10-0181 (PLBG)TAtyl 4
P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY 'DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 3/09/10
Application Number: 10=-0.0.0:0.0-1-81 Owner:
Property Address: 54190 AVENIDA RAMIREZ DINGESS JOHN E
APN: 774-212-009-16 -000000- 54190 AVENIDA RAMI
Application description: PLUMBING LA QUINTA, CA 922
Property Zoning: COVE RESIDENTIAL
Application valuation: 1000 4
Contractor.
Applicant: Architect or Engineer: VALLEY PL ING
78886 AVENUE 1
BERMUDA DUNES, 2010
(760)347-3629 oy
Lic. No.: 273088
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LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the Iollowing 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:.. 36 - Li -se N_o.: 273088 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
,�1�� .,/ /J � - � - I issued.-
�D Contractor: Wl.i(wi / _ I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
•'—tT Code, for the performance of the work for which this permit is issued. My workers' compensation
OWNER -BUILDER DECLARATION insurance carrier and policy number are:
I hereby affirm under.penalty of perjury that I am exempt from the Contractor's State License Law-for.the Carrier SELF-INSURED Policy Number 2246
following reason (Sec. 7031.5; Business and Professions Code: Any, city or county thafrequires apermit to ..r _ I certify that, in the performance of the work for which this permit is issued, I shall not employ any
construct, alter, improve,. demolish, orrepair any structure, prior.to its,issuance, also requires the applicant for the person in*any manner so as to become subject to the workers' compensation laws of California,
permit to file a signed statement that he or she 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 7000) of'Division 3 of the Business and ProfessionsCode) or 3700 of the Labor Code, I shall forthwith co m- y rovi ' ns,
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 byany applicant for a permitsubjects the applicant to a civil penalty of not more than five hundred dollars ($500)'.: Date :'S Applicant:
(_ 1 I, as owner of.ahe 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 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herselfthrough his or her own employees, provided that the DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered 'for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
one year-of.compI tion, the owner -builder will have the burden of.proving that he or she did not build or-
"-
improvefor the purpose of sale.).
(_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project ISec.
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.).
( 1 1 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
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 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 co ty to enter upon the above-mentioned property for inspection purpo .s.
Date/ Signature (Applicant or Agent): 40'.u,—
Application Number . . . . . 10-00000181
Permit . . . PLUMBING
Additional desc . .
Permit Fee . . . . 24.00 Plan
Check Fee
8.25
Issue Date . . . . Valuation
. . .
. 0
Expiration Date 9/05/10
Qty Unit Charge Per
Extension
BASE FEE
15.00
3.00 3.0000 EA PLB GAS PIPE 1-4
OUTLETS
9.00
.00 15.0000 EA PLB GAS METER
.00
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Special Notes and Comments
REPLACEMENT OF PROPANE SYSTEM .PIPING
ONLY. THIS PERMIT DOES NOT INCLUDE
PLACEMENT OF TANK. EXISTING TANK SHALL
BE SCREENED PER LQMC REQUIREMENTS PRIOR
TO FINAL.
March 9, 2010 2:27:12 PM AORTEGA
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Other Fees . . . . . . . . . BLDG STDS ADMIN
(SB1473)
1.00
Fee summary Charged Paid
-----------------------------------------------
Credited
----------
Due
Permit Fee Total 24.00 .00
:00
24.00
Plan Check Total 8.25 .00
.00
8.25
Other Fee Total 1.00 .00
.00
1.00
Grand Total 33.25 .00
.00
33.25
LQPERMIT
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SITE REQUIREME RS
IKTERIOR LOT
SIDEYARD: 5 FEET REARYARD: 10 FEET
MINIMUM EACH SIDE
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LINES
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CURBLINE
CITY OF to QUINTA
BUILDING & SAFETY ®PT.
APPRO
DATE 3 4. ZO�t7 BY
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Bin #
City, of La. Quinta .
Buiiding 81' Safety Division
P O:;Boz:1504,'78 495,0116 Tampico
La Quinta, CA. 92%253 - (760) 777-7012
Building Permit Application and Traeking Sheet
Permit #
,
6
-Project Address:/ g 1 ¢T.
"Owner's.Narrie: J O N ►'c 9
A. P. Number:
Address: S
Legal Description:
City, ST, Zip:
Contractor:
V_Alyksei✓.
Telephone:
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Address:% �qJ i
Project.Description: � ,D
City, ST, Zip: &AVA'. 04
GcwS C_ -A-, Via$
Tele hone: 3
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«sw;:
State Lie. # : ? 7 3 d. F
City Lie. #:
Arch., Engr., Designer:
Address:
City., ST, Zip:
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Telephone:
P
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Construction TYP Occu ancy:
Project type (circle one): New Add'n Alter Repair Demo
State Lie. #:
Name of Contact Person:
Sq. Ft.:
#Stories:
#Units:
Telephone # of Contact Person:
Estimated Value of Project: /0()() W
APPLICANT:.DO.''-NOT,WRITE BELOW THIS• -LINE
#
Submittal
Req'd -
Rec'd
TRACKING PERMIT FEES
Plan Sets
Pian Check submitted
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
2od Review, ready for correctionsrssue
Electrical
Subcontactor List
Called Contact Person
' Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Pians resubmitted
' Grading
IN HOUSE:-
'•' Review, ready;for correctionsrissue
Developer Impact Fee
Planning. Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
_Total Permit Fees