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QU A, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
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Application Number: BPLB2016-0146 D
Property Address: 79835 RANCHO LA QUINTA DEC 16 2016
APN: 602220024
Application Description: WOLFF RESIDENCE / PLUMB
Property zoning: CITY OF LA QUINTA
Application Valuation: $6,000.00 DESIGN AND DEVELOPMENT DEPARTMENT
Applicant:
DI -LAR INDUSTRIAL SUPPLY INC DBA L J HAU
1541 PARKWAY LOOP STE E
TUSTIN, CA 92780
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 Professions Code,
and my License is in full force and effect.
License Class: B. D03 License No.: 326317
Date e'- --'t is 1(9 Con ;
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 a4
permit subjects the applicant to a civil penalty of not more than five hundred dollars .
($500).:
(_) I, as'owner of the property, or my employee's 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.).
(_) 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.).
(_) 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:
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: '12/15/2016
Owner:
KURT WOLFF
79835 RANCHO LA QUINTA
LA QUINTA, CA 92253
Contractor:
DI -LAR INDUSTRIAL SUPPLY INC DBA L J HAU
1541 PARKWAY LOOP STE E
TUSTIN, CA 92780
(714)544-3100
Llc. No.: 326317
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 polity number are:
Carrier: EVEREST NATIONAL INSURANCE COMPANY Polity Number: 7600013335
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 the
workers' compensation provisions of Section 3700 of th Labor Code, I shall forthwith
comply with those provisions.
Date'C / 2-_ S roGl7 Applicant:
n
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 ($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 Building Official 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 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 hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
Dat ��5 l6 Signature•(Applicant-or'Agent): I 4115;e
v
Date: 12/15/2016
Application Number: BPLB2016-0146
Owner:
Property Address: 79835 RANCHO LA QUINTA DR
KURT WOLFF
APN: 602220024
79835 RANCHO LA QUINTA
Application Description: WOLFF RESIDENCE/ PLUMBING_
LA QUINTA, CA 92253
Property Zoning:
Application Valuation: $6,000.00
Applicant:
Contractor:
DI -LAR INDUSTRIAL SUPPLY INC DBA L J HAU .
DI -LAR INDUSTRIAL SUPPLY INC DBA L J HAU
1541 PARKWAY LOOP STE E
1541 PARKWAY LOOP STE E
TUSTIN,_CA 92780
TUSTIN, CA 92780
(714)544-3100
Llc. No.: 326317
Detail: REPLACE EXISTING TUB WITH JACUZZI WALK IN TUB.
SUING EXISTING PLUMBING AND FOOTPRINT. ADD (2) DEDICATED 20 AMP GFI CIRCUITS. PER
2013 CALIFORNIA BUILDING CODES.
v
FINANciAL NFORMATION
DESCRIPTION ACCOUNT QTY AMOUNT
BSAS SB1473 FEE 101-0000-20306 0 $1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DEVICES, FIRST 20
101-0000-42403
0
$25.33
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DEVICES, FIRST 20 PC
101-0000-42600
0
$25.33
Total Paid for ELECTRICAL: $50.66
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PERMIT ISSUANCE ,
.101-0000-42404
0
$96.27
Total Paid for PERMIT, ISSUANCE: $96.27
DESCRIPTION
ACCOUNT
CITY
AMOUNT
FIXTURE/TRAP
101-0000-42401
0
$12.67
DESCRIPTION
ACCOUNT
QTY
AMOUNT
FIXTURE/TRAP PC
101-0000-42600
0
$12.67
Total Paid for PLUMBING FEES: $25.34
Bin # City of La Quin to
Building 8£ Safety Division
Permit, UW . . 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-701,2
p Building Permit Application and Tracking Sheet
Project Address: (Owner's Name: 14 U j2T tAD0C�C
A. P. Number:
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Project (circle one): New Add'n e Repair Demo
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Sq. Ft.:
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# Units:
Telephone # of Contact Person--7e
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Estimated Value of Project: 6 p o �
APPLICANT: DO NOT WRITE BELOW THIS LINE
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Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
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
SubcontactorList
Called ContactPsrson
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN ROUSE:-
''d Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I•P.P.
Pub. Wks. Appr
Dale of permit issue
School Fees,
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Total Permit Fees