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10-1227 (PLBG)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: -`10-000012:T7 Property Address: 79515 ' CETRINO APN: 772 -330 -046 - Application dgscription: PLUMBING Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 1200 Tuvl 4 4v Q" Applicant: Architect or Engineer: 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 B siness and Professionals Code, and my License is in full force and effect. Lase Cl -ss: C36 C53 Lyse No.: 618116 Date:�d ontractor. . OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that 1 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).: (_) 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.). 1 _ I 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: I' LQPERMIT Owner: MCSMITH GAYLON W 79-515 CETRINO LA QUINTA, CA 92253 Contractor: D LEAK DETECTORS P.O. BOX 727 THOUSAND PALMS, CA 9 (760)773-9070 LiC. No.: 618116 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 11/09/10 NOV 092010 ID, CITY OF LA WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: _ 1 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' 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 CALIFORNIA INS Policy Number 460089600105 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 became subject to the workers' compensation laws of California, and agree that, if 1 should become subject to the workers' compensation provisions of Section L 3700 of the Labor �Ishallo�ith c itli those provisions. Da r - ppIicant:/�z . 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 ($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 d county ordinances and state laws relating to building constructio ere thorize representatives is county to enter upon t above-mentioned property for in ecti Date: •��%% ature (Applicant or Agent): Application Number . . . . . 10-00001227 Permit . . . PLUMBING Additional desc . . Permit Fee 18..00 Plan Check Fee 4.50 Issue -Date . . . . Valuation . . . . 0 Expiration Date 5,/08/11 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 60.L.F. 3/4" GAS LINE TO.FEED FUTURE APPROVED APPLIANCE. 2007 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 CITY OF LA QUIN A BUILDING ErDEPT- APPROVED FOR ONSTRUCI WE Bin # rerrNlc,,#ll 1 � �j• lV' PrRjed Address: _ A- P. Number: Legal Description: Contractor. (� Address: .City, ST, Zip: y Tcephono:� G Stats; Lia # Ards., EW'. Dasrgaer: Ad*=: City. ST. Zip: Telephone: State Lilt. #: Name of Contact Person: Telephony # ofContact nmsoa: tl Submittal $ie. Plan Sets Structural CUes. Truss ales. Titre 24 Ca1cs. Flood plain plan Grading plan Subeontaetor List Grant Deed H.O.A. Approval IN HOUSE: - Planning Approval Pab. Wks. Appr School Fees Y 6f ,u Quinta .( Dm" • Box 1504,a La • r(766) 777-7012 Building Perinit APP11cationi 'Tracidng Sheet Am / s• �, 10 r� M::J:::22'GS6. 2i:k2:w4£;•Si�.n�M APPLICANT: DO NOT WRITE BMOW THIS LINE Reed Plan Check Reviewed, Called Centalt • Plans picked Plana resubm 2'! Rewlew, Called Cbata Plans picked Plans resa ' Review, Called Con Date of TRAMING PERMIT FEES s tbmitted item Amount ready for corrections Plan Check Deposit Person Plan Check Baku". Cap Construction fitted Mechanical ratdyfor correctious/Issae Electical ct Person Plumbing Cap S.M.L bm J" ready tact permit ltted Grading for correctionvissuc Developer Impact Fee Person Issue Total Permit Fees