BWFE2019-004878-495 CALLE TAMPICO T4tv/ D �P Q914v
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Permit Type/Subtype: WALL/FENCE/CITY STANDARD/PRE-APPROVED
Application Number:
BWFE2019-0048
Property Address:
81303 COLUMBUS WY
APN:
767690002
Application Description:
WALLACE / 453LF OF GARDEN WALL
Property Zoning:
Application Valuation:
$61,600.00
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
JASON. J. WALLACE, TRUSTEE
81303 COLUMBUS WAY
LA QUINTA, CA 92253
Date: 4/3/2019
Applicant: f Contractor:
BRADSHAW CONSTRUCTION INC / �1 \D BRADSHAW CONSTRUCTION INC
81335 THUNDER GULCH WAY Dz u 81335 THUNDER GULCH WAY
LA QUINTA, CA 92253P 0 LA QUINTA, CA 92253
APR 0 3 2019
(760)347-4246
CITY OF LA QUINTA Llc. No.: 848057
DESIGN & 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 70001 of Division 3 of the Business and Professions Code,
and my License is in full force and effect.
License Class: R License No.: 84$057
ti
Dale w ] / � / Con zracaor:
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).:
(_) 1, 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, 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 r which this permit is issued.
ave and will maintain workers' compensation insurance, as required by
5ectfon 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: STATE COMPENSATION INSURANCE FUND Policy Number: 9245081
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 Id become subject to the
workers' compensation provisions of Section 3 10 oft Labor ode,1 II forthwith
comply with th se pr Wsians.
Care: /� Applkcaot:
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 cit en r upo the
above•mentio ed roperty for inspection purposes.
D Signature (Applicant or .
Application Number:
BWFE2019-0048
Property Address:
81303 COLUMBUS WY
APN:
767690002
Application Description:
WALLACE / 453LF OF GARDEN WALL
Property Zoning:
Application Valuation:
$61,600.00
Applicant:
BRADSHAW CONSTRUCTION
INC
81335 THUNDER GULCH WAY
LA QUINTA, CA 92253
Owner:
JASON. J. WALLACE, TRUSTEE
81303 COLUMBUS WAY
LA QUINTA, CA 92253
Contractor:
BRADSHAW CONSTRUCTION INC
81335 THUNDER GULCH WAY
LA QUINTA, CA 92253
(760)347-4246
Llc. No.: 848057
Date: 4/3/2019
Detail: 365LF OF 6" CMU, GARDEN PERMITER WALL NOT TO EXCEED VIN HIGHT. 27LF OF 12" AND 16" CMU, GARDEN WALL NOT TO EXCEED 6' IN HEIGHT.
33.51-17 OF 12" CMU GARDEN WALL NOT TO EXCEED GIN HEIGHT. 27.51-F OF 16" GARDEN WALL NOT TO EXCEED 6' IN HEIGHT. ALL BLOCK WALLS TO USE
[ANGELUS SPECIAL ENGINEERING CALCULATIONS] 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. PER 2016 CALIFORNIA BUILDING CODES.
I I U I HL.): >Lbb.lb
FINANCIAL INFORMATION
DESCRIPTION ACCOUNT
QTY
AMOUNT
WALL/FENCE - EA ADDITIONAL 50 LF
101-0000-42404
0
$128.08
DESCRIPTION
ACCOUNT
QTY
AMOUNT
WALL/FENCE - FIRST 100 LF
101-0000-42404
0
$53.37
DESCRIPTION
ACCOUNT
QTY
AMOUNT
WALL/FENCE - FIRST 100 LF PC
101-0000-42600
0
$66.71
Total Paid for BLOCK WALL: $248.16
DESCRIPTION
ACCOUNT
QTY
AMOUNT
BSAS SB1473 FEE
101-0000-20306
0
$3.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $3.00
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
I I U I HL.): >Lbb.lb
ta Qa�traPERMIT
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New SFD Construction:
Address:
("Al WORNIA
PLAN LOCATION:
Conditioned Space _ SF
Project Address: 03 ,
Project Description:
State Lic: City Bus Lic:
APN #:
Telephone:
j
•
L
Applicant Name:
W
Fire Sprinklers SF
hA
Address: ( j0- 35 cn�
City Bus Lic:
City, ST, Zip: 15
Telephone:'17-
Email:
Valuation of Project $
ar c�hS r C /Q
Contractor Name:
Construction Occupancy:
`1
New SFD Construction:
Address:
,amu /
Telephone:
Conditioned Space _ SF
City, St, Zip L�
Email:
State Lic: City Bus Lic:
Garage SF
Telephone:
j
Patio/Porch SF
Email:
rek
W
Fire Sprinklers SF
hA
State Lic:
City Bus Lic:
Architect/ Engineer Name:
Construction Occupancy:
Address:
Grading:
City, St, Zip
City, ST, Zip
Telephone:
Bedrooms: Stories: # Units:
Email:
Email:
State Lic: City Bus Lic:
Property Owner's Name: Oh ��
New Commercial / Tenant Improvements:
Address:
Total Building SF
City, ST, Zip
Construction Type: Occupancy:
Telephone:
Email:
78495 CALLE TAMPICO
LA QUINTA, CA 92253
760-777-7000
OFFICE USE ONLY
#
Submittal
Plan Sets
Required
Received
Structural Calcs
Truss Calcs
Title 24 Calcs
Soils Report
Grading Plan (PM10)
Landscape Plan
Subcontractor List
1
Grant Deed
HOA Approval
School Fees
Burrtec Debris Plan
Planning approval
— --- ..__............
Public Works approval
_.................
1
I
Fire approval
_........ .....
City Business License
...........
Recording Requested by:
FNTG Builder Services
RECORDING REQUESTED BY
AND WHEN RECORDED MAIL TO:
Jason J. Wallace, Trustee
400 Doheny Rd.
Beverly Hills, CA 90210
ORDER NO.'
23065401
Escrow No.
23065401 -LN
Parcel No.
767-690-002-9
TRA
020-172
DOC # 2018-0121041
03/30/2018 08:00 AM Fees. $93 00
Page 1 of 4
Recorded in Official Records
County of Riverside
Peter Aldana
Assessor -County Clerk -Recorder
"This document was electronically submitted
to the County of Riverside for recording"
Receipted by: MARIA VICTORIA #411
SPACE ABOVE. THIS LINE 11OR KLVOKDt:R'S t1SE
GRANT DEED
THE UNDERSIGNED GRANTOR(s) DECLARE(s) Documentary Transfer Tax is $__1,265.00
0 unincorporated area 0 computed on full value of interest or property conveyed, or
® the city of La Quinta 0 full value less value of liens or encumbrances remaining at the
time of sale
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
East of Madison, LLC, a Delaware limited liability company
hereby GRANT(s) to
Jason J. Wallace, Trustee of the Jason J. Wallace Living Trust dated 10/28/2009
[lie following real property in the County of Riverside, State of California:
See Legal Description attached hereto and incorporated herein as Exhibit "A".
SUBJECT TO all matters of record including, without limitation, the covenants, and agreements described in Exhibit "A"
attached hereto.
Dated: January 2, 2018
East of Madison, LLC,
a Delaware limited liability company
By: 120 Acre Partners, LLC,
a Delaware limited liability company
Its: Managing Member
By: Discovery La Quinta Investors, LLC
a Delaware limited ' ility compan
Its: Authorized resentaliv
V By: _
Joseph L. renson
Its: Authorized Representative
MAIL TAX S'rA rEMENTS AS DIRECTED ABOVE
Page I of 2
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