12 - EA 101-0000-42404 0 $14.50 $0.00 ADD 50 LF _ RET WALL <=12 - FIRST 101-0000-42404 0 $47.86 $0.00 100 LF RET WALL <=12 - FIRST 101-0000-42600 0 $60.91 $0.00 100 LF PC 1 Total Paid for RETAINING WALL $123.27 $0.00 TOTALS:00 Printed: Wednesday, January 28, 2015 10:06:13 AM 2 of 3 CRt/l/ SY.CTFMS BOND INFORMATION ATTACH M E NTS Printed: Wednesday, January 28, 2015 10:06:13 AM 3 of 3 CR CY.CTFM.S