11-0203 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
11-00000203
Property Address:
556,50 CHERRY HILLS
APN:
775 -170 -024 -
Application description:
PLUMBING
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:.
600
Applicant: Architect or Engineer:
e6k)
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LICENSED CONTRACTOR'S DECLARATION
4
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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 Classsp:, C36 C53 License No:c 618116 _
Date: "U ` Contractor:It HIZ LL*k D C 2s
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Corrtractor'sState 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 e signed statement that he,or sheds licensed Pursuant'to�the provisions -of the Contractor's State
License Law (Chapter 9 (commencing withZection.70001'of-Division 3 -of the BusinessandProfessions Code) or
that he or she is exempt therefrom and the basis forthe:alleged exemption. Any violation of Section 7031.5 by
any applicant for a permit subjectsthe applicant to a civil penalty of not more;than five hundred dollars ($500)•:
(_) I, as owner of the property, or myemployees with-wagesas 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 anowner of property who builds or improves thereon,
and who doesthe 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 _ 1 I, as ownerof the property, am;exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and'Professions Code: The Contractors' State License Lew does not apply to an owner of
property who builds or, improves thereon, and who contracts for the projects with a contractor(s)-,licensed
pursuantto-the Contractors' State License Law.).
(_) I am exempt under Sec. , B.&P:C. for this reason
Date: Owner
CONSTRUCTION LENDING AGENCY
1 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:
LQPERWT
Owner:
ROBERTS LEO
.55650 CHERRY HILLS
LA QUINTA, CA 92253
Contractor:
LEAK:DETECTORS
P.O. BOX 727
THOUSAND PALMS, CA 92276
(760)773-9070
Lic. No.: 618116
VOICE (760) 777-701.2
FAX (760) 777=7011
INSPECTIONS (760) 777-7153
Date. 2/28/11
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjuryone 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' compensationinsurance, assequired 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
shall not employ any
personan any mannerso as to become subject.to the workers' compensation laws of California,.
and agree that; if I should becoine.subject to the workers'.corrmpensation provisions of Section
3700 of the Labor Code, I shall forthwith comply with thoseprovisions.,provisions..
Date:( vApplicant:,
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 restrictionaeatforth 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 Ouinta; 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 nulI 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.
1 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 this county to enter upon the above-mentioned property for inspectio -urposes.
Date: ��,Signature (Applicant.or Agent):
Application Number . . . 11-00000203
Permit . . .
PLUMBING
Additional desc . .
Permit Fee
21.00 Plan Check
Fee
5.25
Issue Date . . . .
Valuation
. . .
. 0
Expiration Date
8/27%11
Qty Unit Charge.
Per
Extension
BASE FEE
15.00
1.00 6.0000
EA, PLB FIXTURE
6.00
-----------------------------------------------------------------------------
Special Notes and Comments
INSTALL NEW REGULATOR
& BRASS
ANTI -SIPHON VALVE FOR
EXISTING POOL AUTO
- FILL LINE.
-------------------_-----------
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
Din #
City of La Quinta
Building a Safety Dh*lon ,
P.O. Box 1.504, 78-495 Calle Tampico
La Qulnta, CA 92253 - (760) 777-7012.
Building Permit Application and Tracking Sheet
Permit #
'
Project Address: SS 6 S C ft 4
Owner's Name: Q
A. P. Number:
Address: S 5 -
Legal Description:
Legal
City, ST, Zip: Qv 1
Contractor: T — Lam' j
Address: ,
Telephone:
Project Decipton:,
MEW RF t11t4� +
Ci"ty,:ST,'Zip:
� �'�°)
Telephone: 6a 7 % 3 — q0 7Q
"Licte
� C
State Lic. # : �i (%( 16
�CF e
Arch, Engr., Designer:
� � AIL
Address:
City., ST, Zip:
Telephone;,
State Lic: #:
Construction Type: Occupancy:
Project type (circle one): New Add'n, Alter Repair Demo
Name of. Contact,Person:�V
h
Sq. Ft.-
# Stories:
# Units :
Telephone,# of Contact Person: d 2 Z ,.I 20
asr
Estimated Value of Project: Loo
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACIMG
PERMIT FEES
Plan Sets
Plan Check submitted
Item Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss.Cales.
Called Contact Person
Plan Check Balance
Title.24 Calm
Plans picked up
Construction
Ftood.plain plan
Plans resubmitted.
Mechanical
Grading plan
2'" Review, ready.for eorrecdons/Issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S:M.L
H.O.A. Approval
Plans resubmitted
Grading
IN'HOUSE:=
Review, ready for correctionalissae
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of,permit issue.
School Fees
Total Permit Fees