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BWFE2016-0120LICENSED 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: B License No.: 410408 r Qe:� Contras OWNER -BUILDER DECR ION I hereby affirm under penalty of perjury that I am ex pt from the Contractor's State License Law for the following reason (Sec. 7031.5, usiness 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 Add WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have nd will maintain a certificate of consent to self -insure for workers' compensation s provided fcr by Section 3700 of the Labor Code, for the performance pp"r r which this permit is issued. h ve and will maintain workers' compensation insurance, as required by, Section 3 f 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: lY Applicant: WARNING: FAILURE TO SECURE WORKERS' COMPE A ON 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,representati oft i yto ter upon the above -menti ned roperty for inspection purpos Date: Signature (Applicant or Agent): 78-495 CALLE TAMPICO D VOICE (760) 777-7125 LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011 COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 6/1/2016 Application Number: BWFE2016-0120 Owner: Property Address: 80785 VIA MONTECITO LARRY KAY APN: 777400024 80785 VIA MONTECITO o—� Application Description: KAY / BLOCK WALL LA QUINTA, CA 92253 Property Zoning: z Application Valuation: $4,380.00tp D M Applicant: Contractor: O 3 MICHAEL JEHA CONSTRUCTION MICHAEL JEHA CONSTRUCTIO Q � fV C� 53408 VIA PISA 53408 VIA PISA m a o� LA QUINTA, CA 92253 LA QUIN`fA; CA 92253 c" M M (925)250-4038 Llc. No.: 410408 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: B License No.: 410408 r Qe:� Contras OWNER -BUILDER DECR ION I hereby affirm under penalty of perjury that I am ex pt from the Contractor's State License Law for the following reason (Sec. 7031.5, usiness 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 Add WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have nd will maintain a certificate of consent to self -insure for workers' compensation s provided fcr by Section 3700 of the Labor Code, for the performance pp"r r which this permit is issued. h ve and will maintain workers' compensation insurance, as required by, Section 3 f 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: lY Applicant: WARNING: FAILURE TO SECURE WORKERS' COMPE A ON 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,representati oft i yto ter upon the above -menti ned roperty for inspection purpos Date: Signature (Applicant or Agent): FINANCIAL •R • DESCRIPTION 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 0 $14.50 $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: $123.27 $0.00 TOTALS:00 Description: KAY / BLOCK WALL CONDITIONS NAME TYPE.L Type: WALL/FENCE Subtype: CITY STANDARD/PRE- Status: UNDER REVIEW Applied: 6/1/2016 SKH_ APPROVED Approved: Parcel No: 777400024 Site Address: 80785 VIA MONTECITO LA QUINTA,CA 92253 Subdivision: TR 29894-4 Block: Lot: A Issued: Lot Sq Ft: 0 Building Scl Ft: 0 Zoning: Finaled: Valuation: $4,380.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 CA Details: 142LF OF 6' WALL (4) SPANS PER APPROVED PLAN [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.L „, NAME""' A � � D'D'RESS1 CONTACTS _.. •• CITY••••,• ........ 5...., TATE ZIP _ .,...._ PHONE FAX EMAIL APPLICANT MICHAEL JEHA CONSTRUCTION 53408 VIA PISA LA QUINTA CA 92253 JEHACONSTRUCTION@ AOL.COM CONTRACTOR MICHAEL JEHA CONSTRUCTION 53408 VIA PISA LA QUINTA CA 92253 1EHACONSTRUCTION9 AOL.COM OWNER LARRY KAY 80785 VIA MONTECITO LA QUINTA CA 92253 FINANCIAL INFORMATION Printed: Wednesday, June 01, 2016 8:28:35 AM 1 of 2 (re?i.J L.J SYSTEtitS INSPECTIONS ATTACHMENTS .... Printed: Wednesday, June 01, 2016 8:28:35 AM 2 of 2 sysTEMS CLTD DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY BY , BSAS SB1473 FEE 1 101-0000-20306 0 $1.00 $0.00 Total Paid for BUILDING STANDARDS ADMINISTRATION $1.00 $0.00 - BSA: WALL/FENCE - EA 101-0000-42404 0 $14.50 $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: $123.27 $0.00 TOTALS: $124.27 00 INSPECTIONS ATTACHMENTS .... Printed: Wednesday, June 01, 2016 8:28:35 AM 2 of 2 sysTEMS Bin # City of La Quinta Building u Safety Division 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit ## Project Address: D Owner's Name: A. P. Number: Address: 9 A9- (�/� ON e/ Legal Description: City, ST, Zip: Contractor: dGWA iZ el hone• Telephone: P Address: U Project Description: City, ST, Z • 3 �s 2 / l GL Telephone: State Lie. # 0&rk F2 City Lie. #; Arch., Engr., Designer: Address: City., ST, Zip: Telephone: h one: �< Con tract' s ion Type: e• an Occu c P Occupancy: State Lie. # • Project hPa (circle one): New Add'n Alter Repair r Dem o Name of Contact Person: Sq. Ft.: #Stories: #Units: Telephone # of Contact Person: Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # 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"" Review, ready for correctionsfissue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN ROUSE:- '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 1;1 --------------' I