10-0474 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA -92253
Application Number:
1=0_^ 0':0:0;0"0:474
Property Address:
80579`PEBBLE
APN:
775 -131 -030 -
Application description:
PLUMBING
Property Zoning:
LOW DENSITY
Application valuation:
620
BEACH
RESIDENTIAL
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
FESTA KEIT D
80579 PEBBLE BEACH
LA QUINTA, CA 9225
(760)771-2427 i
_..._... .. .------Contractor:.
SIMENTAL, RITO ESTE
49901 CALLE EL SOL
COACHELLA, CA -92236
(7600200-7586
Lic- No.: 921951
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/03/10
JU7103 2010 1
CITY OF LA
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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 perjuryone, 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-insurefor workers' compensation, as provided
License Class: C36 License No.: 921951
for.by Section 3700 of the Labor Code, for the performance of the work for which this permit is
.
issued. - .. ....
ff
Date: 3 l0 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
. OWNER -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'(iermit to
_ I certify. that, in the performance of the work for which this permit is issued, I,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. become subject to the workers' compensationlaws of California,
permit.to file a signed statement that he or she is licensedpursuant to the provisions of the Contractor's State
and agree that, if I should become subject to the workers' compensation provisions of Section
License Law (Chapter 9 Icommencingwith Section 7000) of Division 3 of the Business and Professions Code) or
3700 of the Labor Code, I shall ort ith comply with those provisions.
that he or.she is exempt therefrom and the basis for the alleged exemption: Any violation of Section 7031.5 byInz'
any applicant for a permit subjects the applicant to a civil penalty.of not more than five hundred dollars ($500).:
,.Date: Applicant: �-
(_ I 1, as owner of'the property, or. my. employees with wages as_their sole. compensation,*will do the work,, and
�-L I I-
the'structure'is notintended.oroffered for sale (Sec. 7044,Business and Professions Code:- The
WARNIFAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, -AND SHALL
NG:
. 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 -got 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 fora 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.
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 c struction, and hereby authorize representatives
of this county to enter upon the above-mentioned pr ope y far i spe ion purposes.
Date: .316 Signatu�e� (Applic tY oar A ntl:
Application Number . . . . . 10-00000474
Permit . . . . . . PLUMBING
Additional desc . .
Permit Fee . . . . 18.00
Plan Check Fee
4.50
Issue Date . . . .
Valuation . . .
. 0
Expiration Date 11/30/10
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS
3.00
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Special Notes and Comments
RUN 3/4 GAS. LINE FOR -STOVE APROX. 65'
-- --- = -- ---- ---- - -- - BI:ACK 'PIPE -ON THE ROOF -AS APPROVED--
A.J. & APPROVED PLANS.
----------------------------------------------------------------------------
Other Fees . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid
------------ - ---- ---------- ----------
Credited
---------- ----------
Due
Permit Fee Total 18.00
.00 .00
18.00
Plan Check Total 4.50
.00 .00
4.50
Other Fee Total 1.00
.00 .00
1.00
Grand Total 23.50
.00 .00
23.50
LQPERAIIT
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Budfding & Safety-Dh*jon
P.O. Box'1564, 78495 Calle Tamplm,
la Qulnta, CA. 92253'. (760) 777-7012
Building Permit APPII tiogland' Tracking Sheet
Permit # `.
Proje«_Aad� . ,6
READ
,. ._�
Owner s Niime
A. P. Number
Legal Description:
City: ST; Zip: + q. Qui
Contrado3'� ' g �� S�. N--
Address: i `
rTei phone•
Project Descrip6o`n. 3
+
City, ST, zip: Ci CI L�7 `G-
Telephone I66I- 6 --_7f%
O + a0 �� Q r
State-Lic. #: .-1 City Lic. #
Arch., Engr., Designer
Address:
City., ST, zip:
Telephone:
State Lic. #:
Name of Contact Person:
;' Construction Type: Occupancy:
Projed type(circle one): New Add'n Alter Repair Demo
Sq. Ft:
#Stories:
#Units:
Telephone # of Contact Person:'�"'�
/
Value-ofProj6ac C� .
APPUQAMT:-DO
NOT WRrM4jLOW THIS UNE
p .
Submittal
Req'd
. Rce,a'
TRACKING:
PERM_ TP FEES
Plan Seta
Pian Check submitted
Its
Amount
Structural Cales.
Reviewed, ready:for correetiopa
Plan Check Deposit
Truss Cala.
UCalled Contact Person
Plan Check Balance
Title 24 Cales.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
-
Mechanical
Grading plan
2'' Review, ready for correctiona/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.L
H:O A Approval
Plans resubmitted
Grading
IN HOUSE:
' Review, ready. for correetions/rssne
Developer impact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date o[ permit issue
School Fees
Total Permit Fees