11-1034 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 11-00001034
Property Address: 52301 AVENIDA BERMUDAS
APN: 773-275-012-2 -000000-
Application description: PLUMBING
Property Zoning: COVE RESIDENTIAL
Application valuation: 3000
wd!t 4 4a Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
YESSAYIAN RUPERT E
52301 AVENIDA BERMUDAS
LA QUINTA, CA 92253
(760)564-4218
Contractor:
Appl�t: Architect or Engineer: B & M CONSTRUCTION/
P.O. BOX 1977 C
LA QUINTA, CA 92247
(760)578-0406
LiC. No.: 746760
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 Professionals Code, and my License is in full force and effect.
License Class: B C36 Ljonse No.: 746760
Date: ! /aa/ II' 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 file 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).:
(_ 1 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.).
1 _ 1 1, 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.).
1 _ 1 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
I
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/22/11
NC ?r
tom.— P 4:. ij
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.
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 STATE FUND Policy Number 23811
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 he workers' compensation provisions of Section
3700 of the Labor Code all forthwith ply with those provisions.
Date:��1f
1 Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPE ATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DULLARS I$10U,000). IN AUDI`I ION -1 O `fHE COSY OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3708 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 Quima, 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 heret4vauthorize representatives
of this county to en /r upon the above-mentioned property f nspectiRn purpose
Date: county to
(Applicant or Agent):
Application Number . . . . . 11-00001034
Permit . . .
PLUMBING SEWER
Additional desc . .
Permit Fee . . . .
30.00
Plan Check Fee
.00
Issue Date . . . .
Valuation . . .
. 3000
Expiration Date
3/20/12
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 15'.0000
EA PLB BUILDING SEWER
15.00
----------------------------------------------------------------------------
`Other Fees . . . . .
. . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid
--------------------
Credited
--------------------
Due
-----------------
Permit Fee Total
30.00
.00 .00
30.00
Plan Check Total
.00
.00 .00
.00
Other Fee Total
1.00
.00. .00
1.00
Grand Total
31.00
.00 .00
31.00
LQPERMIT
/bU-!)b8-1/89 11:59•:06 a.m. 09-15-2011 2 2
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COACHELLA VALLEY WATER.DISTRICTP.O. BOX 1058, COACHELLA, CALIFORNIA 92236 (760) 398-2651
INVOICE Date: 9/15120.1
SUBJECT: SCC ONLY- 52301'AVENIDA BERMUDAS, LA QUINTA
Yessayian, Rupert Project: 11-3166
52301 Avenida Bermudas Project Date: 9/15/2011
Amount Due:.. $4,231.00
LA QUINTA, CA 92253 GEO: 06-06-12-1
Planner: CAROL PFANNKUCHE
TO INSURE PROPER CREDIT, PLEASE RETURN THIS PORTICIN WITH
REMITTANCE AND INCLUDE THE PROJECT ON YOUR CH;3CK
SUBJECT: SCC ONLY- 52305 AVENIDA BERMUDAS, LA QUINTA
COACHELLA VALLEY WATER DISTRICT
P.O. BOX 1058,- COACHELL.A, CALIFORNIA 92236 (760) 398-2651 page 1
SEP -15-201110:59 From:760-568-1789 ID:7603919638 Pase:002 R=93%
S
Bln.#
City Of LQ Who
Building 8r Safety Divfsion
P.O. Box 1504, 78-495 Calle Tampico
La.Quinta, CA 92253 -:(760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
h3�
V
Project Address: 02 3 A•Vv Q c wi U q Owner's Name:..er Yie� s . /. 01
pp
A. P. Number. Address: 5 a 3 d I Acf e cA t du D e-v
Legal Description: City, ST, Zip: � i
(t p
Contractor. �� COvvsTY-0 t'_ j o n +F l �Utiq �1 Telephone: ,• � '
Address:0 d 7 Project Description: p
C' , ST, Zip: Lt--at-)( -'k- Cry �1 a a Y
Telephone:? GO — S J"e - t7 YQG
r� O s r
State Lic. # : C 3 6. ? C7
City Lie'. M
Arch., Engr., Designer.
Address:
City., ST, Zip:
Telephone: Construction Type:. Occupancy:
State Lie. #: ` " Y6 " Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: r ( CALLA S /� u r ' Sq. Ft.: # Stories: #Units
Telephone # of Contact Person: ? (0 0 (o Estimated Value of Project
APPLICANT: DO NOT WRITE BELOW THIS UNE
Y Submittal Req'd "Reed TRACKING PERMPFFEES
Pisa Sets
Plan Check submitted Item Amount
Structural Cates
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
Flaw resubmitted.'. Mechanical
Grading plan
2" Review, ready for corrections/issue Electrical
Subcoutactor List
Called Contact Person Plumbing
Grant Deed
Plans picked up ML
L
H.O.A. Approval
Plans resubmitted Grading
IN HOUSE:-
'`' Review,' ready for corrections/issue Developer Impact Fee
Planning Approval
Called Contact Person
Pub. Wks. Appr
Date of permit Issue
School Fees
Tota! Permit Fees