12-0313 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 12-00000313
Property Address: 78655 BOTTLE BRUSH DR
APN: 646-312-015-65 -000000-
Application description: PLUMBING
Property Zoning: MEDIUM DENSITY RES
Application valuation: 4000
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
ACEVES, ANDREA A
78655 BOTTLEBRUSH DRIVE
LA QUINTA, CA 92253
Contractor:
Applicant: u Architect or Engineer: HAMMER PUMPING INC
P.O. BOX 2448
CATHEDRAL CITY, CA 9
(760)360-7448
al� Lic. No.: 661018
I hereby affirm under
Section 70001 of Div
License C ss: C42
Date: �1 2,01
'
OWNER -BUILDER DECLARATION
I hereby affirm under penalty o 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 _ 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 I, 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(sl licensed
pursuant to the Contractors' State License Law.).
(_ 1 I am exempt under Sec. , B.&P.C. for this reason
ENS CONTRACTOR'S DECLARATION
I of perjury th 1 a lice sed under provisions of Chapter 9 (commencing with
3 of the Bus s and Profession ode, and my License is in full force and effect.
641
J Licen a No.: 661018
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: /y
Lender's Address:F^
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/27/12
VI,4R ' 7 2012
OF
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 NATIONAL UNION Policy N' tuber 910606
_ I certify that, in the perform of the wo for whic hi Is issued, I shall not employ any
person in any manner so as t become ubject to workers' ompensation laws of California,
land agree that, if I should be ome su act to the work ' co pensation provisions of Section
� 77 3700 of the or Code, I- 11 fo with comply with tho a isions.
A"aro� t..._7
WARNING: FAILURE TO SECLAE'WORKERS' 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 issuedas a result of this application becomes)nII' a work is not commenced
within 180 days from date of issuance of such permit, essation wor or 180 days will subject
permit to cancellation.I certify that I have read this application andstate that tfi above inf tion is correct. I ee to comply with all
city and county prdinances and state laws relating to bui ing con uction, and hereby autlj riz epresentatives
of jhis co�nty ty5 enter upgn the above-mentioned prop Vy for i pectic purposes.
:312'?I) —ilanature lAoulicant or
Application Number . . . . . 12-00000313
Permit . .
. PLUMBING SEWER
Additional desc .
Permit Fee . ...
. 30.00
Plan Check Fee
.00
Issue Date . . .
.
Valuation . . .
. 4000
Expiration Date
9/23/12
Qty Unit Charge Per
Extension
BASE FEE
30.00
------------------------------------------------=---------------------------
Special Notes and
Comments
.SEPTIC ABANDON, SEWER CONNECT. 2010
CODES.
----------------------------------
.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
r
31.00
.00 .00
31.00
4
LQPEPMIT
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City Of .b Quo: ,
Building a. Safety Divtsron .
P.O. Box 1504,"78-495 Cafe Tampico, :. .
La .Quinta, CA 92253 -:(760) 777-7012
Building Permit Application and Tracking Sheet
Permit # '
%
Project Address:.. �-- S� LFA �2
'Owner's Name:. Aim G E � �S
A. P. Number SUS 3 (� �-
Address: $ SOS S a L �?j� u51
Legal Description:.
City, ST, Zip: L,
Contractor. L
��M �- C2 \ 1
Telephone:
Address: — `\-&
Project Description:
City, ST, Zip: �'�—%L`��,pc C, l
S' — C""`' C
Telephone:�—
State Lic. # :
City Lie. #;
Arch., Engr., Designer.
Address:
City, ST, Zip:
Telephone:
State Lic. #: "'
Name of Contact Person:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft:
#Stories:
# Units:
Telephone # of Contact Person:
caU '
Estimated Value of Project: �. (yv —
APPLICANT: DO NOT WRITE BELOW THIS UNE
tt
Submittal
Req'd
'Rec'd
TRACMG PERMIT FEES
Plan Sets
Plan Check submitted Item Amount .
Structural Cafes.
Reviewed, ready for corrections Plan Check Deposit. .
Truss Cafcs.
Called Contact Person Pian Check Balance
Title 24 Cates.
Plans picked up Construction
Flood plain plan
Plans resubmitted.. Mechanical
Grading plan
2'! Review, ready for correctionsfissue Electrical
Subeontactor List
Called Contact Person Plumbing
Grant Deed
Plans picked up S.M.I.
iLO-k Approval
Plans resubmitted Grading
IN DOUSE:-
'^' Review; ready for correctionsliissue Developer Impact Fee
Planning Approval
Called Contact Person A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees