BWFE2017-0190LICENSED 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: License No.:
pite:ownw- CTntractor:
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
sulqpcts Ife applicant to a civil penalty of not more than five hundred dollars ($500).:
L_�/ffrbs 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
o he not build or improve for the purpose of sale.).
_ , owner of the property, am exclusively contracting with licensed contractors to
construct the project. (Sec. 7044, Business and Professions Cod he ontractors' State
License Law does not apply to an owner of property whobuilds or im roves thereon,
and who contracts for the projects with a contractors I or
Icensed pu uant to the
Ptors' State License Law.).
/ m exempt under Sec. . B.&P.C. for fk�is r on
CONSTRUCTION IE�f ^G AGENCY
I hereby affirm under penalty of perjury that t ere is a construction lending agency for
the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's
Lender's
Llc. No.:
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 3770 of the Labor Code, for the performance
of the work for which this permit is issued.
I have and will maintain workers',_ompensation insurance, as required by
Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued. My w rkers' compensation insurance carrier and policy number are:
CArtPolicy Number: rtPothat in the performance oathe wor r whi this permit is issued, I
semploy any person in any manner as to/�ecome s jest to the workers'
compensation laws of California, and agree
*'at ;0
I should come subject to the
workers' compensation provisions of Sectior 3,700 of the bor Code, I shall forthwith
comply with those provisions.
Dat�//9 --0 �Aonli
WARNING: FAILURE TO SECURE WORKOW POMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TOCIM INAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,)00). 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 t its application.
1. Each person upon whose behalf this ap�,lication is made, each person at whose
request and for whose benefit work is perfoomed 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 Citb of La Quinta, its officers, agents, and
employees for any act or omission related tc the work being performed under or
following issuance of this permit.
2. Any permit issued as a result of this appication becomes null and void if work is not
commenced within 180 days from date of is: uance 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 informatio Is correct.
I agree to comply with all city and county ordinances and state laws el ti to buil"ding
construction, and hereby authorize represertatives of this city to ant r the above-
mentioned property
/for
inspection purposes
t)3[P1 /el/ / SIPnatr Anont.
aw
VOICE (760) 777-7125
78-495 CALLE TAMPICO
t
FAX(760)777- 7011
LA QUINTA, CALIFORNIA
92253
DESIGN & DEVELOPMENT DEPARTMENT
INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 10/5/2017
Permit Type/Subtype:
WALL/FENCE/CITY STANDARD/PRE-APPROVED
Owner:
Application Number:
BWFE2017-0190
RAMIRO MENDOZA
Property Address:
77825 CALLE NOGALES
77825 CALLE NOGALES
APN:
773332001
LA QUINTA, CA 92253
Application Description:
MENDOZA / 110 LF BLOCK
WALL AT FRONT AND SIDE YARD
Property Zoning:
Application Valuation:
$7,000.00
.Applicant:
,
Contractor:
RAMIRO MENDOZA
OWNER BUILDER
77825 CALLE NOGALES
_
LA QUINTA, CA 92253
;ITY OFli3OUINTA
;I'nL4kl,:4'!IT',EVF-LOKiEMOUARTMENT
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: License No.:
pite:ownw- CTntractor:
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
sulqpcts Ife applicant to a civil penalty of not more than five hundred dollars ($500).:
L_�/ffrbs 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
o he not build or improve for the purpose of sale.).
_ , owner of the property, am exclusively contracting with licensed contractors to
construct the project. (Sec. 7044, Business and Professions Cod he ontractors' State
License Law does not apply to an owner of property whobuilds or im roves thereon,
and who contracts for the projects with a contractors I or
Icensed pu uant to the
Ptors' State License Law.).
/ m exempt under Sec. . B.&P.C. for fk�is r on
CONSTRUCTION IE�f ^G AGENCY
I hereby affirm under penalty of perjury that t ere is a construction lending agency for
the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's
Lender's
Llc. No.:
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 3770 of the Labor Code, for the performance
of the work for which this permit is issued.
I have and will maintain workers',_ompensation insurance, as required by
Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued. My w rkers' compensation insurance carrier and policy number are:
CArtPolicy Number: rtPothat in the performance oathe wor r whi this permit is issued, I
semploy any person in any manner as to/�ecome s jest to the workers'
compensation laws of California, and agree
*'at ;0
I should come subject to the
workers' compensation provisions of Sectior 3,700 of the bor Code, I shall forthwith
comply with those provisions.
Dat�//9 --0 �Aonli
WARNING: FAILURE TO SECURE WORKOW POMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TOCIM INAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,)00). 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 t its application.
1. Each person upon whose behalf this ap�,lication is made, each person at whose
request and for whose benefit work is perfoomed 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 Citb of La Quinta, its officers, agents, and
employees for any act or omission related tc the work being performed under or
following issuance of this permit.
2. Any permit issued as a result of this appication becomes null and void if work is not
commenced within 180 days from date of is: uance 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 informatio Is correct.
I agree to comply with all city and county ordinances and state laws el ti to buil"ding
construction, and hereby authorize represertatives of this city to ant r the above-
mentioned property
/for
inspection purposes
t)3[P1 /el/ / SIPnatr Anont.
Date: 10/5/2017
Application Number: BWFE2017-0190 Owner:
Property"Address: 77825 CALLE NOGALES RAMIRO MENDOZA
APN: 773332001 77825 CALLS NOGALES
Application Description: MENDOZA / 110 LF BLOCK WALL AT FRONT AND SIDE YARD LA QUINTA, CA 92253
Property Zoning:
Application Valuation: $7,000.00
Applicant: Contractor:
RAMIRO MENDOZA OWNER BUILD, --R
77825 CALLE NOGALES
LA QUINTA, CA 92253 ,
LIc. No.:
Detail: 55LF OF 6' GARDEN WALL EAST PROPERTY LINE AND 55LF OF 3'6" HIGH BLOCK WALL AT NORTH PROPERTY UNE [ANGELUS 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.
FINANCIAL INFORMATION
. DESCRIPTION ACCOUNT QTY
AMOUNT
WALL/FENCE - EA ADDITIONAL 50 LF
101-0000-42404 0
$15.60
DESCRIPTION
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: $132.63
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
TOTALS:4:
n
Bin#
40 City of La Quinta
0% Building & Safety Division .
78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit#
Project Address: f) . p
I� 9
Owner's Name:
A.P. Number
Address: n
IJ ,Y•�
Legal Description:
City, ST, Ziip: /
W
Contractor:
./
Telephone:
p 60 Bf�o ° deo
Address:
Project Description:
W S Gr
i J
City, ST, Zip:
,
Telephone:
- - - -
__.
-
State Lic. #:
City Lic #:
Arch, Engr., Designer:
Address:
City, ST, Zip:
Telephone:
Construction Type: /J
Occupancy:
State Lic. #:
Proj. Type
New
Add'n
Alter
Repair
Demo
Name of Contact:
SgFt:
#Stories
# Units:
Telephone of Contact:
Estimated Value of Project:
�J(/
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check Submitted
Item
Amount
Structural Cates
Reviewed, ready for corrections
Plan Cl-eck Deposit:
Truss Cates
Called Contact Person
Plan Ctcck Balance:
Title 24 Cates
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 /
Develo)er Impact Fee
Planning Approval
Called Contact Person
A.I.P.P'
Pub. Wks. Apps
Date of permit issue
School Fees
Total P✓rmit Fees