BPLB2016-009778-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
.APN:
Application Description
Property Zoning:
Application Valuation:
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COMMUNITY -DEVELOPMENT DEPARTMENT
BUIL"DINCv PERMIT
J
BPLB2016-0097
53905 AVENIDARAMIREZ
774161022
CHRISTINE BIELAWA / GAS, LINE
$10,456.00
Applicant:
A R S AMERICAN RESIDENTIAL SERVICES OF.0
965 RIDGE LAKE BLVD SUITE 201
MEMPHIS, TN 38120,
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 7774153
Date: 7/11/2016
Owner:
CHRISTINE 81ELAWA
92253JUL I I 2016
CITY OFLA QUINTA
LCOMfAUN4TY DEI/ELOPMEtJTDErhRTP,tEfdT
Contractor:
A'RS AMERICAN RESIDENTIAL SERVICES OF C
965 RIDGE LAKE BLVD SUITE 201
MEMPHIS, TN 38120
(901)271-9700
Llc. No.: 765155
LICENSED CONTRACTOR'S,DECLARATION, WORKER'S'COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am license&under provisi s of Ch r : I hereby affirm under penaltybf.perjury one of the following declarations:
9 {commencing with Section 7000} of Division 3.of.the Busine s and P fessio ede,I.have and will maintain a certificate of consent to self -insure for workers'
and my License is in full force and effect. compensation;as provided for by.Section:3700 of the Labor Code, for the performance
License Class: C36, C42, A License No.: 76515 of the work for ;wh'ich'this permit is.issued.
�tl haJe and will maintain workers' compensation insurance, as required by
rlContractor, 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-BUILDERDECLARATION 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 shoul ecome su o e
any structure, prior to its issuance, also requires, th'e;applicant for thepermifto'file a: workers' compensation provisions of Section 3700 of a Labor C hwith
signed statement that he or she is licensed pursuant to the provisions of the, comply with t a provisions.
Contractor's State License Law (Chapter 9 (comrrienang with Section 7000) of•Division
3 of the Business and Professions Code) or that he or she is exempt therefrom and fhe— Date:. I� A
basis for the alleged exemption. Any violation of5ection 7031.5 by any applicantfor 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 ONErHUNDRED 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. 7044, 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 improve`ment's APPLICANT ACKNOWLEDGEMENT
are not intended or offered for sale. If, however, the building orimprovement is.sold . IMPORTANT: Application is hereby madeto the Building Official for a permit subject to
within one year of completion, the owner -builder will have the. burden:of,proving•ihat .the conditions and restrictions set forth on this application.
he or she did not build or improve for the purpose of sale.). 1_Eech person -upon whose behalfthis application is made, each person at whose
(_) I, as owner of the property, am exclusively contracting with licensed contactors request and for whose benefit work is peiformed 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 ernpioyees'for any actor 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:
I certify that I have read this application and state that the above infor on is co
CONSTRUCTION LENDING AGENCY I agree to comply,with all city and county ordinances and state law ting.t u' in
I hereby affirm under penalty of perjury that there is a construction lending agency for construction, and hereby authorise representatives of this city t er up t
the performance of the work for which this permit is issued (Sec: 3097, Civ. C.). above-mentioned property for inspection purposes.
Lender's Name: Date:, _ Signature -or_._ A_ g� )1
Lender's
Description: CHRISTINE BIELAWA / GAS LINE
Type: PLUMBING Subtype:
Status: UNDER REVIEW
Applied: 7/11/2016 RSE
Approved:
Parcel No: 774161022 Site Address: 53905 AVENIDA RAMIREZ LA QUINTA,CA 92253
Subdivision: SANTA CARMELITA VALE LA QUINTA Block: 235
Lot: 10
Issued:
UNIT 22
NAME a
`ADDRE5S1
Lot Sq Ft: 0 Building Sq Ft: 0
Zoning:
Finaled:
Valuation: $10,456.00 Occupancy Type:
Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0
No. Unites: 0
Details: REPLACE GAS LINE FROM PROPANE TANK TO WATER HEATER. 2013 CALIFORNIA BUILDING CODES.
CONDITIONS
CONTACTS
NAME TYPE
NAME a
`ADDRE5S1
;CITY
STATE
ZIP<
PHONE 3;
FAX
:. EMAIL
APPLICANT
A R S AMERICAN RESIDENTIAL
965 RIDGE LAKE BLVD
MEMPHIS
TN
38120
ANALLEN@ARS.COM
SERVICES OF C
SUITE 201
CONTRACTOR
A R S AMERICAN RESIDENTIAL
965 RIDGE LAKE BLVD
MEMPHIS
TN
38120
ANALLEN@ARS.COM .
SERVICES OF C
SUITE 201
OWNER
CHRISTINE BIELAWA
92253
FINANCIAL INFORMATION
Printed: Monday, July 11, 2016 12:14:27 PM 1 of 2 EANJFCRVV
SYSTrMS
DESCRIPTION
-° ACCOUNT;
QTY
AMOUNT
PAID
PAID DATE
RECEIPT #
=CHECK #
METHOD
PAID BY My'
CLTD
BY
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$1.00
7/11/16
R16965
810600827
CHECK
A R S AMERICAN
RSE
0
RESIDENTIAL SER
Total Paid for BUILDING STANDARDS ADMINISTRATION
$1.00 $1.00
BSA:
PERMIT ISSUANCE
F 101-0000-42404
0
$91.85
$91.85
7/11/16
R16965
810606827
CHECK
A R S AMERICAN
RSE
0
RESIDENTIAL SER
Total Paid for PERMIT ISSUANCE: $91.85 $91.85
GAS SYSTEM, 1-4
0
$12.09
$12.09
7/11/16
R16965
810600827
CHECK
A R S AMERICAN
RSE
OUTLETS
.101-0000-42401
0
RESIDENTIAL SER
GAS SYSTEM, 1-4
101-0000-42600
0
$24.17
$24.17
7/11/16
R16965
810600827
CHECK
A R S AMERICAN
RSE
OUTLETS PC
0
RESIDENTIAL SER
Total Paid for PLUMBING FEES: $36.26 $36.26
TOTALS:
INSPECTIONS
PARENT PROJECTS.,,..,,.,.,. -
BOND INFORMATION
ATTACHMENTS
Printed: Monday, July 11, 2016 12:14:27 PM 2 of 2
SYSTEMS
Bin. #
City of La Quinta
Bultdtng 8r Safety Division
P.O. Box 1504,16-495 6116 Tampico
1.a.Quinta, CTA 92253-:(760) 777-7012
Building" Permit •Application` and Trackft Sheet
Permit #
Project Address: .5-390 Averi4 gaetreg
'Owner's Name:. Ur�S¢inc lglek-�a
A. P. Number.
Address:Jygi95 4venisl4 1
Legal Description:
City, ST, Zip: 1.44't*#7t4.` CA 911 3
Contractor: GSWL /"�� l�f�f
Telephone: %�p� Q✓eZ �7(/� As%t�yc��.ss.
Address: p/ t/n/M 5f•
Project Description:
b
City, ST, Zip: woltWe / % , �A
C 1 AA_r
Telephone: frl 3 yI 9S %�
a; c! ",f`;'
:.� d:.!i�< sca
citytic. #; 111344e
O � Q �
State Lic. # :
Arch., Engr., Designer
Address:
City., ST, Zip:
Telephone:
ra ,'
State Lic. #:� • ''` ' '`
Construction Type:. Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: # Stories: #Units:
Name of Contact Person:
Telephone # of Contact Person:
Estimated Value of Project (Q q
APPLICANT: DO -NOT WRITE"BELOW THIS LINE
# Submittal Req'd RecdTRACICI7VG PERMIT FEES
Plan Sets
Plad Check submitted
Item Amount
Structural Calc$.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Cates.
.,Called, Contact Person
Plan Check Balance_
Title 24 Caleffi.
Pians picked up
Construction
Flood plain plan
Plans resubmitted.'.
Mechanical
Grading plan
tad Review, ready for correctionstiissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M I.
H.O.A. Approval
Plans.resubmittedGrading
IN ROUSE:-
'"' Review, ready for.correctionsfissue
Developer Impact Fee
Planning Approval .
Called Contact Person
AJ.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
S(uel PE PrPE
wi TA
" w 1114
Wi lkko kkl Ga444"16)
QIe
-TRK �_.; � Y OF LA QUINTA
Nl G v� . P BUILDING &.
DEPT.
vI
FOR CONSTRUCTION
DATE 1 n b BY