BWFE2017-025778-495 CALLE TAMPICO,. -;
LA QUINTA, CALIFORNIA 92253
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DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Permit Type/Subtype: WALL/FENCE/CITY STAN OAR D/PRE-APPROVED
Application Number: BWFE2017-0257
Property Address: • 53680 AVENIDA MENDOZA
APN: 774133009
Application Description: KNOLL ENTERPRSES / 60 LF BLOCK WALL
Property Zoning:
Application Valuation: $3,000.00
Applicant:
BLOCKWORKS INC DBA A A MASONRY
77-700 DELAWARE PLACE PALM
PALM.DESERT,CA 92211
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: C29 License No.: 804168
Date: 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 ) 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: 12/11/2017
Owner:
KNOLL ENTER?RISES
74386 MYRSIPJE AVE
PALM DESERT, CA 0
Contractor: .
BLOCKWORKS INC DBA A A MASONRY
77-700 DELAWARE PLACE PALM
PALM DESERT, CA 92211
(760)360-738:
Llc. No.: 8041,58
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 perormance of the work for which this permit is
issued. My workers' compensation insurance carrier and policy number are:
Carrier: MID-CENTURY INSURANCE COMPANY Polity Number: A09472165
-I certify that in the performance •)f 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 agreethat, if I should become subject to the
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with those provisions.
Date: Applicant:
WARNING: FAILURE TO SECURE WORKERS'=OMPENSATION COVERAGE -IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100L000). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'S FEES..
APPLICANT ACK40WLEDGEMENT
IMPORTANT: Application is hereby made tc the Building Official for a permit subject to
the conditions and restrictions set forth on ":his 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 Cfry of La Quinta, its officers, agents, and
employees for any act or omission related b 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 cancella5on.
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 oadinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter upon the above-
mentioned property for inspection purpose;.
Date: Signature (Applica it or Agent):
Date: 12/11/2017
Application Number: BWFE2017-0257
Owner:
Property Address: 53680 AVENIDA MENDOZA
KNOLL ENTERPRISES
APN: 774133009
74386 MYRSINE AVE
Application Description: KNOLL•ENTERPRSES / 60 LF BLOCK WALL
PALM DESERT, CA 0
.Property Zoning:
Application Valuation: $3,000.00
Applicant:
Contractor:
BLOCKWORKS INC DBA A A MASONRY
BLOCKWORKS INC DBA A A MASONRY
77-700 DELAWARE PLACE PALM
77-700 DELAWARE PLACE PALM
PALM DESERT, CA 92211
PALM DESERT, CA 92211
(760)360-7385
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Llc. No.: 804168
betail: 60LF OF 6' GARDEN WALL AND 2 PILASTERS AT FRONT OF PROPERTY[CITY SPECIFICATIONS] PRECISION CONCRETE BLOCK SHALL BE COVERED
WITH STUCCO, PAINT, OR TEXTURED COATING WHERE VISIBLE FROM OUTSIDE THE
PROPERTY. THE AREA BETWEEN THE BACK OF CURB AND ANY
FENCING SHALL BE LANDSCAPED, HAVE A SUITABLE PERMANENT IRRIGATION SYSTEM, AND BE CONTINUOUSLY MAINTAINED BY THE PROPERTY
OWNER. 2016 CALIFORNIA BUILDING CODES.
$ Y
DESCRIPTION
l
FINANCIAL
ACCOUNT
QTY
AMOUNT
WALL/FENCE - FIRST 100 LF
101-0000-42404
0
$52.01
DESCRIPTION
ACCOUNT
QTY
AMOUNT
WALL/FENCE - FIRST 100 LF PC
101-0000-42600
0
$65.02
Total Paid for BLOCK WALL:
$117.03
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
RECORDS MANAGEMENT FEE
101-0000-42416
0
$10.00
Total Paid for RECORDS MANAGEMENT FEE:
$10.00
DESCRIPTION
ACCOUNT
QTY
'AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE:
$5.00
'l iTY OF
BUILDING & SAFETY DEPT. _ s
APPROVE
FOR CONSTRUCTION —
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