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10-0602 (PLBG)4 P.O. BOX 1504 VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 7/06/10 Application Number: 10-00000602- Owner: Property Address: 81226 SANTA ROSA CT PROSENJAK APN: 764-270-999-20 -300234- 81-226 SANTA ROSA COURT Application description: PLUMBING LA QUINTA, CA 92253 Property Zoning: MEDIUM HIGH DENSITY RES Application valuation: 750 Contractor: Applicant: Architect or Engineer: WESTLAKE LANDSCAPE INC,BRIAN P.O. BOX 5175 LA QUINTA, CA 92248 / (760)399-,1506 ILI Lia.'No.: 857801 0 ---------------------- ----------- --------—---—-—---- ------—— ---—---——--—----——-------——-----— 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 s: C27 . license No.: 857801 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued: ate:' '���lr'( ractbr• IX 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 /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 NATIONAL UNION Policy Number WC058343827 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 repairany structure, prior to'its issuance; also iequires*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 sheds 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 Busine'ss and Prpfessions.Code) or 3700of the Labor Code, I shall forthwith comply with those provisions. that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of. Section 7031.5 by - �,� y L�TOPSECURE any applicant for a permit subjects the applicant to a civil penalty of not more'than,five hundred dollars ($500)..: ate nt: y i� (_ 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: FAIL 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 ($100,000). 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.)., - APPLICANT ACKNOWLEDGEMENT (_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec, IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the 7044, Business and Professions Code: The Contractors'. State License Law does not apply. to. an owner of conditions and restrictions set forth on this -application. property who builds or improves thereon, and who contracts for the projects with a contractorls) licensed 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 of this application, 1 _ 1 I am exempt under Sec. , B.&P.C. for this reason the owner, and the applicant,' each agrees to, and shall defend, indemnify and hold harmless the City 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: 1 Lender's Address: 1" LQPERMIT of La Quetta, 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 18:0 days will subject permit to cancellation. I 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 co ion, nd hereby authorize representatives of this county to enter up o the above-mentioned propert for �Als'pection �poses, D k/fes' / r/ nature (Applicant or Age - Application Number . . . . Permit . . . PLUMBING Additional desc . . . Permit Fee . . . . 18.00 Issue Date . . . . Expiration Date . . 1/02/11 10-00000602 Plan Check Fee . . 4.50 Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS 3.00 ---------------------------------------------------------------------------- Special Notes and Comments ADD -100 L.F. 1" GAS LINE FOR FUTURE APPROVED APPLIANCE., 2007 CODES. ---------------------------------------------------------------------------- Other Fees . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary ----------------- Permit Fee Total Plan -Check Total Other Fee Total Grand Total LQPERMIT Charged Paid 18.00 .00 4.50 .00 1.00 .00 23.5.0 .00 Credited Due .00 18.00 .00 4.50 .00 1.00 .00 23.50 Bin # City..of La . Qu►nta 8.0ding 8rSafety Division Permit # P.O. Box 1504, 78=495 Calle Tampico La Quints, CA 92253 - (760) 777-7012 Building Permit Application and. Tracking Sheet Project Address: 12c3Sq CY. Owner's Name: Cil `le n A. P. Number. (� (X v� n JC� �. /' I ( t%. `I Address: R Legal Description: City, ST, Zip: L. vl `FGA, / /U L/ .. }} Contractor: r !G-� —C-: '`° ' S� �G�-2 Telephone: � ? :s> Address: 7 Project Description, t,V City, ST, Zip: 6eryblv'r-3 ry-,s . Cil ec Telephone: 6 ZSv Z • .. w State Lic. # : j,S�C) CityLic. #.:^ Cti Arch., Engr., Designer. Address: City., ST, Zip: Telephone: F . 'Construction Type: Occupancy: State Lic. #: ?<"s fss• . .?fig Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person: t f �� .wLo� tit Sq. Ft.: t Stories: #Units: Telephone # of Contact Person: -7 61" o 2. ', G Z q Z �--� Estimated . Value of Project::. (� APPLICANT: DO'NOT WRITE qi LOW THIS LINE b Submittal Req'd Rec'dTRACKING' PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cafes Reviewed, ready for corrections Plan Check Deposit Truss Cala. Called Contact Person Plan Cheek Balance Tide 24.Calcs. Plans picked up Construction Flood plain plan, Plans resubmitted Mechanical Grading plan 2'! Review, ready for correclionvissue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up,` H.OA. Approval Plans resubmitted Grading IN HOUSE:- '`' Review; ready for correctlonslissue Developer Impact Fee Planning Approval Called Contact Person A:I.P.P. Pub. Wks. Appr Date of permit issue ' School Fees Total Permit Fees