BWFE2020-0086Date:
78-495 CALLE TAMPICO T4h/ D 4,u Qk4a
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Permit Type/Subtype:
WALL/FENCE/CITY STANDARD/PRE-APPROVED
Application Number:
BWFE2020-0086
Property Address:
53005 HUMBOLDT
APN:
767700005
Application Description:
GLENN / 10OLF RETAINING WALL
Property Zoning:
Application Valuation:
$3,000.00
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/9/2020
Owner:
ROTNER GLENN / ANN WALKER TRUST
Applicant: D
Contractor:
81335 THUNDER GULCH WAY
BRADSHAW CONSTRUCTION INC BRADSHAW CONSTRUCTION INC
81335 THUNDER GULCH WAY
LA QUINTA, CA 92253 FEB 18 2020 LA QUINTA, CA 92253
CITY OF LA QUINTA (760)347-4246
DESIGN & DEVELOPMENT DEPARTMENT Llc. No.: 848057
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.
iLicense Class: License No.: 84M57
Date: Z �d '-y� Contractor:
OWNER -BUILDER 2LYARATI
I he reby. affirm under penalty of perjury that ! am exempt from the Contractor's State
License Law For the fail Owl ng 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 We 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 via lation of Section 7031.5 by any applicant For a
permit subjects the applicant to a civic penalty of n a t more than five hundred dollars
004:
(_) 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 Me burden of proving that IMPORTANT: Application is hereby made to the Building Official for a permit subject to
he or she did not build or improve for the purpose of sale.), the conditions and restrictions set forth on this application.
( ) I, as owner of the property, am exclusively contracting with licensed contractors 1. Each person upon whose behalf this application is made, each person at whose
to construct the project. (Sec. 7044, Business and Professions Code: The Contractors' request and for whose benefit work is perFormed under or pursuant to any permit
State License Law does not apply to an owner of property who builds or improves issued as a result of this application, the owner, and the applicant, each agrees to, and
thereon, and who contracts for the projects with a contractor(s) licensed pursuant to shall defend, Indemnify and hold harmless the C!ty of La Quinta, its officers, agents, and
the Contractors' State License Law.). employees for any act or omission related to the work beirr (_) I am exempt under Sec. B.&P.C. for this reason g performed under or
Foilnwing 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.
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 Ad
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
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 tZOO
or which this permit is issued.
have and will maintain workers' compensation insurance, as required by
Se 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: TA E COMPENSATION INSVRANCE EUND 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 I should become subject to the
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with those provisions.
Date:` —f,O2V _Applicant:
WARNING: FAILURE TO SECURE WORKERS . MPENSATION 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
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 yppn the
above -mentioned property for inspection purposes.
Date: - O Signature (Applicant or Agent):
v
FINANCIAL INFORMATION
DESCRIPTION ACCOUNT
QTY
AMOUNT
WALL/FENCE - FIRST 100LF
101-0000-42404
0
$53.67
DESCRIPTION
ACCOUNT
QTY
AMOUNT
WALL/FENCE - FIRST 100LF PC
101-0000-42600
0
$67.08
Total Paid for BLOCK WALL 2019: $120.75
DESCRIPTION ACCOUNT CITY
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
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Project Address: oOs
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APN #:
Applicant Name:
Address:
City, ST, Zip: I_1 h
Telephone: 0
Email: t r ,
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PERMIT # �LJ ���[� 2P— 0%6
PLAN LOCATION:
? Project Description: Pool, Remodel, Add't, Elect, Plumb, Mech
r6L
Valuation of Project $
78495 CALLE TAMPICO
LA QUINTA, CA 92253
760-777-7000
LOT52
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EXISTING BUILDING "�� f- Project Number 2010
(986.0 APPROVED PAD) rlhln eT Date 9/20/2018
.—By Author
Checked By Checker
ARCHITECTURAL SITE PLAN ,', A1.10
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