09-0517 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA;: CALIFORNIA 92253
Application Number: 09-00000517
Property Address: 52885 AVENIDA OBREGON
APN: 773-314-020-7 -0000007
Application description: PLUMBING
Property Zoning: COVE RESIDENTIAL.
Application valuation: 2890
Applicant: Architect or Engineer:
LICENSED CONTRACTOR S DECLARATION
4 L .
BUILDING & SAFETY:.DEPARTMENT
BUILDING PERMIT
I hereby affirm under penalty of perjury that I am licensed undeiprowsions of Chapter 9 (commencing with
Section 7000) of; Division -3 of the Business and'Professionals'Code; and niy License is in full force and effect.
License Class: 'B cense No.: 721499
Date ZL Contractor:"
WNER-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 tothe provisions of -the Contractor's State
License taw (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 _ 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
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 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.).
1 1 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:
LQPERMIT
Owner:
SHEPHERD ELEANOR L
52885 AVENIDA OBREGON
LA QUINTA, CA 92253
(766)S64'-24'3-8
Contractor:
INTEX`.CONSTRUCTION INC
PO BOX 11242
PALM, -DESERT; CA 92255
(760)836-0995 '
Li•C. No.: 721499
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/22/09
Ny'2 6
?Opy. .
"lk°de r\/
-- - - - -- -
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the follovaing:declarations:
.. IIt * 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 work for which this permit is
issued.
_ I have and will maintain workers' compensation insurance, -as required by Section 3700 of the Labor
Code, for the performance of the .work far which this permit is issued. Myworkers' compensation
insurance carrier and policy number are:
Carrier STATE FiJND Policy Number .2380003617
I certify that, in theperformanceof the work for which this permit is issued, I shall not employ any
person in any mannerso 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
31700 of.the Labor Code, I shall forthwit co y with those provisions.
�yApplicant:
..'WARNING: FAILURE TO SECURE ORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO.CRIMINAL PENALTIES ANo CIVIL FINES UP TO -ONE HUNDRED THOUSAND
DOLLARS ($100,0001..•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 Director of Building and Safety 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 actor 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, an reby authorize representatives
of this county to enter upon the above-mentioned property for inspectio p ses.
i
Date: / 1/0 -fig nature (Applicant or Agent): �•
'f
Application Number
. . 09-00000517
:"Permit . .
. PLUMBING SEWER
Additional desc .
Permit Fee
30.00
Plan Check Fee
.00
Issue Date.
Valuation"
2890
Expiration Date
11/18/09
Qty Unit Charge Per
Extension
BASE FEE
30.00
-------------------------------------------------------
Special,Notes and
Comments
---------------------
_.SEPTIC AB_ANDQNMENT.:.&.SEWER.
CONNECTION.
-----------------------
OtYier `Fees':'
---------------- --------------------------------------
BLDG ,STDs ADMIN "" (SB14'73)
1.00
s Fee summary.
Charged Paid.
Credited
Due
- _ Permit Fee Total
30.00-
.00 .00
30 00•
Pla: •Check, Total
.0000
. 0'p
O.p
Other Fee Total
-1.00.
00:' .00
1.0.0'
Gra nd Total:
31:0.0
00. 00
31..00
LQPERMIT .
t
T� COACHELLA VALLEY WATER DISTRICT
Q�S�Iti P.O. BOX 1058, COACHELLA, CALIFORNIA -92236 (760) 398-2651
INVOICE DateA/22/2009
SUBJECT: 52-885'AVENIDA OBREGON, LA QUINTA, 606122,490.0.0
ELEANOR L. SHEPHERD Project: 9-1696
52-885 AVENIDA OBREGON Projectbate: 5/22/2009
Amount Due: $3,995.00
LA QUINTA, CA 92253 GEO: 06-06-12-2
Planner: SANDRA VILLALOBOS
TO INSURE PROPER CREDIT, PLEASE RETURN THIS PORTION WITH
REMITTANCE AND INCLUDE THE PROJECT ON YOUR CHECK
1.00 SCC -COLLECTION $1;658:00 $1,668.00
1.00 SCC -TREATMENT $2;337.00 $2,337.00
$3,995.00
AID
$,$s. o0
MAY` 2 a .2009
COACHELLAVALLEY
WATER DISTRICT
COACHELLA VALLEY WATER DISTRICT`',
P.O. BOX 1058, COACHELLA, CALIFORNIA 92236(760) 398-2651
Pagel
Bin #
City of La.Quint_a
Build(ng &r Safety PjvWori
P.O. Box �5�4� 78; 495 Calle Tampico
La. Quinta, 253' - (760) 777-7,.012
Building permit Application and Tracking Sheet
Permit #
5 l'1
Project Address: SZ vis A VQ :05P-644N
Ownei's Name: 5 N �ilb�efl.
A. P. Number:
Address:
Legal Description:
City, ST `Zip: L 1-1 C1v/N TA CA} q 2 Z S3'
Contractor: )/11TB X 'CONS-MU0-76/V , /NL.
6
Telephone: 0'. 5 `� Z � :>s
' >s ... �?: '
>'��r is 4VJ\
�:•>: i i•:4ii
Address: SCJ EWCJX //2 YZ
Project Description: F
City, ST, Zip: r'A4/'0? 17L–'SL–^�TSEPT1
A&/'rTl!>c 1ML,7u7–
Telephone: "7GU id �6 (%�/�/;�
>., '
,•
State Lic. # : �'Ll y q `� ,'
City.Lic. #: 16Z61 (�
Arch., Engr., Designer:.
Address:
City., ST, Zip: �\
Telephone:
K.::y::.::>.:::::>«:<:::»:.:::<:,:><> :.:
,,,� � ;:.,:;,;. :,,.�.,Y�
::. f......
Construction Type: Occupancy:
Project type.(ciicle one): New Add'n Alter Repair Demo
State Lic.
Name of Contact Person: �Q l� g,ls
Sq 'Ft.:.•
#. Stories:
# Units:
Telephone #, of Contact Person:'., 7 6.0 GUI 6 "� 9 Z. c '
s
Estimated: Value ofProject:—
APPLICANT: DO NOTWRITE:BELOW THIS LINE..
#
Submittal
Req'd
Recd
TRACING
PERMIT FEES-
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for. corrections'.
Plan Check Deposit
Truss Calcs.
..Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
' Mechanical
Grading plan
2nd Review, ready fort orrectionirissiW
Electrical
Subcontactor List
Called Contact Person '
Plumbing
Grant Deed
Plans picked up.
S.M.I.
H.O.A. Approval
;:Plans resubmitted
Grading.
IN HOUSE:-
'"' Review, ready for, correctionstissue •
Developer Impact Fee
Planning Approval
Called Contact Person
A.I:P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees