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