13-0105 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA _QUINTA,-CALIFORNIA 92253
Application Number:
LL3-000.0-0.1.0.5•
Property Address:
52790 AVENIDA OBREGON
APN:
773-315-024-4 -000000-
Application description:
PLUMBING
Property Zoning:
COVE RESIDENTIAL
Application valuation:
2554
Applicant:
Architect or Engineer
BUILDING &.SAFETY.DEPARTMENT
BUILDING PERMIT
I VOICE (760) 777-7012
FAX (760) 777-7011
i .NSPECTIONS (760).777-7153
Owner: .
CATHY CUNNINGHAM
5.2790.AVENIDA OBREGON
LA QUINTA, CA 92253
Contractor:
US HOME SERVICES..
2951 KINWEST PARKWAY
IRVING, TX 75063
(626)333.-2001
tic -..No.: 7687.07
4
EEB
4 2013
CITY OF LA QUINTA
FINANCE DEPT. -
/13
-
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LICENSED CONTRACTOR'S DECLARATION
------------------------------------------------
WORKER'S COMPENSATION DECLARATION -
herebyaffirmunder penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Thereby affirm under penalty of perjury one of the following declarations:
' SectionJ000) of Divisiom3.ofthe Business and Professionals Code, and my. License is in full force and effect. -
- Lhave and:wilfmaintain a cehificate.of consent toself-insure'for workers' compensation, as provided
License Class: C36 C17 C6 License N .: 768707.
_
for 6'y Section 3700 of. -the LaI56r Code; for the performance of the -work for which this permit is
Date: � ✓ � Contractor: O/
��WrG 6� ,.
— issued:
I have and will maintain workers' compensation insurance, as.requiredby Section 3700 of the Labor
' Code, for the performance of the work for.which this permit is issued. My workers' compensation
OWNER -BUILDER DECLARATION
insurance carrier and policy number are:
1 hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
Carrier COMMERCE & IND Policy Number WC07171491
following reason (Sec: 7031 .5, Business and Professions. Code: -Any city or county that requires a permit to
I certify that, in the performance of the work for which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any -structure, -prior to its issuance, also requires the applicant for the
_
person in any manner so as to become subject to theworkers' compensation laws of California,
permit to file a signed statement that 'heor she,is licensed pursuant to the provisions of the Contractor's State
and agree that, if I should become subject to the workers' compensation provisions of Section
License Law (Chapter's (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
3700 of'the Labor Code, I shallforthwith comply with those provisions.
that he or she is exempt therefrom and the basis for the aIle ed exemption. Any violation of Section 7031.5'b
any applicant fora permit 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 compensation, will do the work, and
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS.UNLAWFUL, AND SHALL
Contractors' State License Lawdoes not apply to an owner of property who builds or -improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND.CIVIL FINES UP TO ONE HUNDRED THOUSAND '
and who does the work himself or herself through his or her own employees, provided that! the
DOLLARS ($100;000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
SECTION 3706 OF THE LABOR CODE, INTEREST, AND. ATTORNEY'S FEES.
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.).
APPLICANT ACKNOWLEDGEMENT
(_) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
IMPORTANT Application is hereby made to the Director'of Building and Safetyfor a permit subject to the ,
' 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
conditions.and restrictions set forth on this application.
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
1. Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License Law.)...
whose benefit worK is performed under or pursuant to any permit issued as a result of this application,
(_ 1 I am exempt under Sec. , B.&P.C. for this reason
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.
Date: Owner:
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
CONSTRUCTION LENDING AGENCY
permit to cancellation.
I hereby affirm under penalty of perjury that there is a construction.lending agency for the performance of the
I certify that I have read this application and state that the above information is correct. I agree to comply with all
work for which this permit is issued ISec. 3097, Civ. C.).
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
Lender's Name:
of thi cou t enter upon the above-mentioned property for inspection ur os�
.
Data C Signature (Applicam-or._Agent.).
Lender's Address:
1.
LQPERMIT
Application Number . . . . . 13-00000105
Permit PLUMBING
Additional desc .
Permit Fee . . . . 21.00 Plan Check
Fee
.00
Issue Date . . . . Valuation
. . .
. 0
Expiration Date 8/03/13
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 6.0000 EA PLB FIXTURE
6.00
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Special Notes and Comments
Replace bath tub in Master: Bathroom.
2010 Codes.
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Other Fees . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
Due
Permit Fee Total 21.00 .00
.00
21.00
Plan Check Total .00 .00
.00
.00
Other Fee Total 1.00 .00'
.00
1.00
Grand Total 22.00 .00
.00
22.00
LQPERMIT
Bin >9
City. 6F.La QQu nta
kUng d Safety Dtvlslon
Perink #
Box f 504,48-495 Calle Tarripko
r.a.Quinta,.GA 92253 t7 0j'.777 70 1Z
Building Perrnrt Applrcatton and Tracking Sheet
Project Addtwss
"Owner's Name:
A. P. Nwnbcr.
Legal Description:
.City. ST,'Zip:
Contractor. OS
t�5 Teieplion : � QQ—' 8
MOO f
Address:3 J r � (e Or .� rojea Description
city, sr, zip: c v
%v iTelephoneState
*-ty
Lia N : 37 �
Arck. Bags•, Designer
Addr c=
City. ST. Zip:
Telephone:
Construction Type:. Occupancy:
State Lia B:
Project„type (circle one): New ” Add'n Repair Demo
Name of Contad Person:
Sq, Fb; : ! Stories A Units:
Tclephoac B of Contact Person:
ESW.0 d Value of Project , 255, .
APPUCANT:
DO NOT WRITE BELOW THIS LINE_ .
p Sabmittal Req'd
Aced
TRACfc G PERMIT FEES
Pian Sets
Plan Cheek submitted Rem Amount
Structural CdcL
Reviewed, ready for corrections
Plan Check Deposit.
Ttuss Cala.
Called Contact Penoa
Plan Checik Balance
Title 24 Cale@
Plans picked up
Consanctlon
Flood plain plea
Plans rembmittM..
Mechanical
Grading plea
2" Rcview, ready for correctiaasksstre
Electrical
Subco-taetor List
Called Contact Person
Plumbing
Grant Deed
Pians picked up
H.O.A. Approval
Plans-resubmitted
Gradlag
INHOUSE:-
'`' Revtow, ready for correctlonsrwuc
Developer Impact Fee
Planning Approval
Called Contact Person
Pub. Wke. Apps "
Date of permit issue
School Fees
Total Permit Fees