04-7000 (PLBG)P.O. Box 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING PERMIT
Application Number. .
Property Address . . .
APN:
Application description
Property Zoning.. . . .
Application.valuation .
Owner
------------------------
BARNETT JERRY R
*NOT ON FILE
BUILDING & SAFETY DEPARTMENT
(760).777-7012
FAX (760) 777-7011
INSPECTION REQUESTS (760).777-7153
X04-00007000. Date 10/28/04
79673 CIDRA
772-180-054-
.
72-180-054 . . . REMODEL - RESIDENTIAL
. . . LOW DENSITY RESIDENTIAL
3000
Contractor
------------------------
VALLEY PLUMBING COMPANY
46780 CLINTON STREET
UNKNOWN CA 9,999-97_ INDIO CA 92201
t` WCC: CLAREDON INS 10/28/04
WC: 02KR0027214 09/25/05
CSLB: 273088 04/30/05
CCC: C36
Permit . . . ELECT ''= '`ADD/ALT/REM
Additional desc
k
Permit Fee . . `:� 18,i. 00 Plan Check Fee .00
Issue Date . . . .�� Valuation . . . . 0
Qty Unit Charge Per Extension
BASE FEE 15.00
1.00 3.0000 EA ELEC APPLIANCES 3.00
-------------------------------------------------------------=--------------
Permit PLUMBING
Additional desc
Permit Fee 18.00 Plan Check Fee .00
Issue Date 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 - 18 L.F. 1/2" LINE & ELECTRIC LINE
TO BBQ (AGSB-2, ETL APPROVED)
--------=-------------------------------------------------------------------
Other Fees . . . . . STRONG MOTION (SMI) - RES .50
Fee summary Charged Paid Credited Due
---------------------------------------------------------
Permit Fee Total 36.00 .00 .00 36.00
Plan Check Total ..00 .00 .00 .00
Other Fee Total 50 .00 .00 .50
Grand Total 36.50 .00 .00 36.50
P.O: Box 1504ICE VOICE (760) 777-7012
78-495 CALLE TAMPICo FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: 04- 7000 1 Date: /,9•o?8'4y
Applicant:
Applicant's Mailing Address:
Architect or Engineer:
Architect or Engineer's Address:
� l A
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals
Code, and my License is in full force and effect.
License Class License No.
Date Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5, Business 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 Contractors' 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 applicant for a permit subjects
the applicant to a civil penalty of not more than five hundred dollars ($500).):
U 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 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 or through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is
,t sold within 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, 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.).
U I am exempt under Sec. P.C. for this reason
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of pefjary one of the following declarations
I 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 insurance carrier and policy number are:
Carrier Policy Number
y I certify that, in the performance 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'
TF compensation laws of Cal' ia, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with t se pr v'ihs. A
WARNING:L FAlkRE TO SECURE W COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED T OUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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 N
�/j
Lender's Address A
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 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 willsubject permit cellation.
I certify that I have read this application and state that the ove infohVation is correct. I agree to comply with all city and county ordinances and state laws relating to building
construc 'on, an I hereby authorize representatives of this co t e abve-mentined grop
ooed for inspection purposes.
ate DY gnature (Applicant or Agent):
A RE -INSPECTION FEE OF p ED
! BE CRARGED IF TH ARE NOT ON
LAN
P . S AND JOB CARD,,_.
THE SITE FOR A SCHEDULED
INSPECTION -
No EXCEPTION
CITY OF LA QUINT
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUC
2;
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4000
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