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PLBG (05-4157)1 P.O. BOX 1504 4 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Application Number: 05=0.0004157 Property Address: 52975 AVENIDA MENDOZA APN: 773-332-025-12 -000000- Application description: PLUMBING Property Zoning: COVE RESIDENTIAL Application valuation: 3800 Applicant: Architect or alR SEP 16 2005 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.: 803145 Date: ,G contractor. 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.). - (_) 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.). ( ) I am exempt under Sec. , 8.&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: VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date:. 9/16/05 Owner: WARREN JOHN C 52975 AVENIDA MENDOZA LA QUINTA, CA 92253 Contractor: DESERT EMPIRE PLUMBING -& DRAIN P.O. BOX 1836 CATHEDRAL CITY, CA 92235 (760)328-6417 Lic. No.: 803145 WORKER'S COMPENSATION DECLARATION ).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. _y_ 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 1705218-2004 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 I.Abor Code shall forthwith/comply with those provisions. ��6�o pplicant: 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 1$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 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 t/his%county to enter "upon tve-mentioned propert insp tipuose�s. ueAppli� 7aeOJ Sicant or Agent): LQPERNfIT - LQPERMIT Application Number . . . . .. 05-00004157 Permit PLUMBING SEWER Additional desc . .Permit Fee . . . . 30.00 Plan Check Fee .00 Issue Date Valuation .•3800 Expiration Date 3/15/06 Qty Unit Charge Per Extension BASE FEE 30.00 --------7-7---------------------------------------------7------------------- Special Notes and Comments SEPTIC ABANDON; SEWER CONNECT Fee.summary Charged Paid ---------- Credited -------------------- Due --------------------------- Permit Fee Total 30.00 .00 .00 30.00 Plan -Check Total .00 .00 .00 .00 Grand,Total .30.0.0 .00 .00 30.00 Bin # City of La Quinta -- Building -Bi -Safety -Division -- P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet --- Permit # Project Address:' +— v e� 4 the Owner's Name: A. P. Number: Address: 2 Legal Description: Contractor:Oe-5 Q/ j j� City, ST, Zip:. L Q : Z ZS— 3 Telephone: Address: PD, l Project Description: City, ST, Zip: 7 - Telephone: Telephone: 7 6p c�( State Lic. # : e603 4f 5- City Lic. #: Arch., Engr., Designer: Address: a City, ST, Zip: Telephone: c State Lic. #: Name of Contact Person: 0 ` Construction Type: Occupancy: Project type (circle one): New Add'n Alter Repair Demo Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: y 2 3 — 7 6 Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING. 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 Energy Calcs. Plans picked up Construction Flood. plain plan Plans resubmitted Mechanical Grading.plan` 2"d Review, ready for corrections/issue 'Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- d'd Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.LP.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees AwSmAmPm PLI P_/NG Lic #C42'855 851 #WW DESCRIPTION OF MATERIAL USED' CUSTOMER'S ORDER NO.'t DATE ORDERED —7 FAX 760 328-6607 C? P.O. Box 2318 Cath-64ral Cityi CA 92-2'3'Sk ORDER TAKEN BY DATE PROMISED [3 A.M. 13 P.M. BILL TO _ PHONE ADDRESS F fFY MECPIANIC� CITYj!ELPER, JOBND-LOCATIO rx N Ir � ODAY WORK 0 CONTRACT DESCRIPTION OF WORK 13 EXTRA QUANT DESCRIPTION OF MATERIAL USED' PRICE C AMOUNT Gallons CX C, Pumping Fee per 1000 gal. 3: A 156n;Iping fee p6r k1,000 Out of Area Fee Locating Opening Fee (per ho Size System: Jb I V, tjl A SERVICE CHARGE OF $20 WILL BE DUE ON ALL RETURNED CHECKS. k, TOTAL 18% PER YEAR WILL BE CHARGED ON PAST DUE MATERIALS TOTAL LABOR AqC-(5&*g OVER 30 DAYS. - WAIVER:Not respons[6-fe forAdc-ondary damage such as water TAX dq6age, chip ed/concr a, mark on street or driveways or trees. SIGNATRURE DATE COMPLETED TOTAL /rF bal Building Address Owner C, 52"975 Mendoza 4 0.4729.. P.O'. BOX 1504 78-105 CALLE ESTADO LA QUINTA,,CALIFORNIA 92253 John C. Warren, Jr Address, 83-791 AVC 'City I Z17 -P Contractor -imial, Roofing Address 1 1 02-190 van Buran BUILDING:. TYPE CONST. OCC. GRP. ► A:R. Number 778-232-025 r34J'i.fi377 Legal Description , Project Description, City - - Zip Tel. . It f'a92201 342-Y State Lic. City & Classif..71 Lic. # Arch., Engr., Designer Address Tel. Sq. Ft. No. No. Dw.- Size Stories Units New 0 Add OAlter 0 Repair 0 Demolition 0 City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under or�ovisions of Chapter 9 (commencing with Section 7=,tof Division 3 of the Business and Professions Code, and my license is in full fqrca�ncl SIGNATURE DATE -1 OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following Estimated Valuation .$2,il,500 reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a' 'PERMIT A I MOUNT.' 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 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 for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit• Plan Chk. Dep. subjects the applicant to a civil penalty of not more than five hundred dollars ($500). 0 1, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. Const. 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 Mech. 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 Electrical or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale.) Plumbing 0 1, as owner of the property, am exclusively contracting with licensed contractors to con- 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.I. such projects. with a contractor(s) licensed pursuant to the Contractor's License Law:) 0 1 am exempt under Sec. B. & P.C. for this reason Grading Driveway Eric. • Dateowner Infrastructure 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 there6f. (Sec. 3800, Labor Code.) Policy No. Company - -or-- — 0 Copy is filed with the city. 0 Certified copy is hereby furnished. TOTAL f CERTIFICATE OF EXEMPTION FROM, WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation or less.) REMARKS Rp 7w 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 -,L-_Owner NOTICE TO APPLICANT: if, after making this Certificate of Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. ZONE: BY: Minimum Setback Distances: —Front Setback from Center Line Rear Se'tback from Rear Prop. Line 'CONSTRUCTION LENDING AGENCY,' I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Seca 3097. Civil Code.) iSide Lender's Namel. Side Street Setback from Center Line Setback from Property-Lihe - Lender's Address 'This is a building permit when properly filled out, signed and validated, and is subject to 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. 11 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. Signature of applicant Date— Mailing Address ",.-FINAL DATE Issued by, . - :, , e Validated by: - Validation: INSPECTOR Date Permit I I City, State, --Zip GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - I FILE 4- "�WHITE - FINANCE:4q. , PINK - APPLICANT, GREEN BUILDING, JJ- - I x�, CONSTRUCTION ESTIMATL NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL SO F1 (a $ UNITS COLL. AREA 2ND FL SO FT. a YARD SPKLR SYSTEM POR SO FT. er MOBILEHOME SVC. BAR SINK GAR SO. FT. fpr POWER OUTLET ROOF DRAINS ROUGH WIRING DUCT WORK DRAINAGE PIPING CAR P. I SO FT. is GAS (ROUGH) WALL SO. FT. a HEATING (FINAL) DRINKING FOUNTAIN SO. FT. 0 URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES FINAL INSP. WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTONDISH) APPLIANCE DRYER GRADING cu. yd. $ plus x$ GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY AIR HANDLING UNIT CFM FINAL INSP. I 1KITCHEN 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 FIRE ZONE ROOFING SO. FT. @ c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID C 1�A c SEWAGE DISPOSAL SO.FT.GAR @ 3/4c HOUSE SEWER GAR. FIREWALL GAS PIPING PERMIT FEE LATHING PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB FEE STRUCTURE PLUMBING ELECTRICAL HEATING 8 AIR COND. SOLAR SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP.IEOUIP. 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 ' REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING F NAL INSPECTION//- NSPECTION /'CERT. CERT.OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL 7d