13-1074 (PLBG)I►
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
4
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
% FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/26/13
Application Number: 13-00001074 Owner:
Property Address: 55953 PINEHURST DAVID C. GARD
APN: 775-241-066- - - 55953 PINEHURST
Application description: PLUMBING LA QUINTA, CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL (760) 777-9568
Application valuation: 200
Contractor:
ffy'OCANC5
Applicant: Architect or Engineer: AZTEC LANDSCAPINGn84670 •AVENUE 4941COACHELLA, CA 92236 .-I ����(760)398-7738
��Lic. No.: 888272 el-r)FLA,QUINTA
FIPlDEP_ I
-----------------
LIOBNSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury th am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Busine and Professionals Code, and my License is in full force and effect.
License Cl ss: C27 LicenseNo.:- 888272
DDaatte"' OVO- t 3 Contractor
v �/ / 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).:
(_) 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, 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 contractorls) 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
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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 E�CEMPT Policy Number EXEMPT
F111'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 to become subject to the workers' compensation laws of California,
and agree that, if I shout ,come subject to the workers' compensation provisions of Section
�y3700 of the Labo -CO , 1 shall forthwith comply with those provisions.
Date: 0'�)� App1�/
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS (5100,000). 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 atwhoserequest 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 ab information is correct. I agree to comply with all
city and county ordinances and state laws relating to buildin onstruction, and hereby authorize representatives
of this county to enter upon the above-mentioned property r inspection purposes.
D _
&- Signature 1�ant or Agent):
If-*
Application Number
Permit . .
Additional desc .
Permit Fee . . .
Issue Date . . .
Expiration Date .
13-00001074
PLUMBING 2013
11.92 Plan Check Fee . .
Valuation . . . .
2/22/14
Qty Unit Charge Per
Extension
1.00 11.9200 LS PLBG GAS
SYS, 1-4
OUTLETS
11.92
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Special Notes and Comments
INSTALL 40 L.F. OF 3/4 INCH GAS LINE
TO
FIRE PIT. 2010 CALIFORNIA BUILDING
CODES.
----------------------------------------------------------------------------
Other Fees . . . . . . BLDG
STDS ADMIN
(SB1473)
1.00
PERMIT ISSUANCE
M/P/E
90.57
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 91.57
.00
.00
91.57
Grand Total 103.49
.00
.00
103.49
LQPERMIT
Bin #
City Qf ,'c7 Quin
Building & Safety Division
P.O. Box 1504, 78-495.Calle Tampico
La Quinta,. CA 92253 - (760) 777-70.12;
Building Permit Applicat►on.and Tracking Sheet
Permit #
Project Address: - q53 t hl� v� S
Owner's Name:t/+ C r
A. P. Number:
Address: 5 ��j 3 r �'ljVt/ -
Legal Description:
Contractor: ��C � SCGt I-,1
City, ST, Zip: t, . qJ.� . fU g z Z7 3
Tele hone: / %;:.•
P GO
Address: `gq.G � �
Project Description:.
1 r
City, ST, Zip: c4 c( I Ij GI g 7 2 3 b
Telephone: 7�0 — —??-
State Lic. # :
City Lie. #.:
Arch., Engr., Designer:
Address:
City., ST, Zip:
Tele hone:
P
�; ;;iii; �
Construction T e: Occu anc Y
YP P
State ie. #:Project
,
a circle one): New Add'n Alter Repair Demo
J type � ) P
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Perso -9 J r
Estimated Value of Project:�a
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 Calcs.
Called Contact Person
Plan Check Balance.
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2°" Review, ready for correctionslissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O:A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'"' Review, ready for correctionsfissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
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CITY OF LA QUINTA
BUILDING & 'SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DATE�/L3
BY
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