10-0270 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
g=X: 0-00000270
Property Address:
50965 CAL- LE'9PALONIA
APN:
770-104-004-80 -000000-
Application description:
PLUMBING
Property Zoning:.
LOW DENSITY RESIDENTIAL
Application valuation:
2000
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
COVER WILLIAM L
PO BOX 1160
LA QUINTA, CAP
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
_.. ........ Contractor:
PRIDE CONSTR T' ON �D Q 12010
45520 GREEN IL 'COURT
INDIO, CA 9 O1'•'. OF LA
760)413-40 F/�tlA � �:Nr�j
Lic.. No..: 920283
Date: 3/31/10
�. LICENSED CONTRACTOR'S DECLARATION
. WORKER'S COMPENSATION DECLARATION '
I hereby_ affirm under penalty of perjury than amlicensed undeEprovisions 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 'Professiorials-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 CI License B. - License No.: 920283
/� '.../- •. -
, for by Section 3700 of the Labor Code;.forthe performance of the work for which this permit is
Tissued. .. _
Contractor:
1 have,and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
Code, for the performahce of the work for whi6-this permit is issued.' My workers' compensation
OWNER -BUILDER DECLARATION
'insurance carrier and policy number are: -
1 hereby affirm under penalty of perjury'that I am`ezempt 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,
permitao, fife assigned, statement that he'orshe is licensed;pursuant to the provisions of-tfie;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 70001 of Division 3 of'the Business and Professions Code) or
3700 of the Labor Code, I shall fo wit omply with those provisions.
thathe or she is exempt therefrom and the basis for the alleged exemption. Any violationof Section7031 .5 by
for the of more dollars
2 -
—Date V -
any applicant a permit subjects applicant to a civil penalty not than.fivehundred ($500).:
% Applicant:
1 _ I+'1, as,owner of the property, or my employees with wages as their sole compensation, will do the work -and
the structure is.notintended or offered for ISec. 7044, Business and Professions Code:sThe
WARNING: FAILURE TO SECURE.WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
' Contractors' State License Law does•hot 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,.providerdthat the
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended of 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 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 doesnot apply to -,an owner of
property who.builds br improves thereon, and who contracts for the projects with a contractor(s) licensed
pursuant to -the Contractors'- State License Law.)'
(_ 1 I am exempt under Sec. . , B.&P.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
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 aresult 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.) 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 construction, and hereby authorize representatives
of this co ty to enter upon the above-mentioned property for
/inspection ses.
07
Da Signature-lApplicaoto�r,A�gentl:
LQPERMIT
Application Number . . . . . 10-00000270
Permit . . PLUMBING
Additional desc .
Permit Fee . . . 33.00 Plan Check Fee
8.25
Issue Date Valuation
0
Expiration Date 9/27/10
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 3.•0000 -EA .. PLB GAS.PIPE 1-4.OUTLETS
3.00
1.00 15.0000 EA PLB- GAS. METER
-----------------------------------------------------------------------------
Special Notes and .Comments
.NAT[TRAL--GAS_..PIPING�FOR-METER_..&..COOKTOP:._.__.............- -- .......
...._.,_.,...... .. .. .......
20:07 CPC:
:<
Other. Fees -BLDG STDS ADMIN•. (SB1473)
1.00 -
Feesummary Charged Paid Credited
Due
Permit Fe'e Total. p33.00: .00 00
33.00
Plari. Check Total 8.25 . 00 . 00
Other Fee Total. 1•.00 .00 .00.
1.00.
Grand Total:.. 42.25 .00 .00
42:25 -
LQPERMIT
0
SITE REQUIREM' VITS
It"RIOR LOT
SIDEYARD. 5 FEET REARYARD: 10 FEET
MINIMUM EACH SmE MINIMUM
,
1 ,
1 a
- f
f ,
a
FRONTYARD: AREA TO BE
20 FEET lAtiDSG'1FED I
M 4RAw i
PROPERTY
I LINES
CURB LINE
5 �.
Bin #
C►ty of�=La. Qurnta
R,B(Iilding ff Safety'Divislori .
P.O. Box 1504,,78=495 Cafle Tampico '
La Qulnta,: CA•92251, (760) 777-7012;
Building Perh* Application. and Tracking Sheet
Permit #
Project Address:
qt�0
Owner's ame, �fvv% COV. t�eiGGt E%t1�5Ot'�
A. P. Number:
Address: 'SDq�.S CAI e. patoma
Legal Description:
City,' ST Zip; (y� (�V�n ' C - cf,��5 a
Telephone: 4a 7 , 4—
� .
Contractor: ee
Pyr"�lG �iryfi'I lore.
Address: 46-4$ Z iOe(Jt'' A IPJ1 -e—
; Project Descriptio_ n:
City, ST, Zip:
60 r—A
Telephone: .-7(,,33
3 /fes
k i .. i:.:; :; •:>
•:;a.., . v°
•4..
State Lic. # : 2—i728 3.
...::
City Lica.#
Arch., Engr., Designer:
Address:
City,, ST, Zip:
Telephone:.t.xa}
•:
:,. .. .:
r:>�<� -``�< "�:•:; �`;
r•:< si u':N?s° ?. z��..Project
ctwn Type: Occupancy:
type (circle one): New Add'n Alter Repair Demo
State Lic. #:
,,
Name of Contact Person: 2lti�r-°Ftz Sq: Ft.:
#Stories:
#Units:
Telephone # of Contact Person: "1G� ® i
9 T— q� 6 . t Estimated Value, of Project: ; .d
APPLICANT:
DO NOTWRITE, BELOW THIS LINE
#
Submittal
Req'd
':.Reed
TRACKDVJG
PERMIT, FEES
Pian Sets
Plan Check submitted
Item
Amount
Structural Coles.
Reviewed, ready for corrections
Plan Check Deposit
Truss Coles.
CaHed Contact Person
Plan Check Balance
Tithe 24 Caics.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
20° Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing,
Grant Deed
Pians picked no
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:
''' Review, ready for corrections/issue
' Developenimpact Fee
Planning Approval
Called Contact Person
A.I:P.P.
Pub. Wks. Appr
Date of -permit issue
School Fees
L
Total;Permit Fees
a