PLBG (05-3608)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
05 00003600
51617 AVENIDA ME
773-142-019-7
PLUMBING
COVE RESIDENTIAL
2500
,,,--9rchitect or Engineer:
A�
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.
LicenseClass: C36 -C42 -B LicenseNo.: 793482
,,,-Caw l5nra
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, as owner of the property, or my employees withwages as their sale 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, 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.).
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
40"
Y DEPARTMENT
PERMIT
Owner:
CHRISTE MAGANA
51617 AVENIDA MENDOZA
LA QUINTA, CA 92253
Contractor:*
SO CAL PLUMBING & REPIPE CO
P.O. BOX 955
YUCCA VALLEY, CA 92286
(760)369-4104
Lic. No.: 793482
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/12/05
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' compens�tion 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 EKEMPT 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 subiect to th&workers' compensation grovisions of Section
3700 of the La�q� C ose p��v�ons.
��ro—rfFwsth
1 -ale— id
WARNING: FAILURE TO SECURE WORKERS'COM NSATION 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 unde r 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 su biect
permit to cancellation
I certify that I have read this application and state that the above information is correct. I ag�ee to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of this_county to enter =up above-mentioned property .1 for ins
Applicant or
Application Number . .. . . . 05-00003608
Permit . . . . .
. PLUMBING SEWER
Additional desc .
.
Permit Fee . . .
. 30.00
Plan Check
Fee
00
Issue Date . . .
.
Valuation
. . .
. 2500
Expiration Date
2/08/06
Qty Unit Charge Per
Extension
BASE FEE
30.00
----------------------------------------------------------------------------
Special Notes and.Comments
SEPTIC ABANDON; SEWER CONNECT
Fee summary.
Charged Paid
Credited
Due
-----------------
Permit Fee Total
---------- ----------
30.00
---- 7 -----
.00
-----------
.00
30.00
Plan Check Total
.00
.00
.00
.00
Grand Total
30.00
.00
.00
30.00
LQPERMIT
Bin #
Permit #
Project Address: 15
A. P. Number:
X Submittal Rtq'd
Plan Sets
Structural Caics.
Truss Caics.
Energy CalM
Flood plain plan
Grading plan
Subcontactor List
Grant Deed
H.O.A. Approval
IN HOUSE: -
Planning Approval
Pub. Wks. A
School Fees
CRY of La Quinta
Building a Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
D 0%%-ncr*sName:
VN ns,4-e
TAiddrff,s,s:
C n. S
Cin'. ST. Zip:
keicphonc� 031 - 'q --7) 9 __T_
T
Project Description:
1_9A
City Lic. #:
Construction Type:
Occupancy:
'FSProject type (circle one): Ne- 'Add'n Altcr Repair Demo
ories:
Sq. Ft.: # St -
T CA -Y -5f Y
Contractor:
Address:
City, ST,.Zip':
TRACKING
Telephone:.
A
State Lic. $1 _3 -V8
Arch., Engr., Designer:
Address:
City. ST. Zip:
Telephone:
State Lic. #:
Name of Contact Person
X
Telephone # of Contact Person. -
X Submittal Rtq'd
Plan Sets
Structural Caics.
Truss Caics.
Energy CalM
Flood plain plan
Grading plan
Subcontactor List
Grant Deed
H.O.A. Approval
IN HOUSE: -
Planning Approval
Pub. Wks. A
School Fees
CRY of La Quinta
Building a Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
D 0%%-ncr*sName:
VN ns,4-e
TAiddrff,s,s:
C n. S
Cin'. ST. Zip:
keicphonc� 031 - 'q --7) 9 __T_
T
Project Description:
1_9A
City Lic. #:
Construction Type:
Occupancy:
'FSProject type (circle one): Ne- 'Add'n Altcr Repair Demo
ories:
Sq. Ft.: # St -
T CA -Y -5f Y
r -Estimated Val ue of.Proiect:
APPLICANT: DO NOT WRITE BELOW THIS LIN
Rec'd
TRACKING
PERMIT FEES
Plan Check submitted
Item
Amount
Reviewed. ready for corrections
Plan Check Deposit
Called Contact Person
Plan Check Balance
Plans Oicked up
Construction
Plans resubmitted
Mechanical
2" Review. ready for corrections/issue
Electrical
Called Contact Person
Plumbing
Plans picked up
SAI.I.
Plans resubmitted
Grading
' Review. ready for correctionslissue
Developer Impact Fee
Called Contact Person
A.I.P.P.
Date of permit issue
Total Permit Fees
Aw"Sm A w Pw
I __1
PLIMPING
Lic #C42 855 851
I W -goof
FAX 760 328-6607
P.O. Box Cathedral City, CA 92235
8)
ER'S ORDER NO.
DAI�VD E
-;� 19KI,
N BY
DATE PROMISED 0 A.M.
0 P.M..
BILLTO
PHONE
ADDRESS
MECAP 7
CITY L
?7��r
HELPER
JOB NAME AND LOdATION .00- ��e
0 DAY WORK
DESCRIPTION OF WORK
gs of
0 CONTRACT
0 EXTRA
//,T
QUANT
DESCRIPTION OF MATERIAL USED PRICE
AMOUNT
Gallons
Pumping Fee per 1000 gal.
Dumping Fee per 1000 gal.
Out of Area Fee
Locating / Opening Fee (per ho
_,� �510_�
Size System: ,00
IAVI_�IdOf �61�
A SERVICE CHARGE OF $20 WILL BE DUE ON ALL RETURNED CHECKS. TOTAL
18% PER YEAR WILL BE CHARGED ON PAST DUE MATERIALS
ACCOUNTS OVER 30 DAYS. TOTAL
AIVER.Notre onsible for secondary damage such as water LABOR
s
,c 1P co c , m et or driveway
ped n reti, ys or trees. TAX
SI 'DATE COMPLETED
TOTAL
COACHELLA VALLEY WATER DISTRICT CASH RECEIPT DETAIL
N2
Received From: —C� S �j *4
Address: five
10836.1
Account No. V Q./. Loys) Tract
V_le,. nj %0 L4
40 G.A. Code
0 Meter(s)
$
0 Service(s)
0 Backflow(s)
0 House Lateral(s)
0 Detector Check(s)
0 Meter Surcharge
Cleanitation Capacity Charge L5:5—
• W.S.B.FC.
• S.I.W.S.C.
• Temporary Construction Meter
0 Turn on Charge
0 Uncollected Account - Name
0 Inspection Fee - Tract -
Fee -
0 Plan Check Fees Water Sewer -
Tract -
0 Bond Payment - A.D. - Bond— Assmt
0 Customer Deposit
0 Other
TOTAL
Remarks:
0 Copy to:
Cash
Check
Money
Order
Water Service 00
Cashier
CVWD-438 (1/05)
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4 945
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 51-617 Mendoza LA QUINTA, CALIFORNIA 92253
Owner
Mailing Charles areidin BUILDING: T I YPE CONST.—OCC. GR ' P.
Address Same A.P. Number, 773-142-0"J1
City Zip ITO.
La Quinta 9,22-53 Legal Description
Contractor Project Description Room addition
John Harrison Construction
Address
2bb R. El Cielo* Suite 676
City Zip Tel.
Palm Springal 92263 320-4412
State Lic. City
& Classif. 475070 Lic. # 1076 Sq. Ft. 264 No. No. Dw.
Arch., Engr., Size Stories Unit s
Designer New 0 Add 0 Alter 0 Repair 0 Demolition 0
Address Tel.
City Zip State
I Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Profes�ions COC19, and my license is in full force and
effect.
7�- �11_
SIGNATURE .1 DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following Estimated Valuation $12081.60
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, alter, Improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to PERMIT AMOUNT
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that.he is exempt therefrom, and the basis Plan Chk. Dep.
for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civilpenally ofnotmore than five hundreddollars ($500).
0 1, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. 0 UZ
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who Const. 0
builds or improves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for sale. If, however, the building Mech. luouu
or improvement is sold within one year of completion, the owner -builder will have the burden Electrical
of proVing that he did not build or improve for the purpose of sale.)
0 1, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for S. M. 1.
such proje - cts with a contractor(s) licensed pursuant to the Contractor's License Law.) Grading
0 1 am exempt under Sec.—B. & P.C. for this reason
Driveway Eric.
Date Owner Inf rastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
0 Copy is filed with the city. 0 Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) Valuation 64.'� A rk-A, -Ub� _,A
or less.)
I certify that in the performance of thp 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.
Date—Owner
NOTICE TO APPLICANT: N, after making this Certificate of Exemption you should become ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked. Minimum Setback Distances:
Front Setback from Center Line
—Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.) Side Setback from Property Line
Lender's Nam
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to FINAL DATE /---iN—,,PFr.Tn-R
expiration it work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct. Issued by: Permit
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter the above-
mentioned property for inspection purposes. Validated by:
Signature of applicant Date
Mailing Addres Validation:
City, State, Zip
WHITE m FINANCE, PINK -.A PLICANT, GREEN
0.7,A6596SCIR'S OFFICE, HARID,COPY'- FILE
CONS TRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO FT (a
UNITS
L-A
ok�13GRADE
ROUGH PLUMB
BONDING
YARD SPKLR SYSTEM
2ND FL SO FT. Qt
UFORMS 2
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR SO FT. a
GAS(ROUGH)
METER LOOP
GAR SO. FT. Cl
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SO FT. 6
GROUT
WATER HEATER
WALL So. FT. rd
FINAL INSP.
DRINKING FOUNTAIN
BOND BEAM
WATER SYSTEM
URINAL
SO. FT. a
$
LUMBER GR.
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH E R(AUTOY DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. @ c
BATH TUB
SO. FT. @ c
I WATER HEATER
MAX. HEATER OUTPUT, B.7.U.
SO. FT. RESID a 1 'A c
SEWAGE DISPOSAL
SO.FT.GAR (& JVc
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
I TOTAL FEES
MICRO FEE . —7�EE
PL.CK.FEE T
NST.,FEE —1 ELECT.FEE
SMIFEE T LUMB FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
To//"GROUND PLUMBING 5;�
JI--
UN DERGROUND
A.C. UNIT
COLL. AREA
L-A
ok�13GRADE
ROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
UFORMS 2
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS(ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu.yd.
$ _plus_x$
$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
if / V/
MENTILATION
7
REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR"
GAR. FIREWALL
F
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
JVFINAL INSPECTION�
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATUREWINITIALS
GARDEN WALL FINAL
DESERT SANDS UNIFIED SCHOOL DISTRICT
82-879 Highway 111
Indio, CA .92201
CERTIFICATE OF SCHOOL FACILITY FEE WAIVER
V 'NT CANNOT
NOTI.M. THUS o0C ME
BE DUPLICA D.
TO: DATE:
V
This -is to certify that
developer of w h i c h i s
L
I ocated at /:z within
this school dis trict', is not requirc4 to'pay school facility fees
pursuant to the authority generated by Government Code Section"53080.
Building permits for the - p - roject indicated above may now be issued by your
j y Q�dj �F ___ _� �___
-ct-i,on,.--fjF VALU,�TION INDICATED ON BUILDING PERMIT EXCEEDS $20,000
THIS WAIVER IS VOID AND A SCHOOL FACILIT ST—BE—PAID PRIOR TO
ISSUANCE OF BUILDING PERMIT.__r__ IES_FEE—ML
for DESERT SANDS UNIFIED SCHOOL DISTRICT
White -Building Department Yellow-Facili6es Planning Pink -Developer (10)-38