07-1729 (PLBG)le t r I
P.O..BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
04-40M
We
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Application Number: 07-0.0001729
Property Address: 53720 AVENIDA CORTEZ
APN: 774-102-011-14 -00'0000-
Application description: PLUMBING
Property Zoning: COVE RESIDENTIAL
Application valuation: 8000
Applicant: Architect or Engineer:
------------------
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
I hereby affirm under penalty of perjury that Fam 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: C42 I A AlLicenseNo.: 661018
f
Date: v Contractor:. Gt aL
OWNER -BUILD R DEC;TION
I'here6y affirm under penalty of perjury that l 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, after, improve, demolish, or'repairrany '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
Ueense Law (Chapter 9 (commencing with Section 7000) of Division 3 of the, Business and Professions Code) or
that: he or she rs exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
any applicant for a permitsubjects the applicant•to a civil penalty of not more than five hundred dollars (5500).:
I, as owner of the property, or my employees with wages as theirsole 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 1, as�owner of the property, am exclusively contracting with�licensedi contractors to construct the project (Sec.
7044, Business and Professions Code: The Cont rectors' 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
pursuent.to the, Contractors"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:
I-QPER1uT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/15/07
Owner-
DOMINGUEZ LORAINE
53-72.0 AVENIDA CORTEZ
LA QUINTA, CA 02253
Contractor:
HAMMER PUMPINGLL'' 1
48
CATHEDRAL 4CITY., 922JUN
(760,)360-7448 QWNTA
tic. No . e 66101E3 CITY OFLA
_.,�er
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 Section 3700 of the LaborCode, for the performance of the work•for which this permit is
issued.
I haveiand•will maintain workers' compensation insurance, as required by Section 3700 of the.Labor
code, for the performance of thework.for which this'permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier STATE FUND Policy Number 1828655-2007
_ 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'subiect'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 Cod s II forthwith c p w those provisions:
Date: �rs-6 Applicant: � t
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,agreesrto, and shall defend,indemnifyand hold harmless the City
of La Quints, its officers, agents and employees for any actor omission, related to the work being
performed under or following issuance of this', permit..
2. Any permit issued aae 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'certifythat I have read this application=and state that the above irjt_r %._ is correct. I agree to comply with all
oily and county ordinances and state laws relating to buildin n ti ere horize representatives
of this ounty to enter upon the above-mentioned pro ion purp
Date. -'� Signature (Applicant or Ag
Application Number . . . . . 07-00001729
Permit . . . .
PLUMBING SEWER
Additional desc . .
Permit Fee . . . .
30.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. . .
. 8000
Expiration Date . .
12/12/07
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 15.0000
EA- PLB BUILDING SEWER
15.00
Fee summary Charged Paid
Credited
Due
---------------------------
Permit.Fee Total
----------
30.00
----------
.00
----------
.00
30.00
Plan Check Total
.00
00
.00
.00
Grand Total
30.0.0
.00
.00
30.00
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JUN -15-2007 11:21 PM
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Bin #.
City of La- Quinta
Building at Safety Division
-P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
-Building Permit Application and Tracking Sheet
Permit ;#
-
Project Address: s 3 7D,
o AveAlf—
.
Owner's Name: �rx—lie- ,%,(,ce,Z
A. P. Number:
Address: 5737�d
Legal Description:
City, ST, Zip: c�.niw
Contractor: " e4-
Address:
Telephone: �{
Project Description:
City' ST, Zip: `CCA\4
-{-
Telepbone: 2.60J
State Lie. # :
City Lic. #:
'
Arch., Engr.,.Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:
#'Stories:
# Units:
Tele hone# of Com P
p
Zbp
—
Estimated Value of Proj C90
APPLICANT: DO NOT WRITE BELOW THIS. UNE
#
Submittal
Req'd
Reed
TRACMG • .
PERMU FEES
Plan Sets
Plan Check submitted
`
Item
Amount
Structural Cala.
Reviewed, ready for corrections
Plan Check Deposit
Truss.Calcs.
Caned Contact Person
Plan Check Balance
Energy Cales.
Plans bicked.up
Construction.
Flood plain plan ..
Plans resubmitted
Mechanical
Grading plan.
V. ,Review, ready,for correctionslissue .
Electrical
Subcontactor List
Called ContactTerson .
Plumbing
Grant Deed
Plans picked up
SALL
H.O.A. Approval
Plans,resubmitted
Grading
IN HOUSE:-
'"' Review, ready for correctionsfusue
Developer Impact Fee
Planning Approval
Called ContactPerson
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees.