BWFE2015-030811111111111111111111
26
78-495 CALLE TAMPICO TO � 4"i" � � VOICE (760) 777-7125 LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011
COMMUNITY DEVELOPMENT DEPARTMENT
INSPECTIONS (760) 777-7153
BUILDING PERMIT
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: C-8, CIO, C29, C53, C27, D12 License No.: 656128
Contractoral n
\ 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
I�vr 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.
au
Applicant:
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.
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 cit enter upon the
above-mentioned property for inspection purposes. ,"7
Date, Signature (Applicant or Agen
Date: 10/22/2015
Application Number:
BWFE2015-0308
Owner:
Property Address:
80736 CASTILLO DEL AREANA
AV CONST
APN:
762490020
71905 HIGHWAY 111 STE G
Application Description:
FORD / 70LF OF TV' BLOCK WALL
RANCHO MIRAGE, CA 0
Property Zoning:
Application Valuation:
$2,500.00
.
�!
Applicant:
Contractor:
Y p.
K . k „ f�
FORD
TESERRA
t_ " r
80736 CASTILLO DEL ARENA
P 0 BOX 1280
LA QUINTA, CA 92253
COACHELLA, CA 92236
I
(760)389-9222
Llc. No.: 656128
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: C-8, CIO, C29, C53, C27, D12 License No.: 656128
Contractoral n
\ 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
I�vr 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.
au
Applicant:
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.
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 cit enter upon the
above-mentioned property for inspection purposes. ,"7
Date, Signature (Applicant or Agen
FINANCIAL ,{•
DESCRIPTION
ACCOUNT
CITY
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
CITY
AMOUNT
PAID
PAID DATE
COMBINATION GARDEN/RETAINING WALL-
FIRST 10OLF
101-0000-42404
0
$95.72
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
COMBINATION GARDEN/RETAINING WALL-
FIRST 100LF PC
101-0000-42600
0
$60.91
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid for COMBINATION GARDEN/RETAINING WALL:
TOTALS:00
$156.63
$0.00
Description: FORD / 70LF OF 3'6" BLOCK WALL
Type: WALL/FENCE Subtype: CITY STANDARD/PRE- Status: UNDER REVIEW
Applied: 10/22/2015 SKH
APPROVED
Approved:
Parcel No: 762490020 Site Address: 80736 CASTILLO DEL AREANA LA QUINTA,CA 92253
Subdivision: TR 34243 Block: Lot: 20
Issued:
Lot Sq Ft: 0 Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $2,500.00 Occupancy Type: Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0 No. Unites: 0
ADDRESSI
Details: 70LF OF 3'6" COMBO WALL ANGELUS 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
CONTACTS
NAMETYPE
NAME _
ADDRESSI
CITY
STATE
ZIP'
PHONE
FAX
EMAIL
APPLICANT
FORD
80736 CASTILLO DEL
ARENA
LA QUINTA
CA
92253
CONTRACTOR
TESERRA
P 0 BOX 1280
COACHELLA
CA
92236
OWNER
AV CONST
71905 HIGHWAY 111
STE G
RANCHO
MIRAGE
CA
0
Printed: Thursday, October 22, 2015 11:38:33 AM 1 of 2
CRWSYS7EMS
DESCRIPTION
ACCOUNT
CITY
AMOUNT
PAID
PAIDDATE
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:
COMBINATION
GARDEN/RETAINING
101-0000-42404
0
$95.72
$0.00
_
WALL - FIRST 10OLF
COMBINATION
GARDEN/RETAINING
101-0000-42600
0
$60.91
$0.00
WALL - FIRST 10OLF PC
Total Paid for COMBINATION GARDEN/RETAINING WALL: $156.63 $0.00
TOTALS:00
ATTACHMENTS
Printed: Thursday, October 22, 2015 11:38:33 AM 2 of 2
RWSYSTEMS
&lira , CK In
Building a Safety Division
Permit #P.O. B'®^ 1504, 78-495 Calle Tampico
La Q'uinta, CA 9225: - (750) 777-7012
Building Permit Application and Tracldng Sheet
Project Address: UM e Owner's Name: 4 :�=c 7
A. P. Number:
Address: ga Z374a 1
Legal Description: City, ST, Zip:
Contractor: P— a M Telephone: '
Address: g�— ((Xj V ;� Project Description:
City,Zip:
, ST � 1= � � Cr4- ZZ.�
Telephone: �� ZZ Z_ " . s 70 v
State Lic. # :
Arch., Engr., Designer:
City Lic. #:
j�(> f2-ll� (y U ��CJ
Address:
5., 2. 04
City, ST, Zip:
Telephone:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
State Lic. #:
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: (p �% )�-1 !S Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
# Submittal Req'd Recd TRACDaNG . PERMIT FEES
Plan Sets ]Plan Check submitted Item Amount
Structural Calcs.
IYeviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check ]balance
Energy Calcs.
Plans g icked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2"" Review, ready for correctionslissue
Electrical
Subcontactor List
Called Coutact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Apmnl-
—.. --_
— --= - - Plans resubmitted - =-- -- -- — _
-.— - .-Grading-----
-Grading----
IN
IN HOUSE:
7rd 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