BWFE2017-0078LICENSED 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: C-8. C29 ' License No.: 881611
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 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 Address:
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: MIDWEST EMPLOYERS CASUALTY COMPANY Polity Number:
BNUWC0134789
_ 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 should become subject to the
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with those provisions. LL
Date: Applicant:.,gf77'��y
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 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 laws relating to building
construction, and hereby authorize representatives of this city to enter upon,the above-
mentioned property
''for inspection purposes.
Date:4a:& Signature (Applicant or Agent): �.
78-495 CALLE TAMPICO
D t4v
VOICE
(760) 777-7125
'
LA QUINTA, CALIFORNIA 92253
FAX
FAX (760)777-7011
DESIGN & DEVELOPMENT DEPARTMENT
(760) 777-7153
BUILDING PERMIT
Date: 5/15/2017
Application Number: BWFE2017-0078
Owner:
Property Address: 78670 AVENIDA NUESTRA
ROPER MORRIS
y
APN: 770172009
92253r
ai
a w
Property Zoning:
o z o
N
Application Valuation: $5,420.00
C=::)
LO oI
1
r�
o
Applicant:
Contractor:
r
M CASTILLO'S CONCRETE CO
M CASTILLO'S CONCRETE CO
45116 COMMERCE ST STE 13
45116 COMMERCE ST STE 13
INDIO, CA 92201
INDIO, CA 92201
c
(760)398-9227
LIc. No.: 881611
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: C-8. C29 ' License No.: 881611
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 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 Address:
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: MIDWEST EMPLOYERS CASUALTY COMPANY Polity Number:
BNUWC0134789
_ 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 should become subject to the
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with those provisions. LL
Date: Applicant:.,gf77'��y
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 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 laws relating to building
construction, and hereby authorize representatives of this city to enter upon,the above-
mentioned property
''for inspection purposes.
Date:4a:& Signature (Applicant or Agent): �.
1
�.
Date: 5/15/2017"
Application Number: BWFE2017-0078
Owner:
Property Address: 78670 AVENIDA NUESTRA
ROPER MORRIS
APN: 770172009
Property Zoning:
Application Valuation: $5,420.00
Applicant:
Contractor:
`M CASTILLO'S CONCRETE CO
M CASTILLO'S CONCRETE CO
45116 COMMERCE ST STE 13
45116 COMMERCE ST STE 13
INDIO, CA 92201•
INDIO, CA 92201
(760)398-9227
--------------------------------------------------
Llc. No.: 881611
------
------------------------------------
Detail: 90 LF OF 5: GARDEN (2) 6' BLOCK COLUMNS INSIDE P/L. [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.
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $S.00
0.0
FINANCIAL •• •
DESCRIPTION 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
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $S.00
0.0
A
sort" #
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�. Building 8E Safety Division
P.O. Box 1504, 78-495 Caife Tampico
4.Quinta, CA 92253 -:(760) 777-7012
Building Permit Application'and Tracking Sheet
Permit #
Project Address: 7 g 67 O e !• Ownet's Name:.
A. P. Number. Address: -71? -9-70 A
Legal Description; City, ST, Zip: 1,6.Gi S
/� 1 '► n�N
Contractor. &41 lo'S Telephone:
Address: 4S%% �+ CG S� l3 Project Description: u i r a W cal
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City, ST, Zip: =rl d► O
Telephone: O 3&1 _
State Lic. # : 191916.11 Lic- #; 0 02 3 16"'IX IV, '
Arch, Engr., Designer
Address:
CRY.,ST, Zip.
Telephone: CanstructionType: blalf IL WO.JkOccupanay:
State Lic. #: Project type (circle one): ew Add'n Alter Repair Demo
Name of Contact Person: S 5 i Sq. Ft.: # Stories: #Units
Telephone* of Contact Person: ("Mo) S S' 614 $ Estimated Value of Project
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Ree'd
T"CISi1VG
PERMIT FEES
Plan Sets
Pian Cha& submitted.
Item Amount
Stmduml Cala.
Trim Cities.
Reviewed, ready for corrections
Culled Contact Person
Plan Check Deposit. .
Plan Check Sauna
Title 24 Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted.' .
Mechanical
Giadiag Plea
ready for corrationslissue
Electrical
Snbtoataetor List
Called Contact Person
Plumbing
Grant Deed
Pians picked up
S M I
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
''" Review; ready for correettona/issue
Developer Impact Fee
Planning Approval
Called Contact Person
AJ.P.P.
Pub. Wks. Appr
Date of permit Issue
School Fees
Total Permit Fees
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