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12-0305 (PLBG)r' P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: T2-000_00.305� 4 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Property Address: 81202 SANTA .ROSA CT APN: 764-270-999-22 -300234- Application description: PLUMBING Property Zoning: MEDIUM-HIGH DENSITY RES r--�" — Application valuation: 800 Applicant: Architect or Engineer: 0 ,� O. T✓ �� c V4 IN ----=--------------------- ------- - - - - -I 1_` LICENSED CONTRACTOR'S DECLARATION— I hereby affirm under penalty of perjurythat I am licensed under provisions of,Chapter 9 (commencing with ��_ Section 7000) of Division 3 of the Business;arid,Professionals Code, and my License is in full force and effect. License ClassS C27 - License'No.: 857801 r ate:3,^. 6 t�9ritracto . / J OWNER -BUILDER DECLARATION hereby affirm under penalty, of.perj that I am -exempt from the Contractor's:State License Law -for the following reason (Sec. 7031.5,. Bus ess 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 applicantfora permit subjects the applicant to civil penalty of not more than five hundred dollars ($500).: (_ 1 1, as owner of -the property, or my employees with wages astheir 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 ofcompletion, the owner -builder will have the burden of proving that he or she did not build or improve,for the purpose of sale.). (_ 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 contractors) licensed pursuant to the Contractors' State License Law.). (_ 1 I am exempt under Sec. , BAP.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 Owner: BALDWIN 81202 SANTA ROSA COURT LA QUINTA, CA 92253 Contractor: WESTLAKE LANDSCAPE INC,, BRIAN R.O. BOX 5175 .LA QUINTA, CA 92248 (760)399-1506 Lic. No.: 857801 VOICE (760) 777-7012 FAX (760) 777 27011 INSPECTIONS (760) 777-7153 Date: 3/26/12 WORKER'S COMPENSATION DECLARATION :I hereby affirm under penalty of perjury.oneof the following declarations: _ 1 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 y insurance carrier and policy, number are: Carrier LIBERTY MUTUAL` Policy Number WCJZ91455523011 certify. that,.in theperformance 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 1 should becom ubject.to the workers' compensation'provisions of Section 3700 of the Labor Code, I shal orrthwith comply with -those provisions. WARNING: FAI Rt_ O SECUREeWO ERS: COMPENSATION COVERAGE IS UNLAWFUL„AND SHALL - SUBJECT AN EMPLOYER TO CRIMIN L PENALTIES AND CIVIL FINES UP TO ONE, HUNDRED THOUSAND DOLLARS (sioo,000)..IN ADDITIo T.O THE COST OF COMPENSATION, DAMAGES AS,PROVIDED,FOR IN SECTION 3706 OF THE�LABOR CO _ , 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 at whose request 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 1 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 co)rtty t enter upon the above-mentioned prop , r inspection purposes. . Date �Si ature (Applicant or Agent): LQPERMIT Application Number 12-00000305 Permit . . . PLUMBING Additional desc . Permit Fee .. 18.00 Plan Check Fee 4.50 Issue Date Valuation 0 Expiration Date 9/22/12 ' Qty Unit Charge Per Extension BASE FEE 15.00 1.00 3.0000 EA. PLB.GASPIPE 1-4 OUTLETS' 3.00 -Special Notes and Comments INSTALL -100 L.F. 1" GAS LINE TO.FIREPIT. AREA,. PER LANDSCAPE PLAN. 2010 -CODES. --------------------------------------------------------------- Other Fees -BLDG,STDS- ADM2N (SB1473) -------------- 1.00 Fee summary _ Charged '. Paid' Credited" Due' Permit>.Fee, Total 18•.00 00 "..0`0 18:•00 Plan '`Check. Total 4.50 0.0 ° . 00 4.50 ,. Other,:Fee Total 1.00 .00. :00. 1.00 Grand'Total 23.50 .00 .'00 23.50 LQPERMIT sin :# City. Ofuinta Buffing a. Safety Division w. P.O. Box iSO4, 78495 Gaffe Tampico, ta.Quinta,•:CA MSS- (760) 777-70.12 Building Permit ,Application and Tracking Sheet Permit # �- Project Address: I ^ 20.�, . aln t4 �2 US ct. GOwner's Name:: (J f A. P. Number — l/ 1(U address: 8 (_ Z U 2�t Ta /'aSc� C77. Legal Description:. , City, ST, Zip:. CC( Contractor. Telephone: ;_J. Address: P S 'Project Description: /US If //. e lu /Uv City, ST, Zip: b<*4­.0 ' +c t^C� : ('.Z Z . i G S L >re Telephone: - E . . MMI Q � ' '. 011 L �� Cu -e State Lie. #: l . U I City Lie. #; Arch., Engr., Designer. Address:. City., ST, Zip:. Telephone: a State Lia #: � j r ' . , Name of Contact Person: 12f%GC ,^ Construction Type: ✓I bkc(e -e Occupancy: �,proiecttype (circle one): New dd') Alter Repair Demo y Sq. Ft : #Stories: #Units: Telephone # of Contact Person: 76 C)U 2 iZ Estirnated'Valite of Projecx APPLICANT: DO NOT WRITE•BELOW THIS LINE # Submittal Reg'd Recd _ TRACIQNG; PERMIT FEES Plan Sets Pian Check submittedItem Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit. Truss C'1cs• Called Contact Person Plan Check Balance Title 24 Calcs. Plans picked up _ Construction Flood plain plan Plans resubmitted Mechanical Grading plan Review, ready -for correctionstissu.e Electrical Subeontactor List Called Contact Person -Plumbing Grant Deed -Plans picked up SALL Ii O A. Approval Plans resubmitted Grading IN I1OUSE:- ''d Review; ready for correctionsliissue :'Developer Impact Fee Planning Approval Called Contact Person - &LP.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees