05-4727 (PLBG)4 IIIIIIIIIIIIIIIIIIIII1 52
P.O. BOX 1504 IE
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
C-05-00004727-
49803 ADELITO DR
646 -240 -014 -
PLUMBING
LOW DENSITY RESIDENTIAL
500
Architect
alp
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
--------------------------------------------
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 Professionals Code, and my License is in full force and effect.
License Class: C36 License No.: 828264
ate tractor:
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).:
(_ 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 contractorls) licensed
pursuant to the Contractors' State License Law.).
(_ 1 I am exempt under Sec. , BAP.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
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/20/05
Owner:
BIGLER DONALD
49803 ADELITO
LA.QUINTA, CA 92253
Contractor:
FOY, SCOTT A.
79-499 COUNTRY CLUB DR STE 9
INDIO, CA 92201
(760)360-0927
Lic. No.: 828264
------------------
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.
.
_ ave and will maintain workers' compensation insurance, 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 STATE FUND Policy Number 1576840
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 shouldbecome subject to the workers' compensation provisions of Section
3700 of the Labor Code, .I shall forthwith comply with those provisions.
ate✓ L�� ,oma pplicant: ,�—
WARNING: FAILURE TO SECURE ERS' 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 to enter upon the above-mentioned p erty for inspection purposes.
[yt�J�/Y Si a (Applicant or Agent
Application Number . . . . . 05-00004727
Permit . . . PLUMBING
Additional desc .
Permit Fee . . . . 22.50
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. . .
. 0
Expiration Date 4/18/06
Qty Unit Charge Per
Extension
BASE
FEE
15.00
1.00 7.5000 EA PLB
WATER HEATER/VENT
7.50-
----------------------------------------------------------------------------
Special Notes and Comments
_
WATER HEATER -CHANGE -OUT
Fee summary Charged
---------------------------
Paid Credited
Due
----------
Permit Fee Total 22.50
----------
.00
----------
.00
22.50
Plan Check Total .00
.00
.00
.00
Grand Total 22.50
.00
.00
.22..50
.,
LQPERMIT
Bin #
City of La. Quinta
Permit #
Project Address: -1
A. P. Number:
Legal Description:
Con(ractor.
Address:
City, ST, Zip:
Telephone:
State Lic. #
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person:
Telephone # of Contact Person:
# Submittal R,
Plan Sets
Structural C21cS.
Truss'Calcs.
Title 24 talcs:
Flood plain plan
.Grading plan
Subcontactor List
Grant Deed
H.O.A. Approval
IN IIOUSE:-
Planning Approval
Pub. Wks. Appr
School Fees
Building 817 -SAM Division.
P.O. Box 1504, 78-495 Calle Tampico .
La Quinta, CA 92253 - (760) 777-7012
Building Permit .APPlication and Tracking Sheet
Owner's Name:
City Lic. #: ---)Lt 1
APPLICANT: DO NC
Rec'd
Plan Check submit
Reviewed, readv fo
.Called Contact Per;
Plans picked up
Plans resubmitted
2"' Review, readv k
Called Contact Pen
Plans picked up
Plans resubmitted
RevieW, i Cady fol
Called Contact Pers
te o[
Dapermit issue
'Address:'
O
City,'ST, Zip:
Telephone:
Project Description:
a �
Construction Type;
Occupancy:
Project type (circle one): New Add'n Altcr Repair Demo
Sq. Ft.:
# Stories: # Units:.
Estimated Value of Project: BOO ,
,T WRITE BELOW THIS LINE
TRACKING*
. PERIIIT FEES-
ed
Item Amount
'.corrections
Plan Check Deposit
on
Plan Check Balance
Construction
Mechanical
r corrections/issue
Electrical
on
Plumbing
S.M.I.
Grading
corrections/issue
Developer Impact Fee
m
A.I.P.P. .
Total Permit Fees
2005-08-22
020&,JNSTALLED
SALES P 2/2
09.31 (76Q)=393-4062
SSZR135A
LOWE'S HObIE CENTRRS, INC.
ELQ 0208
PAGE': 1
DATE:: 08/21/05
78-865, HICT•TWAV 111
LA 0.O1N'PA
CA
ORDERED FOR:
BIGLER,.`,T,rNOA
('160)'7,71-5566
ADDRESS:
49-803 ADFLITO
LA QUJ NTA CA 92253 PHONE:
(251)423.4,991
VENDOR NAMR:
PAC.'.IFIL'EXPRESS.INSTALLATION CONTACT:
ATMRKSS:
ATT PHONE:
(760)421-0390
CARLSBAD CA 92018 PAX:
(760)421-0395
PROJECT:
11.187b3U5 LA.QTTINTA PERMIT
LOWES P0:
4429Si18 LOWES INVOICE: 971.50 ASSOCIATE:
PETE DEWFV
EST DEL.T.VFRY:
08/22/05 Alt NUMBER:
QTY T.TRM
ITEM ,DESCRIPTION BIN VEND PART # COST
EXT C'.OST
1 133415 LA )UIN`1PA I" .RMTT 8-07250•
22.50
22.50
TOTAL
$22.50