14-0863 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
pp!ir,ation valuation:
Applica
14-00000863
50795 CALLE QUITO
770-1037007-55 -000000-
PLUMBING
LOW DENSITY RESIDENTIAL
1000
Tit�/ 4 4 Q*&
Architect or Engineer:
W_
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
TOM SPRAGGE
114-1124 FIRST ST
BLAINE, WA 98230- -
D -
Contractor:
TOP PROJECT LLC
35325 DATE PALM DR S 1
CATHEDRAL CITY, CA 92 34
(760)778-9964
Lic. No.: 822961
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/17/14
-------------------------------------------------------------------------------------------------
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 following 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: B C53 Licens .. 822961
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
1O
issued.
Date: / Contractor:
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
06 R -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 EXEMPT Policy Number EXEMPT
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to
I certify that, in the performance of the work for which this permit is issued, 1 shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
_
person in any manner so as to becom 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 becom ubject to th ers' compensation provisions of Section
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
3700 of the Labor Code, I shal orthwith co wi h those provisions.
I
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
Date: Applicant: '—
(_ 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
WARNING: FAILURE TO SECURE WORKERSC MPENSATION 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 herself through 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 completion, the owner -builder will have the burden of proving that he or she did not build or
improve for the purpose of sale.).
(_) 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(s) licensed
pursuant to the Contractors' State License Law.).
( 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
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 Quints, 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 certifythat I have read t ' application and state that the above information is correct. I agree to comply with all
city and county ordina es a d state laws relating to building construction, and hereby authorize representatives
of this county to en r upon he above-mentioned property for inspection purposes
Date: ure (Applicant or Agent):
Application Number . . . . . 14-00000863
Permit . . . PLUMBING 2013
Additional desc .
Permit Fee . . . . 11.92 Plan Check Fee
.00
Issue Date . . . . Valuation . . .
. 0
Expiration Date 12/14/14
Qty Unit Charge Per
Extension
1.00 11.9200 EA" PLBG SEPTIC SYSTEM
11.92
----------------------------------------------------------------------------
Special Notes and Comments
SEWER SEPTIC ABANDONMENT 2013 CALIFORNIA
BUILDING CODES.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
PERMIT ISSUANCE M/P/E
90.57
PLAN CHECK, PLUMBING
4.77
Fee summary Charged Paid Credited
---------------------------------------------------------
Due
Permit Fee Total 11.92 ".00 .00
11.92
Plan Check Total .00 ..00 .00
.00
Other Fee Total 96.34 .00 .00
96.34
Grand Total 108.26 .00 .00
108.26
J
LQPERMIT
Bin #
City . of La - Q Grin to
Building &r Safety Division
P.O. Box 1504, 78-495 Calle Tampico .
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: R
Owner's Name: J m
A. P. Number:
Address:. �(J�
Legal Description:
City, ST, Zip: A9 1
Contractor.�P -e— ��.
Telephone: �� ✓�' z::: s:< s:> .>:<.::<<:» <:<:.
Address: 00
Project Description: s✓ f/f✓
City, ST, Zip:
Telephone: *
.,....<•:>:;::>.;;:;:;:.;::;. a :>::>::.
State Lic. # : 7iZ / �O�
City Lie. #..
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telehone:
P
>>zs>
Construction Type: Occupancy:
State Lic. #:
type a circle one ' air Demo : New Addn Alter Re
J ) P
Name of Contact Person:
Sq. Ft.:
# Stories: # Units:
Telephone # of Contact Person:
Estimated Value of Proi �n 19V
APPLICANT: DO NOT WRITE BELOW THIS LINE
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES.
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cala.
Called Contact Person
Plan Check Balance
Title 24 Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2' Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN IiOUSE:-
'rd 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
z
COACHELLA VALLEY WATER DISTRICT
P•0• BOX 1058, COACHELLA, CALIFORNIA 92236 (760)..398-2651
INVOICE Date: 6/11/2014
SUBJECT: DESERT CLUB TR UNIT 5,50795 CALLE QUITO, LA QUINTA, LID 676650'SCC FEE ONLY"
n
TOM SPRAGGE
Project:
THERESA -CAMPBELL
rq�ecf ate:_
114 -1124 FIR STREET
Amount Due:
BLAINE, WA 98230
GEO:
Planner:
TO INSURE PROPER CREDIT, PLEASE RETURN THIS PORTION WITH
REMPTANCE AND INCLUDE THE PROJECT ON YOUR CHECK
,13-4579
-'5/17120'13'
$4,851.00
06-07-06-1
SANDRA VILLALOBOS
9 ����� i. . B ° � tea* • ° < ;�1itl3sa� , -- 'ice.
1.00 FF SCC -COLLECTION $2,415.001$2 415.00
1.00 FJ SCC-TREATMENT$2,436.0012 436.00
.$4,851.00
PAID $A 00 C r�
DeVelo ent Seri
Pm C®s 0®partrrtent ols
JUN 1..2 2014,--
cdachella Valley Water District
75-515 Hovley Lane East
Palm Desert, CA 92211
E
SUBJECT:DESERT CLUB TR UNIT 5,50795 CALLE QUITO, LA QUINTA, LID 676650 "SCC FEE ONLY"
COACHELLA VALLEY WATER DISTRICT
P.O. BOX 1058, COACHELLA, CALIFORNIA 92236 (760) 398-2651
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