11-1084 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92.253
Application. Number:
Property Address:
APN:
Application description:
Property Zoning:
-Application valuation:
'Applicant:
9
511 000010.84
2.97"0 AVENIDA RUBIO
773-313-012715 -000000-
PLUMBING
COVE RESIDENTIAL
500
T4ht 4 XP Q--, "
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
DAVID MULLER
52910 AVENIDA RUBIO
LA QUINTA, CA 92.253
- •'Contractor: -' '`` ' ' ` "" '' � "
WILLIAMS- PLMBNG/ELEC INC; D:
8159,5.;RANCHO SANTANA DR
-'liA-QUINTA; CA 92253
(760)'29,6-1397.
Lic:'No::'924755
VOICE (760) 777-7012
FAX (760) 777-701-1
INSPECTIONS (760) 777-7153
Date: 10/04/11
�,,TM
VE
CITY OF LA QUINTA }
the structure is not intendedof offered for sale _(Sec 7044, Business a.n,d Professions Code: - The,
._Contractors' State License�Law:does not apply'to an owner of proptihywho-,builds'orimproJes thereon,
and who`does the work,himself.or herself through his or her own employees; provided that the - -
' <Am royements are not intended,or offered for sale : If, however; the building_or improvement is sold within
one year of:completion,,Jhe owner,, builderwill,have:the 6urden,1f proving that he or she did not build'or'
_ improve.for'ihe,purpose'of sale.).
(_) :1, as owner. of the•property;;em exclusively contracting with licensed contractors to. construct the project (Sec.
764446siness and Professions Code: The Contractors' State License'Law" does not apply to an owner of
prope-ry w.t _ho;buildstor improves thereon, and who contracts for the projects with a contractor(s) licensed.
pursuant toithe Contractors' State License Law.).
( ) 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: IN
LQPERMIT
.4 WARM NG:-FAILUREdO SECU ORKERS.,COMPENSATION COVERAGE IS UNLAWFUL,, AND SHALL
SUBJECT -AN EMPLOYER T0, CRIMINAL PENALTIESAND CIVIL FINES UP TO,ONE,HUNDRED THOUSAND.
' . DOLLARS.($100'000).- IN;ADDITION TO,THE-COST OF.COMPENSATION, DAMAGES AS PROVIDED FOR IN
'SECTION3706 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 aresult 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 andemployees-for any actor omission related to the work being
performed underorfollowinij.issuance'of this permit..
2. Any permit issued as:a result of:tfiis application becomes.null and void if work is not commenced•
within 180 days from date of•issuance of such permit, orcessation of work for 180 days will subject
permit to cancellation. a -
I certify that I have read this, application and statethat.the above information is correct. I agree to comply with all
city and unty ordinances'dtate laws relating to build' truction, and hereby authorize representatives
of [h' county to enter upon a above-mentioned. property for inspects n purposes. '
ate:' S' ature (Applicant or Agent):
— — —'— — — — —•------------ - — — — — — — — — — - - - — — — — — — — — — — — — ---
UCENSED CONTRACTOR'S DECLARATION_
— — — — — -.— ,. ..
- WORKER'S,COMPENSATION DECLARATION
• I hereby affirm under penalty of perjury':that l amlicensed-under. provisions of Chapter (commencing with
I 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..
J'have.and.will maintain a•certificate of consentto self- insure for workers'-compensation,,as provided
License Class CIO C36 .License No.: - 924755 - - -
'for_by Section 3700 of the Labor Code,- forthe. performance of the work for which this permit, is
- -
C ractor..
issued -
- I have and will maintain w orkers compensation•insurance,-as regwredby.Section3700 of.the Labor .
tCode.for-the performance of the work forwhich this permit is issued ; My workers .compensation
' .OWNER -BUIL .FR DECLARATION '
•iriwrance 6rri6i and policy numberare:"•
'I hereby affirm under penalty•of;perjury i'Q:l, am exemptifrom the'Contractor'sS'tate License Law for the
Carrier SUA•"iNS 'b• "^ r' - , Policy�Num6W. 72WECNG5313 - '` •�
' following reason _(Sec.:7031 -5 Business and:Professions�Code `Any -city or county that'reomres a'permittito .. .R
- „ .+..; I;certrfy that _irr4he performance of ;{he:work.for whicfiahis permit is ' -issued, f shall not'emplpyany -
. construct,'alter, improve demolisfi:.'or'repair any structure prior to itsissuance,-also requires the'applicant,for the
`,
_ ..` person many;manner, so as to become su6jecttothe workers' compensation laws of California,
' permit to file's signed statement that he or,she"isticensed pursuant to tfie provisions of t'he�Contractor's State
L`
- and agree that, if.l should"Become subject to the workers' compensation provisions of-Secfion
_ .
License.Law-IChapter,9=(cornmencing with.Section 7000) of Division 3 of the Business and Professions Code)'or
- f 3700 of: the Labo ..Code I forthwrth'comply with those provisions.
•- that he or she is exempt°therefrom and the. basis forthe alleged`ezemption. Any violation'of Section'.7031.5'by'
- -
y
+` ,.any applicantfor a permit subjects the applicant to a'civil penalty'of'not more than five hundred'dollars ($500).: `
-• ate _ cant
1'1,'as owner of the property;-or,my'employees witt;wages ascompensation wJldo_the work, and
the structure is not intendedof offered for sale _(Sec 7044, Business a.n,d Professions Code: - The,
._Contractors' State License�Law:does not apply'to an owner of proptihywho-,builds'orimproJes thereon,
and who`does the work,himself.or herself through his or her own employees; provided that the - -
' <Am royements are not intended,or offered for sale : If, however; the building_or improvement is sold within
one year of:completion,,Jhe owner,, builderwill,have:the 6urden,1f proving that he or she did not build'or'
_ improve.for'ihe,purpose'of sale.).
(_) :1, as owner. of the•property;;em exclusively contracting with licensed contractors to. construct the project (Sec.
764446siness and Professions Code: The Contractors' State License'Law" does not apply to an owner of
prope-ry w.t _ho;buildstor improves thereon, and who contracts for the projects with a contractor(s) licensed.
pursuant toithe Contractors' State License Law.).
( ) 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: IN
LQPERMIT
.4 WARM NG:-FAILUREdO SECU ORKERS.,COMPENSATION COVERAGE IS UNLAWFUL,, AND SHALL
SUBJECT -AN EMPLOYER T0, CRIMINAL PENALTIESAND CIVIL FINES UP TO,ONE,HUNDRED THOUSAND.
' . DOLLARS.($100'000).- IN;ADDITION TO,THE-COST OF.COMPENSATION, DAMAGES AS PROVIDED FOR IN
'SECTION3706 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 aresult 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 andemployees-for any actor omission related to the work being
performed underorfollowinij.issuance'of this permit..
2. Any permit issued as:a result of:tfiis application becomes.null and void if work is not commenced•
within 180 days from date of•issuance of such permit, orcessation of work for 180 days will subject
permit to cancellation. a -
I certify that I have read this, application and statethat.the above information is correct. I agree to comply with all
city and unty ordinances'dtate laws relating to build' truction, and hereby authorize representatives
of [h' county to enter upon a above-mentioned. property for inspects n purposes. '
ate:' S' ature (Applicant or Agent):
Application Number . . . . . 11-00001084
Permit . . . PLUMBING
Additional desc .
Permit Fee . . . . 24.00 Plan Check Fee
6.00,
Issue Date . . . . Valuation . . .
. 0
Expiration Date 4/01/12
Qty Unit Charge Per
Extension
"
BASE - FEE
15.00
1.00 6.0000 EA PLB FIXTURE
6.00
'
1.00 3.0000 EA PLB.WATER.INST/ALT/REP
3.00
`:
Specal. ;Notes.;:and:,,Comment's_k
ADD HOT &:COLD WATER SUPPLY -FOR NEW
'
WASHING MPCHINE.',INSTALL''NEW 31 SEWER
LINE•AROUND OUTSIDE OF .HOUSE „'AND TIE
INTO EXISTING,SEWER. 2010 -CODES:
- -- - - - - - - - ---- - - -. -- - ---------- - - -- --------------
Other,Fees'. . . . . . . BLDG STDS ADMIN, (SB1473)
--------------
1.00
Fee summary Charged-., - Paid- Credited
Due
'
----------------- ----------- ---------- ------r=-
Permit Fee Total 24..00 QO 00
24::00
Plan CheckTotal 6.0:0 0'0 00
"6,:.00
-
Other .Fee Total 1,.00 .`00 00
.1.00
Grand Total 31.00 _00. :.00 ." "
31..00
a2 Y
l
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w huSG.� r�
CITY.OF, LA QUINTA F!' SEP 2 20>>
BUILDING. & SAFETY DEPT.
APPROVE®
FOR CONSTRUCTION
DATE/0 -3'// .BY
T� ?0 Aye171� RU610
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City of La Quinta
Building. & Safety. Dfyislon
A.0. Box .1504; 78-495 Calle Tampico
La-Qiririta, CA 92253 - (760) 777-7012
Building Permit. Application ,and Tracking Sheet
Pernik #
1
Project Address - 9� V ��v6 l O.
Owner's Name:
A. P. Number.
Address:.
Legal Description:
City; ST, Zip:
o�
Contractor: W I J S
Telephone:
-"Y\a.'.'aa};k�,'y Yt
?r5,'
Address: -
Project Description:
City, ST, Zip: L c I.- l/am C(1
Telephone
/397
ff•.-<-
City Lic. #;'�
.
State Lic. #:
c .
Arch:, Engr., Designer:
Address:
City, ST. Zip:
Telephone:
State Lic. #:
} "r
r y��;
„N'�`i?„•'<,
;.ConstrtictionT an
ype- Occupancy:
�.
;Project type'(citcle on New dd'n ter Repair Demo
Name of Contact Person:
Sq. Ft:
# Stories:
# Units: f
Telephone # of Contact Person:
Estimated Value, of Project:
'-APPLICANT: DO NOT WRITE'BELOW THIS LINE
H
Submittal
Plan Sets
Req,d
Recd
TRiACKDVG PERMIT FEES
Plan Cheek submitted . Item Amount
structural Cala.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cates.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2'! Review, ready for corrections/isme
Electrical
Subeontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
Review, ready for'correctionsrusuc
Developer Impact Fee
Planning Approval
'Called Contact Person
A.I.P.P..
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees