05-4498 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
05=00004498
Property Address:
.539,65 AVENI'DA CORTEZ
APN:
774-14.1-02.1-10 -0000.00-
Application description:
PLUMBING
Property Zoning:
COVE RESIDENTIAL
Application valuation:
300
T4&
t444a&Z
Applicant: Architect or Engineer:
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
X
I, hereby' affirmUnder penalty of perjury that I em licensed, under provisions of Chapter 9 (commencing with
-Section 7000) of Division'1of'the Business and ProfessionaWCode, and my License is in full foree'and effect.
License' Class:
�A' ense No.: 269354'
Data�''Gonsractw:
OWNER BUILDER DECLARATION
I hereby affirm under penalty rjury that I:am exempt from the Contractor's State Ucense,,Law for the
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires is permit to
construct, alter, improve, demolish,.orrepair any structure, prior to Its Issuance, also requires the applicartt:forthe
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
thathe 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 (9500).:
1 _ 1 I, asowner of the property, or my employees'.with'wages as their sole compensation, will do the work, and
the structure isnot 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.buifding 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 I, as owner of the property, am exclusively contracting with licensed contractors to construct the: project (Seca
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,contractorlaLlicensed
pursuant to theContrectors' State License Law.).
(_) 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
OCT. 0 6 2005
Owner:
KELLER KARL
=5 AVENIDA CORTEZ
UINTA, CA 92253
_COVJY INC, H B
229JE COMMERCIAL STREET
POMONA, CA -91767
(9.09)623-2502
Lic. No.: 269354
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
WORKER'S COMPENSATION DECLARATION
Date: 10/06/05
1 -hereby affirm under penalty of perjury one of the following declarations:
1 have and willmaintain 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 STATE FUND Policy Number
I certify that'in-the performance of therwork 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 subjeatp the workers' compensation provisions of Section
3700 of thetabor Code, l shall forth om I with'those provisions.
DateD`Applic
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 (5100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS. PROVIDED FOR IN
SECTION 3708 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 resulvof this, application,
the owner, and thwapplicennt, each agrees to, and shall defend, indemnify and hold harmless the City
of La Ouinta, its officers, agents and employess:forany act or omission related to the work being
performed under or following issuance of this permit:
2: Any permit issued as a resuft,of this application becomes null and,void if work is not commenced
within 180 days from date of issuance of such r cessation of work for 180 days will subject
permit to cancellation. -
1 certify that I have read this,application and state th above inj&mation is correct. I agreeto comply with all
city and county ordinances'and:s[ata laws'relating building c ruction, an reby authorize representatives
of this ycounty to enter upon the above-mentio open inspection- ses.
Dau.- V �� Sip ature (Applicant or Ag
K
Ir
LQPERMn'
Application Number . . . . . 05-000.04498
Permit . . . PLUMBING
Additional desc . .
Permit Fee . . . . 2.2.50
Plan Check_
Fee
.00
Issue Date . . . .
Valuation
. . .
. 0
Expiration Date . . 4/04/06
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 CHANGEOUT
Fee summary Charged
-----------------
Paid Credited
Due
--------------------
Permit Fee Total 22.50
--------
.00
-- ----------
.00
22.50
Plan Check'T._otal .0.0
.00
.00
.0.0
Grand Total 22.50
.00
.00
22.50
Bin #
City of La Quinta
Building ex Safety Division
P.O. Box 1504, 76-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
,Permit #
05,
Project Address: 2-3 i—f_ �,4
Owner's Name:
A. P. Number:
Address: 53 ?4
Legal Description:
City, ST, Zip: L (JILT Z Sf 3
Contractor: 6 CO vd 1.
Telepho :
Address: 3 p (� rj r �� -
Project Description:
City, ST; Zip:
Telephone: Z3 _ j-N—'� Z
State Lic. #': `Z Jb Y, City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person:
Construction Type:. Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.:
# Stories:
#Units:
Telephone# of Contact Person:
Estimated Value of Project: O
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd'
TRACKING
PERMIT FEES
Plan Sets
Plan Cheep submitted.
Item
Amount
Structural Galls.
Reviewed,' ready for corrections
Plan Check Deposit
Truss Cales.
Called Contact Person
Plan Check Balance
Energy Cale&
Plans nicked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading,plan
2" Review, ready for correction&%sue
Electrical
Subcontaetor List
Called Contact Person
Plumbing
Grant Deed
Pians picked up
S.M.I.
H.O.A. Approval
Plans resubmitted'
Grading
IN HOUSE:-
3A Review, ready for correctionsissue
Developer Impact Fee
Planning Approval
Called Contact Person
y.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees