BWFE2017-004178-495'CALLE TAMPICO
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LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number:
BWFE2017-0041
Property Address:
81905 FOUR SEASONS PL
APN:
767860004
Application Description:
LA QUINTA HOUSING 1 LLC/BLOCK WALL
Property Zoning:
Application Valuation:
$5,850.00
Applicant:
WOODBRIDGE PACIFIC GROUP LLC
27271 LAS RAMBLAS SUITE #100
MISSION VIEJO, CA 92691
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.: 963887
D� ate: 3 ZPi 77 Contractor:
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 Na
Lender's Address:
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date:
3/9/2017
Owner:
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LA QUINTA HOUSING 1 LLC
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81905 FOUR S(.=ASONS PL
MISSION VIEJO, CA 92691
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Contractor:
PACIFIC GRO
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WOODBRIDGE:
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27271 LAS RAMBLAS SUITE #100
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MISSION VIEJC, CA 92691
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(949)348-8162 �
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Llc. No.: 963887 l o
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one Othe 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.
<1 C:1I have and will maintain workers' compensation insurance, as required by
Section 3700 of the Labor Code, for the perfcrmance of the work for which this permit is
issued. My workers' compensation insurance carrier and policy number are:
Carrier: GRANITE STATE INSURANCE COMPA14Y Policy Number: WC065256310
_ I certify that in the performance olthe 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 fo hwith
comply with those provisions.
Date:ZZ J_L_ Applicant: �a�,,rzj
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 FCR IN SECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT: Application is hereby made to tie Building Official for a permit subject to
the conditions and restrictions set forth on th s application.
1. Each person upon whose behalf this appl cation is made, each person at whose
request and for whose benefit work is perforned under or pursuant to any permit issued
as a result of this application , the owner, andthe 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 issiance of such permit, or cessation of work
for 180 days will subject permit to cancellatio i.
I certify that I have read this application and state that the above information is correct.
I agree to comply witltall city and county ordinances and state laws relating to building
construction, and hereby authorize representztives of this city to ent upon the ab ve-
mentioned proper y for inspection purposes.
Date6: 3 Signature (Applicant or Agent
_— —
Date: 3/9/2017
Application Number: BWFE2017-0041 Owner:
Property Address: 81905 FOUR SEASONS PL LA QUINTA HOUSING 1 LLC.
APN: 767860004 81905 FOUR SEASONS PL
Application Description: LA QUINTA HOUSING 1 LLC/BLOCK WALL MISSION VIEJO, CA 92691
Property Zoning:
Application Valuation: $5,850.00
Applicant: Contractor:
WOODBRIDGE PACIFIC GROUP LLC WOODBRIDGE PACIFIC GROUP LLC
27271 LAS RAMBLAS SUITE #100 27271 LAS RAFABLAS SUITE #100
MISSION VIEJO, CA 92691 MISSION VIEJO, CA 92691
(949)348-8162
LIc. No.: 9638&7
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Detail: 90LF OF 6' GARDEN AT WEST PROPERTY LINE [PROTOTYPE II) PRECISION CONCRETE BLOCK SHALL BE COVERED WITH STUCCO, PAINT, OR
TEXTURED COATING WHERE VISIBLE FROM OUTSIDE THE PROPERTY. 2016 CALIFORNIA BUILDING CODES.
0
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
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DESCRIPTION
FINANCIAL •• •
ACCOUNT QTY
AMOUNT
WALL/FENCE - FIRST 100 LF
101-0000-42404 0
$50.67
DESCRIPTION
ACCOUNT QTY
AMOUNT
WALL/FENCE - FIRST 100 LF PC
101-0000-42600 0
$63.33.
Total Paid for BLOCK WALL:
$114.00
DESCRIPTION.
ACCOUNT
QTY
AMOUNT
BSAS SB1473 FEE
101-0000-20306
0
$1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA:
$1.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
0
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
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