06-0692 (PLBG)P.O.-BOX-1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
,1
`) Application Number:
Property Address: .
APN:
Application description
Property Zoning:
Application valuation:
Applicant:
06-00000.6.9.2
53190 AVENIDA RUBIO
774-043-010- -
PLUMBING
COVE RESIDENTIAL
6000
Architect or
Til4t 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
JOHN & LAURIE MOORE
53190 AVENIDA RUBIO
LA QUINTA, CA 92253
Contractor:
Owner
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 2/15/06
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- - LICENSED CONTRACTOR'S DECLARATION ..
-----------------------
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that Lam_ 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 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
. License Class, - License.No.:.
_
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
4 .. ..
Issued.
Date... Contractor
I -have andwill maintain. workers' compensation insurance, as required by Sectio&3700 of the,Labor
_
_
Code, for the performance'of.thework for which this permitis issued.'My workers'compensation
OWNER BUILDER DECLARATION' -
hereby affirm under penalty of perjury that I am.exempt fiom,the Contractor's State License Law for the
insurance carrier anA policy number are: _
Carrier_ . �. •:' "- ".. Policy Number. ..
following reason (Sec. 7031.5, Business. and Professions Coae: Any city or county tnatiegwres a'permit to
r(r 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;he'applicant for the
i.�-+person in any 'manner'so as•to become subject to the workers' compensation laws of California,
permit to file -a signed statement that he ocshe-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 70 00) of. Division 3.of the Business and Professions Code) or
3700 of the Labor Code, I fo i ith comply: with those provisions.
' that he o,-she:is exempt therefrom and,the basis for the alleged exemption. 'Any violation of Section 7031.5 by
!��►. d> +;,'
y applicant fo'r a permit subjects the applicant to a civil penalty of not,more than five hundred dollars ($5001:
`
a
Date:
f ( I, as owner. of.ihe 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 orherself through his or her own employees, providedthat the' '
improvements'are not intended or offered•for sale. If, however' the buildingor 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 contractoi(s) licensed
pursuant'to the Contractors' State License Law.).
(_ 1 f am exempt under Sec. , B.&P.C. forpis reason
___ Date: � (a wner.� I r •' L` i'.
CONSTRUCTION LENDING AGENCY
I hereby affirm u der penalt perjury that there is a construction lending agency for the performance of the
work for"which t 's pe is issued ISec. 3097, Civ. C.1.
Lender's Name:
Lender's Address:
LQPERMIT
WARNING: � LURE TO r URE WORKERS':COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT ;EMPL TO CRIMINAL PENALTIESANO CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS( 100 0).' IN ADDITION TO THE COST
Co"ENSATION, 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 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. Anypermit 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 c o truction, and hereby authorize representatives
of this county to enter upon the above-mentionedproperty,fo s oJn/pprposes.
—Dat _21 /tCl naturn Mrinlicanr nr Aar
LQPERMIT
(� j COIACHELLA VALLEY WATER DISTRICT CASKRECEIPT DETAIL � MOO Ayf
Received From: � o �- Date:
Address: ' C7 G? f r ,t: t , �A'/ 6
Account No. ` ' �'� �l /f v _ Lot(s)' e-� Tract K; { r
.Service Address. I i ��. i,? (l1 �+�1 A'�I C�. G.A. Code
❑. Meter(s) $
❑ :Service(s)
❑ Backflow(s)
❑ House Lateral(s)
❑ Detector Check(s)
❑ Meter Surcharge
Sanitation Capacity Charges ,�!7
❑ . W.S.B.F.C.
❑ S:I.W.S.C.
❑ Temporary Construction Meter
❑ Tum on Charge
. ❑ Uncollected Account - Name
❑ Inspection Fee -Tract -
Fee -
❑ Plan Check Fees Water / Sewer -
Tract - .
❑ Bond Payment - A.D. - Bond Ads�++t
❑ Customer Deposit
❑ Other i
TOTAL $
Remarks: f f% 1 lz?l�.(%
O Copy to: I .
Cash 7 Water Service
Check
Money f H Cashier
.Order { nr? CVWD-438(1/05)
I V 0
Bin #City
of La Quinta
Building'u.Safety, Division ;
P.O. Box .1504,'. 78-495 Calle Tampico
La Quinta, CA 92.253 - (700),177-7012
Building,Permit Application and Tracking Sheet
Permit #
Project Address:
J G
Owner's NaNme: _G o
A. P. Number:
Address:
Legal Description:
City, ST, Zip: _
Contractor: O
-Telephone. '
Address:
Project Description:
City, ST, Zip:
t� ✓! - \�
Telephone:
city Lic..X:
.,#:
State Lic. # :
Arch., Engr., Designer:
Address:
City, ST, Zip: ~
Telephone:
Construction Type: Occupancy:
State Lic. #: =`
`,Project type (circle one): New .' Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:
# Stories:
#Units:
Telephone # of Contact_ Person:
Estimated Value, of Project:•. A QQO �—
APPLICANT: DO NOT WRITE -:BELOW THIS LINE
#
Submittal
Req'd ' .
Recd ` i
^ n TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
;Plan Check Balance .
Energy Calcs.
%Plans picked up
Construction
Floodplain plan
Plans resubmitted
Mechanical
Grading.plan
2p° Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
''d Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit.issue
School Fees
Total Permit Fees
6
tr,
OWNER/BLJILDER ;INFORMATION
A
Dear Property Owner:
An application for a building permit has been'submitted in your name listing yourself as the builder of the property
improvements specified.
For your protection you should,be aware that as "Owner/Builder" you -are the responsible party of record on such a
permit. Building permits are not.requiredto be signed'by property owners unless they are.personally performing their
own Work. If your work -'is being performed by someone other than yourself, you'may protect your from possible
liability if that person applies for the proper permit in his or her name..
Contractors are required by *law to be -licensed and bonded by the ,State of California and to have a business license
from the City or County. They are, also required- by law to put their license number on all permits for which they
apply,
If -you plan to do your own work, with the exception of various .tra&s' that you plan to subt6ritract, you should be
aware of the following informatioir for,your benefit "arid protection:
is
If you employ or otherwise engage any personspther.:than your.immediate family, and the work (including materials
and other costs) is $200.00 or more for the entire project, and such persons. are not licensed as contractors or
subcontractors, then you may be an employer.
If you are an employer, you must register with the State and. Federal Government as an employer and you are subject
to several obligations include State and..Federal income tax ;withholding, federal social security taxes, worker's
compensation insurance, disability insurance costs and unemployment compensation.contributions.
There may be financial risks for you ifyou,do not carry out these obligations, and these iisks are especially serious with
respect to worker's compensation -,insurance.
For more specific information about your obligations under Federal.Law, contact,the Internal Revenue Service (and, if
you wish, the U S •:Small Business Administration). ForJnore specific information about your obligations under State
Law, contact the Department of BenefitPayments and;ethe Division'. of Industrial Accidents.
If the structure is intended for sale, property owners who are no't,aicensed contracts "are allowed to perform their
work personally or through their own employees; without a licensed•contractor or.subcontractor, only under limited
conditions.
A frequent practice of unlicensed persons professing to be contractors isto secure an "Owner/Builder" building
permit, erroneously implying that the property owner`is providing:<his or her, own labor and material personally.
Building permits'are not required to be signed by property owners unless they are .performing their own work
Personally.
Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your
community,or at 1020 N. Street, Sacramento, California 95814.
Please complete,and return the enclosed owner -builder verification•form s'o' that we can confirm that you are aware of
these matters. The building permit will.not be issued until, the verification.is returned.
Very truly yours,
CITY OF LA QUINTA
DEPT. OF BUILDING AND SAFETY
78-495 Calle Tampico
La Quinta, CA 92253
(760) 777-7012
FAX: (760) 777-7011
WNER'S SIGNATURE/DATE " '
S.S O vim.. 2wl7ia
PROPERTY ADDRESS
PERMIT NUMBER(S)