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12-0814 (PLBG)79832 Arnold Palmer I IIIIIII VIII III VIII (III 35 v P.O. BOX 1504 IE 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 12-00 0 0 0814 Property Address:. 79832-ARNOLD-PALMER APN: 775 -241 -076 - Application description: PLUMBING Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 700 T-it4t 4 e(P Q" Architect or Engineer: Ok 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. Lic se Class: B C53 CIO License No.: 836088 Date: E l ontractor: NER-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 1$5001.: 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 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 Owner: JONES 79832 ARNOLD PALMER LA QUINTA, CA 92253 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 7/23/12 ----------------------------------------------- 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.I have 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 0028277008 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 becomeubject to the workers' compensation provisions of Section 3700 of the Labor Code, I sh fo 'tti c mply with those provisions. Date: 0_7(A(10( licant: WARNING: FAILU TO SECURE WORKS S' 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 ordinance nd state laws relating to building construction, and hereby authorize representatives of f county to enter on the above-mentioned property for ins pec ' urposes. Date: ?_9 nature (Applicant or Agent): Contractor: 1ST ATRIUM INCP.O. rtica. BOX 3882 UL 2'PALM DESERT, CA 92261 (760)880-6606 QUINTA Lic. No.: 836088 pF ket .ul eAvO% ----------------------------------------------- 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.I have 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 0028277008 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 becomeubject to the workers' compensation provisions of Section 3700 of the Labor Code, I sh fo 'tti c mply with those provisions. Date: 0_7(A(10( licant: WARNING: FAILU TO SECURE WORKS S' 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 ordinance nd state laws relating to building construction, and hereby authorize representatives of f county to enter on the above-mentioned property for ins pec ' urposes. Date: ?_9 nature (Applicant or Agent): Application Number . . . . . 12-00000814 Permit '.PLUMBING Additional desc . Permit Fee 18.00 Plan Check Fee 4.50 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 1/19/13 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS 3.00 ---------------------------------------------------------------------------- Special Notes and Comments INSTALL 120 L.F. 3/4" GAS LINE FROM POOL EQUIPMENT FOR NEW FIREPIT. 2010 CODES. ---------------------------------------------------------------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473). 1.00 Fee summary Charged Paid Credited Due Permit Fee Total 18.00 .00 .00 18.00 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 LQPERMIT 0 -M(dsC —� � �° CITY OF LA QUINTA BUILDING & SAF DDEPT. APPROVE FOR CONSTRUCTION DATE ? �ZBY v1 Q, S S �j # City. of La Quina Budding U Safety Division P.O. Box 1504,'78-49S Calle Tampico La.Quinta, CA 92253. (760) 777 7012 Building Permit Application -and Tracking Permit # 1(vi 2' Project Address: `7 fT 32 4vw ,q(e RCC.Ga e., /S'heet Owner's Name:. 2 f r L! t'>Gf Q A. P. Number. Address: . 2,2? k 0 ct LLN (N Legal Description: ni e s.tCCc Q� City, ST, Zip. Contractor. % f 1.��(�L� t Telephone:s� . Address: _ Q,©�— �� 2 Project Description: City, ST, Zip`:- 2�C� 6 ci is 4c,- L C_ Cl/to ! 2Q Telephone: 7(0 0 �QCJ . p .. i€f '* ;i t( ?Lriit cSV ►` D C �j,� ewe G . State Lic. # : (j City Lic. tf•:Q Arefi., Engr., Designer: Address: City., ST, Zip: Telephone: �Z` , P State Lic. #: Name of Contact Person: Construction Type: Occupancy: Project type (circle one)� New Add'n ' Alter Repair Demo Sq. Ft.: # Stories: # Unity: Telephone # of Contact Person: Estimated Value of Project APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Rcq'd Recd TRACMG PERMiT FEES Plan Sets Plan Check submitted Item Amount Structural Cafes. Reviewed, ready for corrections Plan Chcck Deposit. . Truss Calcs. Called Contact Person Pian Check Balance. Title 24 Ca.16. Plans picked up Construction ' Flood plain plan Plans resubmitted.. Mechanical Grading plan 2" Review, ready for correctioustiissue Electrical Subeontector List Called Contact Person Plumbing Grant Deed Plans picked up S.M.L H.O.A. Approval Plans resubmitted Grading IN HOUSE:- 1ie Review; ready for correetionsfissue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. . Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees