05-4687 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
L'A QUINTA, CALIFORNIA 92253
Application. Number: 05-00004687
Property Address: 78720 SAGUARO DR
APN: 646-312-029-79 -000000-
Application description: PLUMBING
Property Zoning: MEDIUM DENSITY RES
Application valuation: 1000
Applicant:
T,iht 4 4 Q"
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING' PERMIT
r
Owner:
BRONSON BRAD
78720 SAGUARO DRIVE
LA QUINTA, CA 92253
----------------------
Contractor:
Owner
VOICE (760)777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/18/05
a
LICENSED CONTRACTOR'S DECLARATIONWORKER'S
COMPENSATION DECLARATION
heretiyaffirm under penaltyof. perjury that I am licensed under, provisions ofChapter.9'(commencing with` _
I hereby affirm under penalty of perjury one ofthe following.declarations: -
; Section 7000) ofDivision 3 of: the Business arid 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:A -License No
for by Section 3700 of the Labor Code; for the performance of the work for which this permi6s .
s -
�.--r
ss, ed'
•
`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
�•'¢
- - - ...°{. OWNER -BUILDER DECLARATION -
insurance carrierandpolicy- number are: •^
I hereby affirm under. penalty of perjury',that I. am,eicempt from.the Contractor''s License Law for the
w.
Carrie? ` Policy Number - -
• -
,State
following-reasori-ISec.`7031 :5; Business and Professions Code: `Any city orcounty"that requires a permit to
- I certify that, in the performance of the woik for which this permit is issued, I shall not employ any
-
construct, alter, improve -,;demolish, or repair any.structur'e,,,priorto its issiiance, also requires the applicant for the
person in any manner so as to.becomesubject to the workers' compensation laws of California,
permit to file a signed statement that he, orshe is licensed,pursuant to the provisions: of the Contractors State
.. and agree that, if 1 should become subject to the workers' compensation provisions of Section
.
License Law (Chapter:,9((commencing"wit) Section -7000) of Dwision3 of'the Businessland Professions Code) or
3700 of,the Labor Code, I shall forthwith comply with those provisions. .
..c.• that he or she is exempt therefrom and the basis for the alleged exemption Any,violatwnof Section 7031 5 oy
any applicant for apermit subtest§;the applicant too civil penalty of than fivetiundred dollars IS5001::
(� I as,owner of the property, or myemployees:with wages-asitheirsole will do thewoik, and.
_ e ',,canter: -
;he structure is not'intended-or.tiffered-for sale (Sec:�7044j:Business8nd:'Professions�Code: The
- WARNING: FAILURE-,T•O:SECURE.WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL -
;iy
- • Contractors' State License Law does'Adt 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 herselfthrough hjs;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..'lf, however, the building'orimprovement is sold within
SECTION 3706.0E THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES... : --
& year.of completion, the owner.budder;will-Have the burden of proving that he or she did not build or
p improve for3hepurpose of sale.)'.+ c ';
'APPLICANT ACKNOWLEDGEMENT '
1, as owner of, the';pioperty; am' exclusive)ytontracting'with*Iicensed.coniractorsto'construct the,project (Sec.
IMPORTANT Application is hereby made to the. Director of Building and Safety for a permit subject to the
-7044, du* siness:and'Professions Code: TheContractors' State License taw does,not apply to amowner of..
_`
' con_ditions and restrictions set forth on this application. -
property who -builds or improves-thereon-and,who contracts for the protects with a contractor(sl'Ijcensed
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 ofthis-application,
(_ 1 I am.exempt under:Sec., k-t'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. "
'of
Date: ner:'2.
Any permit issuedas aresult this application becomes null and void if work is not commenced
within 180 days from date of issuance ofsuch permit, or cessation of work for 180 days will subject
.r CONSTRUCTION LENDING AGENCY
-
permit to. cancellation.
I hereby affirm under penalty of perjury that there is a coAstruction..lending agency,for the performance of the
I certify that I have read�this application and state that the above information is correct. I agree to comply with all
_
work for which this permit is issued (Sec: 3097, Civ. C.). -
city and county ordinancesand state laws relating to building construction, and hereby authorize representatives
of this county to enter upon the above-mentioned property for inspection purposes.
Lender's Name: -
'-
e: Si ure (Applicant or Agent):
Lender's Address:
LQPERMIT
Application Number . . . . . 05-00004687
Permit . . . PLUMBING
Additional desc .
Permit Fee 18.75 Plan Check
Fee
4.69
Issue Date . . . . Valuation
. .
.
0
Expiration Date .. 4/16/06
Qty Unit Charge Per
Extension
BASE FEE
15.00
5.00 .7500 EA PLEB GAS PIPE >=5
a;
3.75
Specia1,,Notes,,and Comments,
ADD 2" GAS LINE & 3/4" STUB OUTS. TO,
FEED ' 5 .:FIXTURES
Fee summary. Charged Paid Credited
Due.
------------------------- - - -
,',Permit -Fee Total. 18.75 .00
- -- -
.00
- --
18.95
P1an:.Check Total' 4...6:9:._ .00
.00
-.4.69-
Grand Total 23.44° 00
.00,
23.44
LQPERNTT
.. A ^ a:�;;'•. `F—
Bin #
City sof La• QUinta
Building ,&'Skety Division '
P:O Box 1A504� 78-495 Calle'Tampico
Permit #
L'il Quetta, CA 92253•- (760) 777-701;2
Building;Per"it Application and. Tracking Sheet
Project Address: T {
Owner's Name:
A. P. Number:
Address:
Legal Description:
City, ST, Zip: —
Contractor.
: Telephone:
Address: ^� `
!'Project Description:
City, ST, Zip:
i
Telephone: TY
State Lic. # : City Lic #'
Arch, Engr., Designer:
Address:
City, ST, Zip:
Telephone:
° Construction Type: Occupancy:
State Lic. #:
= Project type (circle one): o.New Add'n Alter 'Repair Demo
Name of Contact Person:
'Ft.:
#Stories:
#Units:
Telephone # of Contact Person: ' .r_
` Estimated Value of Project:
APPLICANT: DO NOT,WRITE.BELOW.THIS'LINE
N
-Submittal
Req'd
Recd
17r. 7
f TRACKING :
PERMIT FEES
Plan Sets
:r.
an Check submitted
'Item
Amount
Structural Calcs.Ikevkw4,;
ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact"Pirson
,Plan Check Balance
Energy Calcs.Plans
picked up `*
Constr ction
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
P1ans resubmitted -
Grading
IN HOUSE:-
'^' Review, ready for correctionshisue
Developer Impact Fee
Planning Approval
Called Contact Person .�
A.LP.P.
Pub. Wks. Appr
'Date of permit issue
School Fees
,.
total Permit Fees
m
R TEI%\.
�QTu�
QTS
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
OWNER/BUILDER INFORMATION
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified.,
For your protection you should .be aware that as ".Owner/Builder" you are the responsible.'party of record on such a
permit. Building permits are not required to be, signed by;.property owners unless they arepersonally performing their
own work. If your work is being.performed'by someone�'other;than yourself; you may_piotect yourself from possible
liability if that person applies for the proper, permit in, his. or heir 'name.
T
Contractors are required by law to be licensed and bonded by the yState of California and fo have a business license
from the City or County. They are also'required by law to.`put their license number on all permits for which they
apply
if you plan to do your own work, with the exception. of various trades that you'plan to'subcontract, you should be
aware of the following information for.your benefit arid.protection:
If you employ or otherwise engage any_persons other ,than your immediate family, and the work (including materials
and other costs) is:,$200.00 or more -for the entire project, and such,persons'are,not licensed as contractors or
subcontractors, then you may be an employer.
If you are an employer, you must register with the State arid" Federal Government as an employer and you are subject
to several obligations include' State and Federal income. tax withholding, federal social -security taxes, worker's
compensation insurance, disability. insurance, costs_.:and._unemployment-compensation"contributions. _ _, ......_.
There, may be financial risks for you if you.do not carryout these obligations, and these risks are especially serious with
respect to worker's compensation insurance.,
For more specific information about your obligations under Fed eral,Law, contact the Internal Revenue Service (and, if
you wish, the U.S. Small Business Administration). For,more:specific information°about your obligations under State
Law, contact the Department of BenefitPayments and the Division of- Industcial'Accidents.
If the structure is intended for sale-, property owners who are, not licensed: con tracts are allowed to perform their
work personally or through their own employees, withouta-licensed *contractor,or subcontractor, only under limited
conditions.
A frequent practice of unlicensed persons professing to be contractors' is, to securean "Owner/Builder" building
permit, erroneously implying that the property owner_ is providing. his •'or. her_ own labor,and material personally.
Building permits are not required to.be signed by:property owners ;unless they are performing their own work
personally.
Information about licensed contractors maybe, obtained:by contacting the -Contractors' State License Board in your
community or at 1020 N. Street, Sacramento, California 95814.
Please complete and return the enclosed:owner.-bu�iider'.yerification' f. hi',so that,we -,can- confirm that you are aware of
these matters. The building permit will not be issued iin"id.;the verification is returned.
Very truly yours,
CITY OF LA QUINTA
DEPT. OF BUILDING AND SAFETY
78-495 Calle Tampico
La Quinta, CA 92253
(76� 777-7012
FA: (60) 777-7 1
i
'S SIGNATURE/DATE
PROPERTY ADDRESS
PERMIT NUMBER(S)