PLBG (11-0175)P.O. BOX 1504 .
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
.Application description:
Property Zoning:
Application valuation:
Applicant:
11-000.0,0175-:_
56255 MOUNTAIN VIEW
762 -410 -016 -
PLUMBING
LOW DENSITY RESIDENTIAL
400
Tlit(f 4
u'ftiw
BUILDING & SAFETY DEPARTMENT
BUILDING. PERMIT
Architect or Engineer:
PIP
Owner:
RON ARNDT
56255 MOUNTAIN
LA QUINTA, CA
Contractor:
HEGARTY PLUM NG
44489 TOWN C
PALM,.DESERT, CA
(760)285-7678
Lic. No.: 915504
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760)"777-7153
r. FEB
7 1 j
9226
Date: 2/17/11.
----------------------------------------------------------
" - LICENSED CONTRACTOR'S DECLARATION
----------------------------------------
WORKER'S COMPENSATION DECLARATION ...
1 hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
I hereby affirm under penalty of perjury one of the following declarations:
Section"7000)'of Division 3 of t to Business andprtifessionals.Code, and my License is in full force and effect.
_ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: C36 se No.: 915504
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
Date: ontracton'J�l
issued:
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
• N -B LIE ECLARATION
insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exe p from a Contractor's State License Law for the
Carrier TOWER INS Policy Number WCCO01194500
following reason (Sec. 7031.5, Business and.Professions Code: Any city or county that requires a permit to
_ 1 certify that, in the performance the work f which s permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
person in any manner so as b come ) t to workers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
and agree that, if I shoul esu a orkers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
3700 of the LaborC , I I fo +wit co pl ith those provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
1r I
any applicant for a permit subjects the applicant to a civil penalty of not more than fivehundred•dollars ($500).:
ate: v pplicant:
- 1 _ 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
the structure isnot intended or offered for sale (Sec. 7044, Business and Professions Code: The
WARNING: FAILURE TO SEC E ORKERS' PENSATION OVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an'owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO C M AL PE IES AND CIV FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees,provided that the
DOLLARS ($100,000). IN. AID ITIO ATO COST OF CO PENSATION, DAMAGES AS PROVIDED FOR IN
- improvements are not intended or offered for sale. If, however, the building or improvement is sold within
SECTION 3706 OF THE LABOR CODE, TEREST, AND A ORNEY'S FEES.
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.).APPLICA
ACKNOWLEDGEMENT
(_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the '
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
conditions and restrictions set forth on this application.
property who builds or improves thereon,and who contracts for the projects with a contractor(s) licensed
1. Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License Law.). -
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
(_ 1 I am exempt under Sec. , B.&P.C. for this reason
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
Date: O' I 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
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 information is r ct. I agree to comply with all
city and county ordinances and state laws relating to b di c structio and eby authorize representatives
oft is county to enter upon the above-mentioned pr pert fo spec ' rpo s.
Date: a"1_'I S' azure (Applicant or Age 1: ,
i
Application Number 11-00000175"
Permit PLUMBING
Additional desc .
Permit"Fee 21.00 Plan Check_ Fee
5.25
Issue Date Valuation . . .
. 0
Expiration Date 8/16/11
Qty UnitChargePer
Extension
BASEFEE15..00
1.00 3.0000 EA PLB WATER INST/ALT/REP
3.00
1.00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS
3.00
------------ -
Special Notes and Comments
INSTALL 11 L.F. GAS LINE FOR FUTURE
FIREPIT. SEE ATTACHED.FOR SPECS.. 2010
CODES .
- -----------------------
--------------------------
Other Fees BLDG STDS ADMIN (SB1473)
1.00
Fee summary. Charged Paid Credited
Due
--- ---------- ---------- ---------- ----------
Permit Fee'Total 21.00 00 .00
21.00
Plan Check -Total 5.25 .00 .00
5.25
Other Fee Total 1.00 .00 .•00
1.00
Grand Total: 27.25 .00 .00
27.25
CIN OF LA QUINTA
BUILDING & SAFETY DEPT,
APPROVED
FOR CONSTRUCTION
DATE- Z /? // BY g4t
M
I'�
�,Ab
O)WIC165-
Bin #
Qty Of La Quinta
Building & 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: ,�[Q a-+S� /W Irp! f#4rJ VVJW Owner's Name: a,f &eV b —t
A. P. Number: Address: $•(,Q a~S�ar /Its ypl p�f �fI qj
Legal Description: -- City, ST, Zip: LIQ OUte-l;4-1 ��# • Q��S' 3
h�:�•.
Contractor: "75 •�/�fITelephone: CO 3 — V��v — Y".GO�.�>�K:v�.<`;.f<:1.:<.::::,v:v:.::::�Crv•.fnw.. TL:iJi)S:2viy�StiE:�i
Y.i.a.i..iii
Address: NN % �( � (,rte- v,V ProjectDescription: DUIWZlJi L- Dt�sCpj��0�/'
City, ST, Zip: xv— ixr, i {'tom I'P •
Telephone: �
P
�v:.�:s�•: ;:;;;h <:.�;,:..:..:.� : .. —
City Lic. #../a 531 A- 2/q Iq 14 H
State Lic. # : G 3 C,2 9 /, ASO
Arch., Engr., Designer.3I4 t ' `'Tvinx
Address: T �. , GQ� (�/ /✓a
City., ST, Zip: S�SI✓laj ZED . .
Telephone: : Construction Type Occupancy:
State Lia #: �.; �. i.>„;::<; ,<:.: s,y Project circle one): New Add'n air Demo Alter Re
1 type � P
Name of Contact Person: � C, Sq. Ft.: # Stories: # Units:
Telephone # of Contact Person: -102— '7a0---:-'7-71JEstimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Reed
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item Amount
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cales.
Called Contact Person
Plan Check Balance
Title 24 Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2' Review, ready for corrections/issue
Electrical
Subcoutactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading .
IN HOUSE:-
''' Review, ready for correetionstissuc
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees