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BWFE2017-015078-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: BWFE2017-0150 Property Address: 53830 AVENIDA JUAREZ APN: 774151004 Application Description: BLOCKWALL Property Zoning: Application Valuation: $5,000.00 Applicant: HENRY'S MASONRY INC PO BOX 5185 LA QUINTA, CA 92248 c&'�t 4 4� Qu&& DESIGN & DEVELOPMENT DEPARTMENT BUILDING PERMIT AUG 0 9 2017 . CITY OF LA OU,NTA DESIGN AND DEVELOPMENT DEPARTMENT 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. r License Class: C29 License No.: 704270 Date e: �� 1 ✓�� 1 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.). (1 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.: i I VOICE (760) 777-712S' FAX (760) 777-70111 INSPECTIONS (760) 777-7153 i I Date: 8/9/2017 Owner: THOMAS WILLIAMS ! 53830 AVENIDA JUAREZ LA QUINTA, CA 92253 ! Contractor: HENRY'S MASONRY INC PO BOX 5185 LA QUINTA, CA 92248 (760)250-8253 Llc. No.: 704270 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 ork for which this permit is issued. II have and will maintain workers' compensation insurance, as required by Sectio 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: NORGUARD INSURANCE COMPANY Policy Number: HEWC823543 _ I certify that in the performance of the work for which this permit 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 I workers' compensation provisions of Section 3700 o the Labor Code, I shall forthwith comply with those provisions. nor 11 20/ 1 n - WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLM AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR f INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT: Application is hereby made to the Building Official for a permit subj ct to the conditions and restrictions set forth on this application. 1. Each person upon whose behalf this application is made, each person at who e request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application, he owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, an 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 wo 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. CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm under penalty of perjury that there is a construction lending agency for I agree to comply with all city and county ordinances and sZ[awsgtoIthe performance of the work for which this permit is issued (Sec. 3097, Civ. C.). construction, and hereby authorize representatives ofthis on thi mentioned property for inspection purposes. Lender's Name: Lender's Address: r Date: 8/9/2017 t Application Number: BWFE2017-0150 Owner: Property Address: 53830 AVENIDA JUAREZ THOMAS WILLIAMS 'APN: 774151004 53830 AVENIDAJUAREZ Application Description: BLOCKWALL LA QUINTA, CA 92253 Property Zoning: Application Valuation: $5,000.00 Applicant: Contractor: HE,NRY'S MASONRY INC HENRY'S MASONRY INC , PO BOX 5185 PO BOX 5185 LA QUINTA, CA 92248 LA QUINTA, CA 92248 (760)250-8253 Llc. No.: 704270 --------------- ------------------------------------- --------------------------------------- - Detail: 49' OF MASONRY GARDEN WALL 2' RET 6' GARDEN STUCCO FINISH r r ��a t J ��a FINANCIAL INFORMATION DESCRIPTION ACCOUNT ' CITY AMOUNT RETAINING/COMBINATION WALL EA 501-F 101-0000-42400 0 •$15.20 DESCRIPTION ACCOUNT CITY AMOUNT WALL/FENCE - FIRST 100 LF 101-0000-42404 0 $50.67 DESCRIPTION ACCOUNT CITY AMOUNT WALL/FENCE - FIRST 100 LF PC 101-0000-42600. 0 $63.33 Total Paid for 3LOCK WALL: $129.20 DESCRIPTION ACCOUNT CITY AMOUNT BSAS SB1473 FEE 101-0000-20306 0 $1.00 Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 DESCRIPTION ACCOUNT CITY AMOUNT DEVICES, FIRST 20 101-0000-42403 0 $25.33 DESCRIPTION ACCOUNT CITY AMOUNT DEVICES, FIRST 20 PC 101-0000-42600 0 $25.33 DESCRIPTION ACCOUNT CITY AMOUNT DEVICES/FIXTURES, ADDITIONAL 101-0000-42403 0 $73.37 DESCRIPTION ACCOUNT CITY AMOUNT DEVICES/FIXTURES, ADDITIONAL PC 101-0000-42600 0 $18.27 Total Paid for ELECTRICAL: $142.30 DESCRIPTION ACCOUNT CITY AMOUNT _TECHNOLOGY ENHANCEMENT FEE 502-0000-43611 0 $5.00 Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00 TOTALS: $277.50 Bin# City of La • Quinta Building & Safety Division 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit# Project Address: 5 3 i-3oque un . e-L J Owrner's Name: :n M y '040 Is A.P. Number Address: C,�3 g 30 Mle Ute, e7 `/ Legal Description: City, ST, Zip: 9 t Q� Contractor: hl A-5 OAU 11 Telephone: Address: Ol60 I� G raAkle' Project Description: City, ST, Zip: c e� Telephone: �UV 'A0 �a S 3 `U o1 e t' Sf �► r�tp State Lie. #: `' , 90 City Lie #: Q ' Arch, Engr., Desier. Address: City, ST, Zip: Telephone: Construction Type: Occupancy: State Lie. #: Proj. Type New Add'n AlterRepair Demo Name of Contact: SgFt:. #Stories• #Units: Telephone of Contact: Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'd TRACKING PERMIT FEES Plan Sets Plan Check Submitted Item Amount Structural Calcs Reviewed, ready for corrections Plan Check Deposit: Truss Calcs Called Contact Person Plan'Check Balance: Title 24 Calcs Plans Picked Up Construction:. Flood Plain Plan Plans Resubmitted Mechanical: Grading Plan 2nd Rev, Ready for corrections / Electrical Subcontractor List Called Contact Person Plumbing: Grant Deed Plans Picked Up S.M.I. HOA Approval Plans Resubmitted Grading IN-HOUSE 3rd Rev, Ready for corrections / Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Apps Date of permit issue School Fees Total Permit Fees a .. CITY �F LA ( QUINTA. t BUILDING & SAFETY DEPT. App FOR c APPROVED ONSTR CTION DATE BY a � F.OU aqL t4 pK �o _ oo 5 T�L� rax u"ch fi . 5 p ' - ; ., �✓ � - f. /gyp. - `T ... • r 260 9,� o c o0 i ar leo) tKi i '/5 wall