07-2519 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:.
07-00002519
78395. SAND FLOWER PL
6437181-009-46 -2117
PLUMBING
LOW DENSITY RESIDENTIAL
2500
BUILDING & SAFETY DEPARTMENT
- BUILDING PERMIT
Owner:
ROMAN CATHOLIC BISHOP
C/O DIOCESAN PASTORAL
1201 E HIGHLAND AVE
OF SB
CTR TAX
SAN BERNARDINO, CA 92404
Contractor:
Applicant: Architect or Engineer: SO CAL & ASSOCIATES PLMBNG
P.O. BOX 955
YUCCA VALLEY, CA 92286
(760)464-3147
Lic. No.: 793482
-
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LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I 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 in full force and effect: _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: B C36 C42 License No.: 793482 .for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
I— A issued.
"Date: �z�" 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
�i]WNER-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 permit 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' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant 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 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3700 of the Labor_ Code, I shall forthwith co visions.
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).: \ _Dater ' �lZ.O .,Appli`
1 _ 1 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 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
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 J$1 00,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not 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.).
1 _ 1 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
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/12/07
Date: Owner:
CONSTRUCTION LENDING AGENCY
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 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 Ouinta, 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. 1 agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of this county to enter upon the above-mentioned property for ins
Date: `" `w/ Signature (Applicant or Ag�
Application Number 07-00002519
Permit PLUMBING SEWER
Additional desc .
Permit Fee, 30.00 Plan Check Fee .00
Issue Date Valuation 2500
Expiration Date•. 3/10/08
Qty. Unit Charge Per Extension
BASE FEE 15.00
1.00 15.0000 EA PLB BUILDING SEWER 15.00
-------------- -- - ---- -------------------------------------
Special Notes and Comments
SEPTIC ABANDONMENT AND SEWER HOOK UP
Fee summary Charged Paid Credited Due
Permit Fee Total 30.00 .00 00 30.00
Plan Check Total .00 .00 .00 .00.
Grand Total 30.00 .00 .00 30.00
LQPERMIT _
Bin #
City of La uinta.
Building u SafetyDivision
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253.- (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address:' - �� 5 D
A. P. Numbed:
Owner's Name:
Address:
Legal Description:
City, ST,'Zip:
Contractor:
Address:
Telephone:
Project Description:
ST, Zip+
Letlydphone:. r I
.
c.
Lic..# : '�j l.(� �i City Lic. #:
'
Arch., Engr.,Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Construction Type:. Occupancy..
P cY.
Project type (circle one): New . Add'n Alter Repair Demo .
Name of Contact Person:
Sq. Ft.:
#Stories:
# Units:
Telephone # o r Contact Person:
Estimated Value of Project: Z S�
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submitt 1
Req'd
Recd
TRACMG .
PERMIT FEES
Pian Sew
Plan Check submitted
Item
Amount
Stractur il Calcs:,
Reviewed, ready -for corrections
Pian Check Deposit
Truss CS lcs.
Caned Contact'Person
Plan Check Balance
Energy Calcs..
Plans picked up
Construction
Flood ph in plan
Plans resubmitted
Mechanical
Grading.plan'
2" Review, ready for eorrcetionstissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant D d.
Plans picked up
S.1 LL
II.O.A. A proval
Plans resubmitted
Grading
IN HOU E:-
Review, ready for corrections issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School F es
Total Permit Fees
. i
(/ COACHELLA VALLEY WATER DISTRICT CASH RECEIPT DETAIL2 108
Date:
Received Fr m: / 1
. r.
Address:
Account No. _50%7°0
Service Address
❑ Meter(s)
C • ❑ Services)
'❑ Backflow(s)
❑ House Lateral(s)
1-
Gkk: ❑ Detector Checks) -
r`-- ❑ Meter Surcharge
sanitation Capacity Charge
❑ W.S.B.F.C.
�.: ❑ S.I.W.S.C.
G . ❑ Temporary Construction Meter
❑ Turn on Charge
€ ❑ Uncollected Account - Name
❑ Inspection Fee - Tract -
Fee -
j' ❑ Plan Check Fees Water / Sewer -
�. Tract -
I
❑ Bond Payment - A.D. - Bond Assmt
❑ Customer Deposit
i.
is ❑ Other
Remarks:
i,
Tract
G.A. Code {
TOTAL
��Copy to: Water Service
Cash n //�
Check i { ..Cashier
Money CVWD-438(1/05)
Order r
LQPERNIIT