11-1203 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 4=�1_-I-- 0001203
Property Address: 79485 HIGHWAY 111 STE 5
APN: 600-020-027- -
Application description: PLUMBING
Property Zoning: REGIONAL COMMERCIAL
Application valuation: 11500
• 40"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
STAMKO DEV CO
10345 W OLYMPIC BLV 2 FL
LOS ANGELES, CA 90064
I DContractor:
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/03/11
Applicant: Architect or Engineer:
EGGAN, RICK EDWARD 2U1�
73680 HIGHWAY 111, STE #V,3
LLJJ
PALM DESERT, CA 92260
(760)404-6325
CITY OFLAQ P4A
n
al �X
Lic. No.: 950244
---------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter'9 (commencing with
1 hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business and Professionals 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
Licens lass: C42 License No.: 950244
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
r��v`
ate: l>ntractor:
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
OW ILDER DECLARATION
insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor% State License Law for the
Carrier EXEMPT Policy Number EXEMPT
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to
I certify that, in the performance of the work for which this 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 to become subject to the 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 should become subject to the workers' 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 Labor Code I shall f hwith comply with those provisions.
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).:
e:_ ,cant: _
• (_) 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
WARNING: FAILURE TO SECURE WOR ERS' CO NSA+ ION COVERAGE 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 CRIMINAL PENALTIES AND CIVIL 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 ADDITION TO THE COST OF COMPENSATION, 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, INTEREST, AND ATTORNEY'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.).
APPLICANT 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:
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 Qu,nta, its officers, agents and employees for any as 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 this coynfy to enter upon the above-mentioned property f r inspe n purposes.
_Yat
e: %�T % Si ure (Applicant or Agent): .
Application Number . . . . . •11-00001203
Permit . . . PLUMBING
Additional desc .
Permit Fee . . 27.00 Plan Check Fee
6.75
Issue Date Valuation . . .
. 0
Expiration Date 5/01/12
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 12.0000 EA PLB INTERCEPTOR
:
12.00
----------------
Notes and Comments
ABANDON EXISTING GREASE INTERCEPTOR &
INSTALL NEW 2000 GALLON INTERCEPTOR WITH .
SAMPLE'BOX. 2010 CODES.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
Due c
---------------------------------------------------------
Permit Fee Total 27.0,0 .00 .00
27.00
Plan Check -Total 6.75 .00 .00
6.75
Other Fee Total 1.00 .00 .00
1.00
Grand Total 34.75 .00 .00
- v
34.75-
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'Bin #.
City of La Quint's
Building.8r.Safety. Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
1��
Project Address:, Ift SJ
Owner's Name: L,00A.)
A. P. Number:
Address: 7,7 f Ip 57,L
Legal Description:
City, ST, Zip:
J �T�
Contractor: G
J
Telephne: :a>, s<.::: v; ; a.• .w:
Address:
Project Description:
City, ST, Zip:
� L -PL) 6 4 5e 7 e
'
Telephone:
Vii.; '' :�Xk-•R};'a'.i7.:':; t� r s. `.:•,+'.�•:u>`<,:Y`i+
„,«g.>,:;:;<:>:•::ay
State Lic. # :
City Lia
Arch., Engr.,' Designer:
Address:
City, ST, Zip:'
F
Telephone:. 4 �r., .t••;.: w:- :<
,• '.,k<• s
State Lic. #: `' '> ' "' `f v
Name of Contact Person:Sq.
Construction Type: Occupancy:
Project circle one): New Add'n Alter Repair Demo
Ft.:
# Stories:
# Units:
Telephone # of Contact Person: Z
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item Amount
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Pians picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2'! Review, ready for correctionstissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
7rd Review, ready for correctionstissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees