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BWFE2016-002478-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Tww 4 4Qumrw 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 $153.27 INSPECTIONS ATTACHMENTS Printed: Wednesday, February 03, 2016 3:06:31 PM 2 of 2 V , SYSTCti1S BERG Wuo1�I�Tu'0.1 w� i sa��,v�$ us,saq xlc�spue� �3un.LnJ [ ESZZ6 VINa0d17VJ'V LNI(1a V1 S1111-1 AU1171-ID 06Z99 ISM V9d 3DN9a1S321 SNV3C NV]d N011XIIIISNOJ IIII a a a a jE tll y 51 it 119 � N R i R o � d� _ d � �j ry n ♦ n c �- O - N o • R u r- o e' Si d C fl 1I 4 �l di 2 ♦n<�o�o- H3V3e 3,ee3d CITY OF LA QUINTA BUILDING & SAFM DEFT. APPROVED FOR CONSTRUCTION DA at EgqE4yy Q d MMI �a1:ba; U N B;" # S 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� s 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: it �D Telephone: ele P ,2 —A I �S Address:8/(,),0 C Project Description: 22�1.4•e4,G al City, ST, Zip: Z�3 Lyvt Pne• h Tele o . in G / 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 ..............................................:...... 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 .