BWFE2017-0125C�
4
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LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of -perjury that I am licensed under provisions of Chapter 9 1 hereby affirm under penalty of perjury one of the following declarations:
{commencing with Section 7000) of Division 3 of the Business and Professions Code, and _ I have and will maintain a certificate of consent to self -insure for workers'
my License is in full force and effect. compensation, as provided for by Section 3700 of the Labor Code, for the performance
License Class: B License No.: 963887 �.� / of th rk for which this permit is issued.
..�'L� SA 1 have and will maintain workers' compensation insurance, as required by
Dat, e/ / Contractor l//� 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:
OWNER -BUILDER DECLARATION Carrier: GRANITE STATE INSURANCE COMPANY Policy Number: WC065256310
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 _ I certify that in the performance of the work for which this permit is issued, I
city or county that requires a permit to construct, alter, improve, demolish, or repair any shall not employ any person in any manner so as to become subject to the workers'
structure, prior to its issuance, also requires the applicant for the permit to file a signed compensation laws of California, and agree that, if I should become subject to the
statement that he or she is licensed pursuant to the provisions of the Contractor's State workers' compensation provisions of Section 3700 of the Labor C�shhalllith
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business comply with those provisions.
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 Date Applicants
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
( 1 I, as owner of the property, or my employees with wages as their sole WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
compensation, will do the work, and the structure is not intended or offered for sale. AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
(Sec. 7044, Business and Professions Code: The Contractors' State License Law does not ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
apply to an owner of property who builds or improves thereon, and who does the work COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
himself or herself through his or her own employees, provided that the improvements INTEREST, AND ATTORNEY'S FEES.
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.). . IMPORTANT: Application is hereby made to the Building Official for a permit subject to
(_) I, as owner of.the property, am exclusively contracting with licensed contractors, to the conditions and restrictions set forth'on this application.
construct the project. (Sec. 7044, Business and Professions Code: The Contractors' State 1. Each person upon whose behalf this application is made, each person at whose
License Law does not apply to an owner of property who builds or improves thereon, request and for whose benefit work is performed under or pursuant to any permit issued
and who contracts for the projects with a contractor(s) licensed pursuant to the as a result of this application , the owner, and the applicant, each agrees to, and shall
Contractors' State License Law.). defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and
(� I am exempt under Sec. . B.&P.C. for this reason 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.
VOICE (760) 777-7125
78-495.G4LLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 DESIGN &DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 7/13/2017
Application Number: BWFE2017 0125 Owner:
Property Address: 55120 SPRING CREEK CT LA QUINTA HOUSING 1, LLC
APN: 767860025 27285 LAS RAMBLAS, SUITE 2 0 — -
Application Description: MONTERRA /BLOCK WALL 65 LF 5' WALL WEST PL /65LF 6' SOUTH PL MISSION VIEJO, CA 92691 s'
Property Zoning:
Application Valuation: $4,750.00
Applicant:
APPLICANT ACKNOWLEDGEMENT
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
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 bove-
mentioned property for inspection purposes.
Date Jfo / 7 Signature (Applicant or Agent),
s
(
Contractor: w
WOODBRIDGE PACIFIC GROUP LLC
WOODBRIDGE PACIFIC GRO P LLC e� U
27271 LAS RAMBLAS SUITE #100
27271 LAS RAMBLAS SUITE #100
MISSION VIEJO, CA 92691
MISSION VIEJO, CA 92691`
0
(949)348-8162
Llc. No.: 963887
APPLICANT ACKNOWLEDGEMENT
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
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 bove-
mentioned property for inspection purposes.
Date Jfo / 7 Signature (Applicant or Agent),
s
(
Date: 7/13/2017
Application Number: a BWFE2017-0125 Owner:
Property Address: 55120 SPRING CREEK CT LA QUINTA HOUSING 1, LLC
APN: 767860025 27285 LAS RAMBLAS, SUITE 230
Application Description: MONTERRA / BLOCK WALL 65LF 5' WALL WEST PL /65LF 6' SOUTH PL MISSION VIEJO, CA 92691
Property Zoning:
Application Valuation: $4,750.00
Applicant: Contractor:
WOODBRIDGE PACIFIC GROUP LLC WOODBRIDGE PACIFIC GROUP LLC
27271 LAS RAMBLAS SUITE #100 27271 LAS RAMBLAS SUITE #100
MISSION VIEJO, CA 92691 MISSION VIEJO, CA 92691
(949)348-8162
Llc. No.: 963887
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Detail: BLOCK WALL - 35LF 5' WALL INSIDE WEST PL/ 6' WALL AT SOUTH ON PL [PROTO II 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.
;<DESCRIPTION
FINANCIAL INFORMATION
ACCOUNT
QTY
AMOUNT
WALL/FENCE - EA ADDITIONAL 50 LF
101-0000-42404
0
$15.20
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:
$129.20
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: $5.00
Bin !{ .
Qty, of La Quinta
Buildin; 8r Safety Division
Permit i; 78-495 Caife Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Project Address: 55-120 Spring Creek Court Owner'sName:La Quinta Housing 1,LLC
A. P. Number: 767-860-025
Address:27271 Las Ramblas, Suite 100
Legal Description: Lot 25 Tract 32742
City, sT, zip:Mission Viejo, Ca 92691
Contractor: Woodbridge Pacific Group
Telephone: 94945-4612
A
" ;;:;:••• ;;;v�:.„ `.{r��>
Address:27271 Las Ramblas Suite 100
Project Description: Block Wall Fencing Per Approved
city, sT,zip: Mission Viejo, CA 92691
Precise Grade Plan For Tract 32742
Telephone: 949-445-4612
State Lie. # : 963887
City Lic. 9.:0112138
Arch., Engr., Designer: Heitec
Address:777 E. Tahquitz Canyon Way, Ste 200-50
City, ST, zip: Palm Springs, CA 92262
Telephone: 760-969-5033
State Lic. #- 55606
...f:M..
Construction T ypc: Masonry Occupancy-
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: Bob Richards
Sq. Ft_:
#Stories:
#Units:
Telephone # of Contact Person: 949-445-4612
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Xteq'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cafes.
Reviewed, ready for corrections
Plait Check Deposit '
Truss Cates.
Called Contact Person
Plan Check Balance.
Title 24 Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
3°' Review, ready for correctibnslissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Dced
Plans picked up
S.M.I.
1I.O.A. Approval
Plans resubmitted
Grading
IN IIOUSE:-
''° Reyiew, ready for corrections/issuc
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Dale of permit issue
School Fees,
Total Permit Fees
r
CITY OF LA (�19�TPa
BUILDING & SAFETY DEPT.
F COAppROVED
NSTRUCTION
DATE' l I1— BY
w
U
Z
LOT 25
PLAN 1
55-120 SPRING CREEK COURT
Q
). pg __e° (
T.
LEGEND NOTE: SOME ITEMS MAY NOT BE APPLICABLE FOR THE LOT SHOWN HEREON.
® ELECTRIC -MANHOLE FENCE
a ELECTRIC -TRANSFORMER —�- AREA DRAIN &DRAIN LINE
® ELECTRIC-PULLBOX �C BLOCK WALL SWALES
® RETAINING WALL ■ BUBBLER BOX
TELEPHONE -PEDESTAL I@ PILASTER CURB & GUTTER
' POWER, TELCO, CATV & GAS (—.. 1 FLATWORK
METER LOCATION PROPERTY LINE PCATCH BASIN
° ° AIR CONDITIONING UNITS -__ v' STREET/STOP SIGN
MM PUBLIC UTILITY EASEMENT _ - RIGHT-OF-WAY 1=1 H.O.A. MAINTAINED LANDSCAPE
- STREET CENTERLINE pg POOL EQUIPMENT
mss- SEWER MAIN & MANHOLE -W- WATER MAIN
�— SEWER CONNECTION WATER SERVICE METER o
SLOPE u � POOL/SPA
� FIRE HYDRANT REV: 11/15/16
Wpg 27271 Las Ramblas MONTERRA
LOT EXHIBIT
Suite Vie LOT 25
Mission Viejo
WOODBRIDGE California92691 (7�"` A 1 A /r�� TRACT 32742
PACIFIC GROUP Tel: 949-348-8162 PGA A �/ �/ tLA QUINTA, CALIFORNIA 55-120 SPRING CREEK COURT
WOODBRIDGE PACIFIC GROUP RESERVES THE RIGHT TO MAKE MODIFICATIONS AND CHANGES TO ITEMS INCLUDING BUT NOT LIMITED TO LOT GRADING AND
DRAINAGE, LOT LINES, FENCE LOCATIONS, PAD ELEVATIONS, TOP AND TOES OF SLOPES, RETAINING WALLS, UTILITIES LOCATION, MAILBOXES, DRIVEWAYS,
SIDEWALKS AND SETBACKS. ALL UTILITIES, SIGNS, FENCES AND DIMENSIONS ARE SHOWN AS APPROXIMATE. LOCATIONS AND DIMENSIONS MAY VARY
DEPENDING UPON CONSTRUCTION CONDITIONS. THIS LOT EXHIBIT WILL NOT BE UPDATED TO REFLECT ANY MODIFICATION, CHANGES OR REVISIONS THAT
HAVE BEEN MADE ASA PART OF THE CONSTRUCTION OF THIS LOT. BUYER IS EXPRESSLY ADVISED NOT TO ALTER THE DRAINAGE OF THE LOT.