07-0385 (PLBG)P.O. BOX 1504-
78-495 CALLE TAMPICO .
LA QUINTA, CALIFORNIA 92253
Application Number: (r 0'7-00000385
Property Address:
54339 SHOAL CREEK
APN:
775 -061 -056 -
Application description:
PLUMBING
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
500
Applicant: Architect or Engineer:
4XP
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
-----7--------------------------------------------
CE ED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury at 1 am licensed under provisions of Chapter 9 (commencing with -
Section' 7000) of Division 3 of the Bus ass and rofessionals Code, and my License is in full force and effect.
License Class: B1 License No.: 594043
Datek.;--o 7 Contractor:
DECLARATION
Ihereby affirm under penalty of perjury that I a�LNER-BUILDER
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 7031.5 by
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
(_) 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 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.).
(_) I, as owner of the property, am exclusively contracting withlicensedcontractors 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
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 2/02/07
Owner:
KEN SIVE
54339 SHOAL CREEK
LA'QUINTA, CA 92253
Contractor: v
7C'S CONSTRUCTION & T
48236 VISTA DE NOP FE6 42.2007
LA QUINTA, CA 92253
(760) 564-5811 CITYQF
Lic. No.: 594043 . OF AQ��A
-------------------------------------'----------
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 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. EXEMPT. Policy Number EXEMPT
_ 1 certify that, in the. performs f the work for which this permit is issued, I shall not employ any
person in any manner s s to b ome subject to the workers' compensation laws of California,
and agree that, if I sho Id becom subject the workers' compensation provisions of Section
3700 of the Labor C e, I sh orthwit c mply with those provisions.
�1
Date: ^0-4 1 Applicant:
WARNING: FAILURE TO SECURE W RKERS' CUAPENSATION 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 suc2permi, ssation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that theion is correct. I agree to comply with all
city and county ordinances and state laws relating to bui i, an er by authorize representatives
of this coounnty,to enter upon.the above-mentioned prop ypur ses.�Dater0'-0'' � Signature (Applicant or Agent):
Application Number 07-00000385
Permit . . . PLUMBING
Additional desc .
Permit Fee . . . 18.00 Plan Check Fee
4.50
Issue Date . . . . Valuation
0
Expiration Date 8/01/07
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
PERMIT FOR GAS LINE INSTALLED
PREVIOUSLY WITHOUT PERMIT. CURRENT
CONTRACTOR IS ASSISTING HOMEOWNER TO
PERMIT THIS EXISTING GAS LINE.
Fee summary Charged Pa -id Credited
---------------------------
Due
------------------------------
_ `Permit Fee Total 18.00 .00 .00
18.00
Plan Check Total 4.50 .00 .00
4.50
Grand Total 22.50 .00 .00
22.50
LQPERAIIT
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3000
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Bin #
Permit #
Project Address:
A. P. Number:
Contractor: J
Address: 8
City, ST, Zip: i
Telephone:
State Lie. # : q
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. #:
City of La Quinta
Building 8L Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Ciee
1( rNS'�fV C 1 OrAl
Vii✓ Co
"l City Lic. #:
Name of Contact Person:
Telephone # of Contact Person:
# Submittal
Plan Sets
Structural Calcs.
Truss Cala.
Energy Cities.
Flood plain plan
Grading plan
Subcontactor List
Grant Deed
H.O.A. Approval
IN HOUSE: -
Planning Approval
Pub. Wks. Appr
School Fees
APPLICANT: DO NOT 1
Recd
Plan Check submitted
Reviewed, ready for coi
Called Contact Person
Plane picked up
Plans resubmitted
2" Review, ready for c<
Called Contact Person
Plans picked up
Plans resubmitted
Review, ready for.co
Called Contact Person
.Date of permit issue
ner's Name:
E
dress: S�ec;
City, ST, Zip;
s�
AAA A
Telephone:
Project Description:
MEN
�� 511 6�
�A
l j `w G
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: # Stories: # Units:
Estimated Value of Project: X o o .06
VRITE BELOW THIS LINE
tCIMG . PERMIT FEES
Item
Amount
rection
Plan Check Deposit
Plan Check Balance
Construction
Mechanical
rrcetions/issue
Electrical
Plumbing
S.M.I.
Grading
rections/issue
Developer Impact Fee
A.I.P.P.
Total Permit Fees
i