13-0458 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 13-00000458
Property Address: 54792 SHOAL CREEK
APN: 775-141-071- -
Application description: PLUMBING
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 400,,
Applicant: Architect or Engineer:
4 4 awe Xj1-40-1
`�P
. C
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
DENNIS BALE
547.92 SHOAL CREEK
LA QUINTA, CA 92253
(760)831-5212
LICENSED CONTRACTOR'S DECLARATION
hereby affirm under penalty of perjury that,l-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.: 921951
Dater - t' i . Con'
tractor:
i_
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury,tha 1 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 sheis 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).:-
1—)
$500).:--1) 1, 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 improvementissold 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 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
Contractor:
A, R K PLUMBING
49901 CALLE EL
COACHELLA, CA 9
(760)200-7586
Lic. No.: 92195
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/11/13
ASR yl?o
_ 13_
-- - - - - - - - - - - - - - - - - --
- -- -----------
WORKER'S COQ A, ON _
I hereby affirm under penalty of perjury one of the following declar ( „�1� 4
I have and will maintain a certificate of consent to self- ns
r or workers' cc pensation, as provided
for by Section 3700 of the Labor Code, for the performance of•th work or 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 thework for which this permit is issued. My workers' compensation
insurance carrier and policy number are: -
Carrier EXEMPT Policy Number EXEMPT
_ 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
370220 of the Labor Co , I sh forth ith comply with those provisions.
...Date:_- �_ _7✓. -Applicant: - _ ___----
WARNING: FAILURE TO SECURE WORK S.
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, indemnity 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 cons uction, and hereby authorize representatives
of this county to enter upon the above-mentioned propert for ins _c urposes.
Date: "�I�Signature (Applicant or AgenU:
Application Number . . . .13-00000458
Permit PLUMBING
Additional desc .
Permit Fee 18.00 Plan Check Fee'.
4.50
Issue Date. Valuation .
. 0
Expiration Date.. 10/08/13
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
GAS LINE - INSTALL 22 L.F., 3/4 INCH GAS
LINE FROM EXISTING STUB OUT LOCATED AT
' REAR OF HOUSE TO SIDE OF HOUSE FOR NEW
STOVE INSTALLATION IN KITCHEN.2010
CALIFORNIA BUILDING CODES.-
-----------------------------
Other Fees . . . . . BLDG STDS ADMIN (SB1473)
1.00'
Fee summary Charged. Paid Credited
------
Due
----------------- ----------
Permit Fee 18.00 .00 .00
18.00
-Total
Plan Check Total 4.50 .00 .00
4:50
` Other Fee Total. 1.00 .00 .00-
1.00
Grand Total 23.50 .00 00
23.50
J
LQPERMIT. - - -
-
L
CQw
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
:.APPROVED
FOR CONSTRUCTION .
DAT
�h,
. S.
r
i
�h,
Bin. #
City of La Quints
BufldlnS' a Safe Division
tY
P.O. Box 1504,78-495 Ca1fe Tampico
La.Quinta, CA 92253 -:(760) 777-7012
Permit Application' and Tracking Sheet
Permit #
/Building
Project Address: L —�� i)(.'t' L.trPe
Owner's Name:. ` S .
ni
A. P. Number.
Address; oc,
Legal Description:
Contractor%
Q K I u
City, ST, Zip: C( V
Telephone - 33� I
Address: '��{' L�1 t� �. S
ProjectDescription: v-V�
City, ST, Zip: IC71 l tT Jr�
Tel bo Am lSF�� s
- l 1 � W ;
Y a.s
State Lic. # : City Lic. #;
Arch., Engr., Designer
Address:
City., ST, Zip:
Telephone:
State Lic. #: - _
!C
Name of Contact Person:
Construction Type:. Occupancy:
Project type (circle one): New Add'n Alter Repair Derno
Sq. FL: # Stories: # Units:
Telephone # of Contact Person:
Estimated Value of Project: d T
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
'Rec'd
TRACMG PERMITFEES
Pius Sets
Plan Check submitted
Item Amount
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit.
Truss Calcs.
Called Contact Person
Plan Check Balance.
Title 24 Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechaldcal
Grading plan
V Review, ready for correctioWiissue
Electrical
Subeontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
SMI.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
''` Review; ready for correctionwIssue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees