BPLB2016-006778-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application Description
Property Zoning:
Application Valuation:
Applicant:
CAMPESINOS UNIDOS INC
P 0 BOX 39
BRAWLEY, CA 92227
4
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
BPLB2016-0067
51735 AVENIDA RAMIREZ
.773125023.
JORGE SANTO / WATER HEATER
$1,000.00
LICENSED CONTRACTOR'S DECLARATION
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 Professions Code,
and my License is in full force and effect.
License Class: B. C36 License No.: 618140
Da !,.Contra 9�
Owner:
JORG€t---- --
93D
MAY .0 L 213"0
Ctor:
ESINOS UN�SOFqAQUjNTA
14NgyXVEL0PMENT DEPARTMENT
PO
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Dater .5/2/2016
(760)344-4500
Llc. No.: 618140
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 issued.
al 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:
OWNER -BUILDER DECLARATION
Carrier: _ Policy Number:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State
I certify that in the performance of the work for which this permit is issued, I
License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
shall not employ any person in any manner so as to become subject to the workers'
city or county that requires a permit to construct, alter, improve, demolish, or repair
compensation laws of California, and agree that, if I should become subject to the
any structure, prior to its issuance, also requires the applicant for the permit to file a
workers' compensation. provisions of Section 3700 of the Labor Code, I shall forthwith
signed statement that he or she is licensed pursuant to the provisions of the
comply with those provisions.
Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division
�� 4
'�
3 of the Business and Professions Code) or that he or she is exempt therefrom and the
Date Applica
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
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
($500).:.
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
(� I, as owner of the property, or my employees with wages as their sole
ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
compensation, will do the work, and the structure is not intended or offered for sale.
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
(Sec. 704'4, Business and Professions Code: The Contractors' State License Law does not
INTEREST; AND ATTORNEY'S FEES.
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
APPLICANT ACKNOWLEDGEMENT
are not intended'or offered. for sale. If, however, the building or improvement is sold
IMPORTANT: Application is'hereby made to the Building Official for a permit subject to
within one year of completion, the owner -builder will have the burden of proving that
the conditions and restrictions set forth on this application.
he or she did not build or improve for the purpose of sale.).
1. Each.person upon whose behalf this application is made, each person at whose
(� I, as owner of the property, am exclusively contracting with licensed contractors
request and for whose benefit work is performed under or pursuant to any permit
to construct the project. (Sec. 7044, Business and Professions Code: The Contractors'.
issued as a result of this application ,.the owner, and the applicant, each agrees to, and
State license Law does not apply to an owner of property who builds or improves
shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and
thereon, and who contracts for the projects with a contractor(s) licensed pursuant to .
employees for any act or omission related to the work being performed under or
the Contractors' State License Law.).
following issuance of this permit.
(� I am exempt under Sec. B.&P.C. for this reason
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.
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:
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 city to enter upon the
above-mentioned property for inspection purposes.
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CAMPESINOS:UNIDOS INC .'. CHECK ": R15190. ` 6954 RSE
Total Paid for BUILDING:STANDARDSADMINISTRATION BSA , r $1.00.' . $1.00
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CAMPESINOS UNIDOS INC.
CHECK
R15190
6954
RSE
.. To612Piid#or CASH�OVER: !.. $34.19 $34.19
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DATE
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'CON
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101 0000-42404
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$91:8
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CAMPESINOS UNIDOS INC
CHECK
R15190
6954.
RSE
• TotaLPaid-for PERMIT ISSl1A�gNCE ' ,• $91.85; � �$91.85�.,��.
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, :
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PAID DATE
WATER HEATER/VENT
101-0OOQ-42401
0 .:
Vf $12 09:
$12.09'
5/2/16
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CAMPESINOS.UNIDOS INC.:
CHECK
R15190 a
. 6954
RSE
a6 ACCO£UNT��
QTY
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PAID
l
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PAID�DATE'
ice." ;DESCRIPTION
aAMOUNT
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.-WATER HEATER/VENT PC `
101-0000-42600 ..
0
$T 25
$7.25
5/2/16
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CAMPESINOS.UNIUOS INC",.
CHECKR15190
,
6954
RSE
Total Pard for PLUR MING;Fx$19EES 34 $19.34..,
L
Y l.�k
Description: JORGE SANTO / WATER HEATER
Type: PLUMBING Subtype:
Status: UNDER REVIEW
Applied: 5/2/2016 RSE
Approved:
Parcel No: 773125023 Site Address: 51735 AVENIDA RAMIREZ LA QUINTA,CA 92253
Subdivision: SANTA CARMELITA.VALE LA QUINTA Block: 55
Lot: 11
Issued:
UNIT 5
Lot Sq Ft: 0 Building Sq Ft: 0
Zoning:
Finaled:
Valuation: $1,000.00 Occupancy Type:
Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0
No. Unites: 0
Details: WATER HEATER CHANGE OUT - 40GALLON/GAS [2013 ENERGY] CARBON MONOXIDE ALARM(S) TO BE. INSTALLED PRIOR TO FINAL
INSPECTION. 2013 CALIFORNIA BUILDING CODES.
Printed: Monday, May 02, 2016 10:42:09 AM 1 of 2
SYSTIMS
INSPECTIONS
PARENT PROJECTS
RETURNED - STATUS ` REMARKS
REVIEW TYPE REVIEWER SENT DATE" DUE DATE x DATE,NOTES as
, .
BOND_
.----.
INFORMATION
ATTACHMENTS''
`- t
ACCOUNT,,.,.
QTY
AMOUNTt
n PAID' '
.PAID DATE
RECEIPT #
.CHECK #
METHOD
?
r. PAID BY
CASH OVER
101-0000-42300
0
$34.19
$34.19
5/2/16
R15190
6954
CHECK
CAMPESINOS UNIDOS
RSE
INC
Total Paid for CASH OVER: $34.19 $34.19
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$9
5/2/16
R15190
6954
CHECK
CAMPESINOS UNIDOS
RSE
INC
INC
Total Paid for PERMIT ISSUANCE: $91.85 $91.85
WATER HEATER/VENT
101-0000-42401
0
$12.09
$12.09
5/2/16
R15190
6954
CAMPESINOS UNIDOS
.CHECK
NCRSE
WATER HEATER/VENT
101-0000-42600
0
$7.25
$7.25
5/2/16
R15190
6954
CHECK
CAMPESINOS UNIDOS
RSE
PC
INC
Total Paid for PLUMBING FEES: $19.34 $19.34
TOTALS:4.$146.38
INSPECTIONS
PARENT PROJECTS
RETURNED - STATUS ` REMARKS
REVIEW TYPE REVIEWER SENT DATE" DUE DATE x DATE,NOTES as
, .
BOND_
INFORMATION
ATTACHMENTS''
Printed: Monday, May 02, 2016 10:42:09 AM 2 of 2
sysrrMs
Bin # Qty o6 is Quinta
Building 8z Safety Division
Permit # P.O. Box,.1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
�� 2'1 b Building Permit'Application and Tracking Sheet
Project Address: (� l s- 7 Owner's Name: �0 S
A. P. Number:
Address f 7• 96—A vr,� 1 �* �� Y t'.Z
Legal Description: t�
Contractor:
Address: Address: V�-31
City, ST, Zip:
Telephone: %�O'�-i'j— 2 -
Project Description:
City, ST, Ziobna,.ki
�y
Telephone: �'�d"
is<i:i:ti:: �•�:; ; Vii:};M1i:;}} �:4(Li:i:iC�:�ni?�:L}::i.
}->:s?>'.k<:'..,:.:
� .
�� S �� 1A, 'A
State Lic. # : CO- City Lic. C
Arch., Engr:, Designer:
Address:
City., ST, Zip:
Telephone:
;i�;`.;SS:^SytiTryv?:S:Yi>�:'rS:i;:iJly.\.ESYyv"
_.rY...._:. ; ,._,, :y} _•-,;;.:•}}:,:•:;<'yi.;%
' " r ' = <}.
"
', Construction Type: Occupancy:
State Lic. #:
Project type /circle one): New Add'n Alter Repair Demo
Sq. FL: # Stories: # Units:
Name of Contact Person: —
Telephone # of Contact Person:
P ��0 7t!PD7
Estimated Value of Project: ; a
APPLICANT: DO NOTWRITE BELOW THIS' LINE
#
Submittal
'Req'd
Recd TRACKING'
PERMIT FEES
Plan Sets
Plan Checksubmitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
' Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
.Plans.picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
god Review, ready for correctionstissue
Electrical
Subcontactor List
Called "Contact Person "
Plumbing
Grant Deed
Plans picked up
S.M.1.
H.O.A. Approval
Plans resubmittedGrading
IN HOUSE:-
'"' Review, ready for correctionsriissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
' Date of permit issue
School Fees
Total Permit Fees