BWFE2019-016178-495 CALLE TAMPICO C� 0 D e(PN�I41Ct1
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Permit Type/Subtype: WALL/FENCE/CITY STANDARD/PRE-APPROVED
Application Number:
BWFE2019-0161
Property Address:
81630 SHACKLETON WY
APN:
767690034
Application Description:
DUDUM / 47LF RETAINING & 106LF GARDEN WALL
Property Zoning:
Application Valuation:
$10,000.00
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
JASON AND KIETH DUDUM
81630 SHACKLETON WAY
LA QUINTA, CA 92253
Date: 8/20/2019
Applicant: Contractor:
DISCOVERY BUILDERS CALIFORNIA INC DBA DB /� 1 DISCOVERY BUILDERS CALIFORNIA INC DBA DB
14605 N 73RD STREETD 14605 14605 N 73RD STREET
SCOTTSDALE, AZ 85260 SCOTTSDALE, AZ 85260
AUG 2 0 2019 (480)624-5200
CITY OF LA QUINTADo Llc. No.: 915336
------------------------------- DESIGN&DEVEWRENT-OPARTIVEWT _---_-------__------__---------
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: B License No.: 915336 f ,
Date8___,rb1A ,■ —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 N
Lender's Add
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 work4or which this permit is issued.
CILIL+ ave and will maintain workers' compensation insurance, as required by
ScC;im'33700 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: TRAVELERS PROPERMCAWALTY COMPANYPolicy Number:
_ 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. , , N
Dater IL7 1 7. Applicant
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.
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`► 1 Signature (Applicant orAgeri
Date: 8/20/2019
Application Number:
BWFE2019-0161
Property Address:
81630 SHACKLETON WY
APN:
767690034
Application Description:
DUDUM / 47LF RETAINING & 106LF GARDEN WALL
Property Zoning:
Application Valuation:
$10,000.00
Applicant:
DISCOVERY BUILDERS CALIFORNIA INC DBA DB
14605 N 73RD STREET
SCOTTSDALE, AZ 85260
Owner:
JASON AND KIETH DUDUM
81630 SHACKLETON WAY
LA QUINTA, CA 92253
Contractor:
DISCOVERY BUILDERS CALIFORNIA INC DBA DB
14605 N 73RD STREET
SCOTTSDALE, AZ 85260
(480)624-5200
Llc. No.: 915336
Detail: 47LF OF 6' GARDEN WALL FROM GRADE W/2' RETAINING AT NORTH PL AND 106LF OF 6' GARDEN WALL FROM GRADE AT NORTH, NORTHEAST
AND SOUTHEAST SIDE YARDS AND PROPERTY LINE [ANGELUS 5-1.1LQAND CITY RETAINING 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 • •
DESCRIPTION ACCOUNT
CITY
AMOUNT
RETAINING/COMBINATION WALL EA 501-F
101-0000-42400
0
$16.01
DESCRIPTION
ACCOUNT
CITY
AMOUNT
WALL/FENCE - EA ADDITIONAL 50 LF
101-0000-42404
0
$32.02
DESCRIPTION
ACCOUNT
CITY
AMOUNT
WALL/FENCE - FIRST 100 LF
101-0000-42404
0
$53.37
DESCRIPTION
ACCOUNT
CITY
AMOUNT
WALL/FENCE - FIRST 100 LF PC
101-0000-42600
0
$66.71
Total Paid for BLOCK WALL: $168.11
DESCRIPTION
ACCOUNT
CITY
AMOUNT
BSAS SB1473 FEE
101-0000-20306
0
$1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION I ACCOUNT j CITY I AMOUNT
RECORDS MANAGEMENT FEE 101-0000-42416 10 $10.00 J
Total Paid for RECORDS MANAGEMENT FEE: $10.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
TOTALS::4
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PERMIT # �
PLAN LOCATION:
Project Address: —(��
P oject Description:
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Applicant Name:
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Address:
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Telephone:
Email:
Project Valuation $
Contractor Name: 1C
New SFD Construction:
Address: -_�
Conditioned Space SF
City, St, Zip.
Garage SF
Telephone:
Patio/Porch SF
Email:
Fire Sprinklers SF
State Lic:
City Bus Lic:
Architect/Engineer Name:
Construction Occupancy:
Address:
Grading:
City, St, Zip
Telephone:
Bedrooms:
Stories:
# Units:
Email:
State Lic: City Bus Lic:
Property Owner's Name:a� \
New Commercial / Tenant Improvements:
Total Building SF
Address:
City, ST, Zi
Construction Type: Occupancy:
Telephone:
Email:
18495 CALLE TAMPICO
LA QUINTA, CA 92253
760-777-7000
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