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06-4292 (PLBG)P.O. BOX 1504 -------- - -- - - - - - - - - - - - - - - - - - - -- -- -A-== -- 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 06-00004-292 Property Address: 558.5.0"-PINEHURST APN: 775-241-015- - - Application description: PLUMBING . Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 3700 Applicant: Architect or Engineer: BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: MR. AGNEW 55850 PINEHURST LA QUINTA, CA 9.2253 VOICE (760) 777-7012 FAX .(760) 777-7011 INSPECTIONS (760) 777-7153 Contractor: MAPLE LEAF PLBG'HEAT/AIR COND. P.O. BOX 3563 D PALM DESERT, CA 92261 (760)346-6758 Lic. No.: 481393 Date: 12/15/06 DEC -1.5 °:2006. CITY OF LA G1UiNTA --------------.-------- - - - - ------------------- -------- - -- - - - - - - - - - - - - - - - - - - -- -- -A-== -- LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION 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 infull force and effect. I have and will maintain a certificate ofconsent to self -insure -for workers' compensation, as provided. License Cla5s: C -C36 License No.: 481393 for by Section 3700 of the labor Code, for the performance of the work for which this permit is 11 / �I//1,1/���1 _ issued. Date: __) 5 l��I) Contras ctor�- ^'�" L�..�/� - _ I have and will maintain workers compensation insurance; as required by Section, 3700 of the Labor • f`+tea—+' •„ Code, for the performance ofith' work for which this'permit is issued. My workers' compensation . - OWNER -BUILDER DECLARATION insurance carrier and "policy number are: , I hereby affirm under *penalig.of peilurY that l;am exempt from the Contractor's State License Law for.the , Carrier. ENDURANCE- REINS Policy Number, ' WEN1000915 - Gl1 W followingreawri'ISec. 7031.5,;616n'ess7and Professions Code: - Any city or county that requires a permitto I certify that, in the performance, of the work for which this permit is issued;,.l'shallfiot'employ *any construct,.alter, improve, 'demolish,`or repairany structure;, prior to its issuance, also requires the applicant for the _ person in any manner so as to become'subject to tfie workers' compensation laws of California, permit to file a signed statement that he or she.islicensed pursuant to the provisions of the Contractor's State - a d agree that, if I sh become subject to the workers' compensation provisions of Section License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 00 of the Lab -omply with ththat he or she is exempt therefrom and the basis for the alleged exemption:- Any violation'of Section 7031.5 by��any W1hPaII,,yrthh applicant for a permit subjects the applicant.to;a civil penalty of not more than five h6ri&id dollars ($500).: D� ate:. Applicant. •• (_ 1 I, as owner of the property; or rriy employees with wages as their sole compensation, will do the work, and %— ..thestructure 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 6wner ofproperty who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINESUP. TO ONE'HUNDRED THOUSAND and•who does the work himselfor herself through his or her own employees, provibed that the DOLLARS:.($100,000)..�IN,ADDITIONTO.THE,COST OF COMPENSATION;, DAMAGES AS PROVIDED FOR IN . . improvements. are not int 6nded.or offered for sale. If, however, the building or improvement is sold within CT SEIO_ N3706 OF THE LABOR, 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.). APPLICANT ACKNOWLEDGEMENT (_) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.' IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application. property who: builds or improves thereon, and who contracts for the projects with a contractor(s) licensed 1. Each person.upon whose behalf this. application is made, each person at whose request and for pursuant to the Contractors' State License Law.). whose benefit work is performed under or pursuant to any.permit issued as a result of this application, (_ I I am exempt under Sec:' . , B.&P.C. for this reason - 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. Date: Owner:" 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 CONSTRUCTION LENDING AGENCY permit to cancellation. ' I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of.the I certify that I have read this application and state that the bove mformapd's correct. I agree to comply with all work for which this permit is issued (Sec. 3097, Civ. C.). city and county o finances and state laws relating to i ding ons ct hereby authorize representatives ' Lender's Name: of this couly toter upon the above-mentioned pr perty finoses. / „I .............. / Lender's Address: LQPERMIT r �n LQPERMIT Application Number . . . . . 06-00004292 Permit . . . PLUMBING Additional desc . . Permit Fee . . . . .18.00 Plan Check Fee 4.50 Issue Date Valuation . . . . 0 Expiration Date 6/13/07 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS 3.00 ---------------------------------------------------------------------------- Special Notes and Comments REPLACE EXISTING GAS LINE WITH NEW TO EXISTING POOL/SPA-HEATER. ' Fee summary Charged Paid Credited Due -----------------------------=------- .Permit Fee Total 18.00 ---------- .00 ---------- .00 18.00 Plan Check Total 4.50 .00 .00 4.50 Grand Total 22.50 .00 .00 22.50 Bin #City of -:La: Uinta Building. 8t :Safety .Division P.O..Boz 1504;. 78-495 Calle Tampico. La Quirita, Ck 022,53:- (760) 777-70-12 Building f ermit Application and Tra'ding'Sheet Permit # Project Address:• � I �/)_'9_1 �`y Owner's Name: W\ r .View A. P. Number: Address: ts7q_ s^ 1� Legal Description: Contractor: Imo 1 e. Le4 1 Ci y, ST, Zip: CA .)- 1 Address: �• C� 3(0.5: Project Description: •' �v t,}-Q,v 1 City, ST, Zip: \ Telephone. ,. f([Q 75 State Lic. # : Arch., Engr., Designer: City`Lic. #: Address: City, ST, Zip: Telephone: State Lic. #: :Construction Type: Occupancy: :Pro ect type (circle one): New , Add'n Alter Repair Demo Name of Contact Person: „ Sq:.Fk:. #Stories: #Units: Telephone # of Contact Person: Estimated Value of Project. APPLICANT: DO NOT WRITE BELOW THMUNE # Submittal Req'd, .. Rec'd TRACKING PERMIT FEES Pisa Sets Plan Check submitted Item Amount Structural Caics, Reviewdfo` ' econsready Plan'CheckDeposit. Truss Calcs. Called Contact.PeMon Plan Check Balance Energy Cales. Plans picked by Construction Flood plain plan -Plans resubmitted mechanical . Grading.plauZ'" Review, ready for correction§/issue Electrical Subcoutactor List Called Contact Person . Plumbing Grant Deed Plans picked up S:M.I. ' FLO.A. A roval PP Plans resubmitted Grading IN HOUSE:- . -" Review, ready for: correctionsrassueDeveloper Impact Fee Planning Approval Called Contact Person A LPSP. Pub. Wks. Appr Date of permit issue School Fees Tot.I Permit Fees.