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10-0890 (PLBG)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application description: Property Zoning: Application valuation: Applicant: Co�/T/�►c-'tv� 10-60000890 53620 AVENIDA RUBIO 774-113-005-20 -000000- PLUMBING COVE RESIDENTIAL 250 ce­itit4'4Q�� Architect or Engineer W#f ------------------ LICENSED CONTRACTOR'S DECLARATION BUILDING & SAFETY DEPARTMENT BUILDING PERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 9/10/10 Owner: VILLALOBOS CLARITA M/MENDOZA 53620 AVENIDA RUBIO LA QUINTA, CA 92253 C LETE WATER SERVICE •8 OPHIR CANYON STREET DA DUNES, CA 92203 SEP 10 2010 ) 972-8068 No.: 896899 C17 Y OF LA QUINTA 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 arofessionals Cod d my License is in full force and effect. LicenseClass: C3/6) Lice e 896899 xDate: (� `� Contractor: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I 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 fife 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.). _ (_ 11, 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.). ' ( 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: LQPERMIT ------------------ WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: _ I 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 /1 issued. 'X (. 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 STHERN INS Policy Number WS10019169 _ 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 become subject to the workers' compensation laws of California, and agree that, if I should become subject to workers' o pensation provisions of Section /♦3700 of the Labor Code, I I f thwi comply th t os provisions. xDate: ! �( �/ Appficant - WARNING: FAILURE TO SECURE ORKERS' 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 informatio ogre comply with all city and county ordinances and state laws relating to building nstr , and hereb autho 'ierepresentatives of this county to enter upon the above-mentioned roperty r ' pur oses. &ate_/ll Signature (Applicant or Agent): Application Number. . . . 10-00000890 Permit PLUMBING INV FEE Additional desc . Permit Fee . . . . 36.00 Plan Check Fee 4.50 Issue Date . . . . Valuation . . . . 0 Expiration Date 3/09/11 Qty Unit Charge Per Extension BASE FEE 30.00 1.00 6.0000 EA PLB GAS PIPE 1-4 OUTLETS 6.60 -----------------7---------------------------------------------------------- Special Notes and Comments UNDERGROUND METAL GAS PIPING (CORROSION PROTECTED) FROM EXISTING PROPANE TANK TO RESIDENCE. 2007 CALIFORNIA PLUMBING CODE. ***INVESTIGATION FEE ASSESSED PER 2007 CALIFORNIA BUILDING CODE APPENDIX CHAPTER 1-§108.4 FOR WORK COMMENCING BEFORE PERMIT ISSUANCE*** September 10, 2010 10:30:38 AM AORTEGA ---------------------- ------------------------------------------------------ Other Fees . . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged Paid Credited Due Permit Fee Total 36.00 .00 .00 36.00 Plan Check Total 4.50 .00 .00 4.50 Other Fee Total 1.00 .00 .00 1.00• Grand Total 41.50 .00 .00 41.50 LQPERMIT Bin # Qty of La Quinta Building 8T Safety Dh4slon P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # I e •09►90 Project Address: 0 UC 12a,6 U Owner's Name:./ .. &Aj 16o '5-3- A. P. Number: Address: (%i. �eaB/o Legal Dcscription:. City, ST, Zip: 1-4- 6WI —Telephone--?& � Address: -V-3- all &WbAJ S 7--- Project Description: City, ST, Zip: 2N 8/U eW lr�U3 V/C F- D A421,-YCC— Telephone:?&Z) 3/ f USYI G City Lia #; State Lic. # : %9 p Arch., Engr., Designer. Address: City, ST, Zip: Telephone: State Lic. #: Name of Contact Person:Sq. Construction Type: Occupancy:. Project type (circle one): New Add'n Alter Repair Demo Ft : #Stories: # Units: Telephone # of Contact Person: Estimated Value of Project: '�.W.'f- �Q APPLICANT: DO NOT WRITE BELOW THIS LINE N Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cafes. Reviewed, ready for corrections Plan Check Deposit Truss Cafes. Called Contact Person... Plan Check Balance Tille U Calces Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2" 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.LP.P. .--- Pub. Wks. Appr Date of permit issue IWD& VID ' School Fees Total Permit Fees `• S� i t la I;w • omw U 136 V 6