05-4725 (PLBG) (2)P.O. BOX 1504 '
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant: .
05-00004725
53705 AVENIDA NAVARRO
774-134-020-10 -000000-
PLUMBING
COVE RESIDENTIAL
500
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
--------------------------------------------------
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: C36 License No.: 828264
ate: Contracto .
OWNER -BUILDER DECLARATION '
I hereby affirm under penalty of perjury that I am exempt from the Contractor's 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 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 703.1.5 by
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
(_ 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
Contractors' State License Law does not apply town 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 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.) - - - - - - -
(_ 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
Owner:
GONSALVES FRANCES D
53705 AVENIDA NAVARRO
LA QUINTA, .CA 92253
Contractor:
FOY, SCOTT A..
79-499 COUNTRY CLUB DR STE 9
INDIO, CA 92201
(760)360-0927
Lic. No.: 828264
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/20/05
----------------------------------------------—
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
_ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
for by Soction 3700 of.the Labor Code, for the performance of the work for which this permit is
issued..
T� K 1 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 STATE FUND Policy Number 1576840
_ 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' compensation laws of California,
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 those provisions.
D.16--*
at6Applicl.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
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.
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 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 construction, and hereby authorize representatives
of this c unty to enter upon the above-mentioned property for inspection. purposes.
Fte: Signature (Applicant or Agent): �/
Application Number . . . . 05-00004725
Permit . . . PLUMBING
Additional desc .
Permit Fee . . . . 22.50 Plan Check Fee .00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 4/18/06
Qty Unit Charge Per Extension
BASE FEE 15.00
1.00 7.5000 EA PLB WATER HEATER/VENT 7.50
-------------------------=--------=-----------------------------------------
Special Notes and Comments
WATER HEATER CHANGE -OUT
Fee summary Charged Paid Credited Due
------------------------------------------------=--------
Permit Fee Total 22.50 .00 .00 22.50
Plan Check Total .00 .00 .00 .00
Grand Total 22.50 .00 .00 22.50
LQYERMIT
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city of La. Quino
Building § Safety Division
ermif # ,
P.O. Box 1504,, 78-495 Calle Tampico
.
La Quinta, CA 92253 • (760) 777-701.2
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Building Permit- Application and Trackhg Sheet
Project Address: S
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Owner's Name: nC2� Ceun c.>a Vf
A. P. Number:
Address: S3' j Atf-emcU
Legal Description:
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City, ST, Zip:. .Qj ulY14fa- CA4w,15
Contractor.
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Telephone:
Address: ' ' (� (•/�,n T1�
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Project Description:
City, ST, Zip:
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Telephone:
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State Lic. #: �Z�.2
City Lic. #::<:::;::::>::::<.:.::::
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Arch., Engc, Designer:.
Address:
City, ST, Zip:
Telephone:
Construction T• o•
Type: Occupancy:
State Lic.
lc. #•
-
Name of Contact Person:
ProJe ct • �ci rc
le
Pe one):. . Need Adc'n Alt cr ReP.
air Demo
Sq. Ft.:
# Stories:.
# Units:.
Telephone # of Contact Person-
Estimated Value of Project:
APPLICANT: DO NOT WRITE 13ELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
Plan Sets
PERMIT FEE&
Plan Check submitted .
Item
Structural Calcs.
Reviewed, ready for corrections'
Amount
Truss Calcs.
Plan Check Deposit
Called Contact Person
Plan Check Valance
Title 24 Gales:
Plans picked up
Flood plain'plan
Construction
Plans resubmitted'
Atechanie'all
Grading. plan
2" Review, ready for corrections/issue
Electrical
Subconfactor List
Called Contact Person
Grant Deed
Plumbing '
Plans picked up
H.O.A. Approval
Plans.resubmilled'
INHOUSE:-
"d Review,
Grading
ready for correctionsrssue
Developer Impact Fee '
Planning Approval
Called Contact Person '
Pub. 1A'ks. Appr
---------------
Date of permit issue .
A.I.P.P.
School Fees
Total PcrmitFees
2005-09-12 14:36 (760)-393-4062 0208 -INSTALLED SALES P 1%1
SSZR135A LOWE'S HOME CENTERS, INC. ELQ 0208
•PAGE: 1 'DATE: 09/12/05 78-865 HICHWAY:111
LA QUINTA CA 's
ORDERED FOR: GONSALVES, FRANCES (760)771-5566
ADDRESS: 53705 AVENIDA NAVARRO
LA QUINTA CA 92253 PHONE: (760)771-1038
VENDOR NAME: FOY, SCOTTY•A CONTACT:
ADDRESS: ATT PHONE: (760)360-0921
BERMUDA DUNES CA 92201 FAX: (760)360-0479
'PROJECT: 112420071. PERMIT, WATER HEATER
LOWES PO: 4429686 LOWES INVOICE: 97431 ASSOCIATE: GARY REAGLES
RST DELIVERY: 08/26/05 AR NUMBER:
QTY 1TEM ITFM DESCRIPTION SIN VEND PART# COST E7.1' COST.
1 154374 PERMIT FEE 8-02250 7.2.50 22.50
WATER HEATER
INSTALL CITY
OF .LA
FREIGHT $0.00
TOTAL $22.50
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