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10-0644 (PLBG)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 10-0-0000644 Property Address: 56285 RIVIERA APN: 762-021-026- Application description: PLUMBING Property Zoning: LOW DENSITY RDOIDENTIAL Application valuation: S00 Applicant: Architect or Engineer: LICENSED CONTRACTOR'S DECLARATION BUILDING & SAFETY•.DEPARTMENT BUILDING PERMIT 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 Professionals Code, and my License is in full force and effect. License Class: C36 C �1 License No.: 921951 Date:..l_ co-Contracto Q,Z� OWNER -BUILDER DECLARATION 1 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 70001 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 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 1, as owner of the property,,am exclusively contracting with licensed contractors to construct the project ISec. 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 acontractor(s) licensed pursuant to the Contractors' State License Law.). ' I—) 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: LQPERA11T VOICE (760) 777-7012 ' FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: .7/15/10 Owner: MILOSEVICH DAN & LORAINNE 56285 RIVIERA D e LA QUINTA, CA 9225 '( JUL 15 2010 ----Contractor:--. _:.-..._..._.......------- SIMENTAL, RITO EST BAN CITVOFLAQUINTA 49901 CALLE EL SOL FINANCE DEPT. COACHELLA, CA 92236 (760)200-7586 Lic. No.: 921951 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 work for which this permit is issued. _ I have and will maintain workers' compensationinsurance, as required by Section 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 EXEMPT Policy Number EXEMPT _ 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. Dater I t0 Applicant: bt 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 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 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 county enter upon the above-mentioned property for inspection purposes. .,�? I�Dategplg:NL4 . LQPERM[T Application Number . . . . . 10-00000644 Permit PLUMBING Additional desc . Permit_Fee 18.00 Plan Check Fee 4.50 Issue Date . . . . Valuation . . . . 0 Expiration Date 1/11/11 Qty Unit Charge Per Extension BASE FEE 15.00 - 1-.00 3::0000 D PLD GAJ PIPE 1-4 OUTLETS 3.00 Special Notes and Comments INSTALL 3/4 INCH GAS LINE FOR FIREPIT 70 " LN-FT—(YELLOW-PIPE)'UNDERGROUND-FOR w----- - -.____........... ... .............. ---.._--.--...:_-..._._.-___ LISTED APPLIANCE. APPROVED PER A.J. ---------------------------------------------------------------------------- - -,Other Fees . . ... . . . . . BLDG STDS ADMIN (SB1473). 1.00 'Fee summary Charged Paid Credited ------------------ ----------------------------------------- Due r - C` Permit Fee Total C 18.00 .00 .00 18.00 s Plan Check Total 4.50 .00 .00 4.50 Other Fee Total 1.00 .00 .00 1.00 Grand Total =- 23.50 .00 .00 23.50 LQPERM[T Bin # Qty of La Quinta Building &' Safety Division- ivision P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit Permit # Project Address:5� •• Is t �, A. P. Number: Owner's Name: vK) gwowM Address:- Legal Description: City, ST, Zip:LA Contractor: Contractor. . Address: IQ� °�C c ' 'A A Project Description:0.�i S City, ST, Zip:JG .w:• v Tele hon say %f 7 ?17. .0f�� //440 %_ 9 i pq�P� •- ) I J State Lic. # City Lic. i{; Arch., Engr., Designer: Address: . -ity, ..ip- Telephone: Y State Lic. #: Name of Contact Person: i Construction Type: Occupancy: Project type (circle one): New Addl'n Alter Repair Demo Sq. Ft: #Stories: T# Units: Telephone # of Contact Person: Estimated Value of Project: o b APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Reed TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cafes.Reviewed, ready for corrections Plan Check Deposit Truss Cates. Called Contact Person Plan Check Balance Tide 24 Calcs. Plans picked up Constructon Flood plain plan Plans resubmitted Mechanlcrl Grading plan 20° Review, ready for correctionsAssue Electrical Subcontactor List I Called Contact Person Plumbing. Grant Deed Plans picked up S.M.1. H.O A. Approval ' Plans resubmitted Grading IN HOUSE:- ''' Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P, Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees i