BWFE2016-002478-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
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COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number:
BWFE2016-0024
Property Address:
55290 CHERRY HILLS
APN:
775170030
Application Description:
JEANS RESIDENCE / BLOCK GARDEN WALL 220 LF
Property Zoning:
Application Valuation:
$15,000.00
Applicant:
SOUTHERN HILLS DEVELOPMENT INC
81070 CHANTICLEER
LA QUINTA, CA 92253
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.: 838041
Date: 2 —3 sContractor:
OWNER-BUI R 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 thai 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
hebasis 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).:
(1 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
i 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 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
11111111111111111111 _
23
VOICE (760) 777-7125
FAX (760) 777-7011
777-7153
Owner: -
DONALD JE
4501 REDV
IRVING, TX
Contractor:
SOUTHERN HILLS DEVELOPMENT INC
81070 CHANTICLEER
LA QUINTA, CA 92253
(760)771-3497
Llc. No.: 838041
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 sh Id become subject to the
workers' compensation provisions of Section 3-7 of a Labor Code, I shall forthwith
comply with 2 those provisions.
D'ate:' s3 -so 16 .Applicant: . J11k19X__
WARNING: FAILURE TO SECURE WORKE 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 lags relating to building
construction, and hereby authorize representatives of this cityto .ter upon the
above-mentioned property for inspection purposes. � //] _ -
�a
Date: • 2 —3—)x1`•f5ignature (Applicant or Agent
FINANCIAL INFORMATION
DESCRIPTION
ACCOUNT`
QTY
e : AMOUNT
PAID
PAID DATE`
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$1.00
2/3/16
PAID BY
METHOD :,
RECEIPT #.'
CHECK # ,
CLTD W.
JEFFERY READ
CHECK
R12560
814
MFA
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA:
$1.00
$1.00
DESCRIPTION
ACCOUNT
CITY~
: AMOUNT
PAID
PAID DATE.
WALL/FENCE - EA ADDITIONAL 50 LF
101-0000-42404
0
$43.50
$43.50
2/3/16
PAID BY
METHOD
RECEIPT #
CHECK # .
CLTD BY
JEFFERY READ
CHECK
R12560
814
MFA
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
WALL/FENCE - FIRST 100 LF
101-0000-42404
0
$47.86
$47.86
2/3/16
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD.BY
JEFFERY READ
CHECK
R12560
814
MFA
DESCRIPTION
ACCOUNT', " :
CITY
AMOUNT
PAID
PAID DATE
WALL/FENCE - FIRST 100 LF PC
101-0000-42600
0 •
$60.91
$60.91
2/3/16
PAID BY
METHOD
RECEIPT#
CHECK #
CLTD BY
JEFFERY READ
CHECK
R12560
814
MFA
Total Paid for FENCE OR FREESTANDING WALL:
$152.27.
$152.27
Description: JEANS RESIDENCE / BLOCK GARDEN WALL 220 LF
Type: WALL/FENCE Subtype: CITY STANDARD/PRE- Status: ISSUED
Applied: 2/3/2016 MFA
APPROVED
Approved: 2/3/2016 MFA
Parcel No: 775170030 Site Address: 55290 CHERRY HILLS LA QUINTA,CA 92253
Subdivision: TR 25397 Block: Lot: 30
Issued: 2/3/2016 MFA
Lot Sq Ft: 0 Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $15,000.00 Occupancy Type: Construction Type:
Expired: 8/1/2016 MFA
No. Buildings: 0 No. Stories: 0 No. Unites: 0
PHONE FAX EMAIL
Details: 228 LF GARDEN BLOCK WALL LINES [CITY SPECIFICATIONS] PRECISION CONCRETE BLOCK SHALL BE COVERED WITH STUCCO, PAINT,
OR TEXTURED COATING WHERE VISIBLE FROM OUTSIDE THE PROPERTY. 2013 CALIFORNIA BUILDING CODES.
Printed: Wednesday, February 03, 2016 3:06:31 PM 1 of 2 C9?
SYS7EAAS
FINANCIAL••
CONTACTS
DESCRIPTION ACCOUNT QTY
AMOUNT
PAID
NAME TYPE
NAME
ADDRESSI
CITY
STATE
ZIP
PHONE FAX EMAIL
APPLICANT
SOUTHERN HILLS DEVELOPMENT INC
81070 CHANTICLEER
LA QUINTA
CA
92253
(972)795-2556
CONTRACTOR
SOUTHERN HILLS DEVELOPMENT INC
81070 CHANTICLEER
LA QUINTA
CA
92253
(972)795-2556
OWNER
DONALD JEANS
4501 REDWOOD CT
IRVING
TX
75038.
(972)795-2556
Printed: Wednesday, February 03, 2016 3:06:31 PM 1 of 2 C9?
SYS7EAAS
FINANCIAL••
•
DESCRIPTION ACCOUNT QTY
AMOUNT
PAID
PAID DATE RECEIPT # CHECK # METHOD PAID BY CLTD
BY
BSAS SH1473 FEE 101-0000-20306 0$1.00
$1.00
2/3/16 R12560 814 CHECK JEFFERY READ MFA
Total Paid for BUILDING STANDARDS ADMINISTRATION
BSA:
$1.00
$1.00
Printed: Wednesday, February 03, 2016 3:06:31 PM 1 of 2 C9?
SYS7EAAS
DESCRIPTION
ACCOUNT
CITY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID BY
CLTD
BY
WALL/FENCE - EA
101-0000-42404
0
$43.50
$43.50
2/3/16
R12560
814
CHECK
JEFFERY.READ
MFA`
ADDITIONAL 50. LF
WALL/FENCE - FIRST
101-0000-42404
0
$47.86
$47.86
2/3/16
R12560
814
CHECK
JEFFERY READ
MFA
100 LF
WALL/FENCE -FIRST
101-0000-42600
0
$60.91
$60.91
2/3/16
R12560
814
CHECK
JEFFERY READ
MFA
100 LF PC
Total Paid for FENCE OR FREESTANDING WALL: $152.27 $152.27
TOTALS: $153.27 $153.27
INSPECTIONS
ATTACHMENTS
Printed: Wednesday, February 03, 2016 3:06:31 PM 2 of 2 V ,
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BUILDING & SAFM DEFT.
APPROVED
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City of La Quinta
Building 8z Safety Division
78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit
Project Address�
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Owner;s Nae: /� .$p
A. P. Number: _ D ,� 3 0
Address: Q/ L(/DDOL &4
Legal Description: 'ZaOV P 04,/— ; 2 5#cf7
City, ST, Zip:
Contractor:
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Telephone: ele
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Address:8/(,),0 C
Project Description: 22�1.4•e4,G al
City, ST, Zip: Z�3
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Pne•
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Tele o .
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State Lie. # : (�'J� I
City Lie. #.:
Arch., Engr., Designer:/&Jk2 Alaey ��
` urn
Address: 22 d fa• bl�-
City., ST, Zip: a4abawl-, (�f- Yza,6o
ne:
Telephone: t- Y
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Construction Type: Occupancy:an
cY:
Project type (circle la ne • New Add'n Alter Repair air Demo
Name of Contact Person:`/ �p�
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: - ,' - �O!?
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets,
Plan Check submitted
Item
Amount
Structural Cates.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cates.
Called Contact Person
Plan CJieck Balance.
Title 24 Cates.
Plans picked up
Construction '
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2q. 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 I10USE:-
'"' Reyiew, 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 .