09-1174 (PLBG)P.O.'•BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA,-CALIFORNIA 92253., BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 11/06/09
Application Number: f0. 9-00001174/� f Owner: D d
Property Address: 7-/ 335:'( 0/4Q/JJ'ADAVIES RESIDENCE Q
APN: 772-340-043- - % 93�� _ ' TORONJA `.
Application description: PLUMBING LA QUINTA, CA 92253 ,1fo1'
Property Zoning: -LOW DENSITY RESIDENTIAL Nov 06'
Application valuation: 800 ` C/ri
OFLA
Contractor: F�:N4l� QbUy%q . .
Applicant: Architect or 4Enineer: ARTISTIC LANDSCAPE INC.78206 VARNER RD, #D PMD244
PALM DESERT, CA 92211 .
(760)360-1395
r' Lic. No.: 379421
dos..e_. //• /a •09
CENSED CONTRA T.QR'S DEC R ION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury/ t I am licensed un er pr``ovis'o f apter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Perjury/
ss and Prof ssiona Co e, aid y cense is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided _
License Cla s: 27 . i se No.• 37 421 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
Date- Contractor:/ _ 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
• .,OWNER -BUILDER DECLARATION insurance carrier and policy number are: ..
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier DELOS INS CO Policy Number OIKDRMI2 25 4
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to _ I certify that, in the perfor ce of the work for which this perm- i iss d, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the ,person in any manner so s to becom subject t e worke 4' om nsation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State - and agree that, if I sho d beco , S Ject to e orkers'' oo pen tion provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 7 of the Labor e, I shal for wit c m with .FSo .provi ions.
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 (55001: - Dat �� �-Applicant. - -
1 _ 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 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL•PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the - DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
• 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.). _ - - APPLICANT ACKNOWLEDGEMENT -
(_) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application. .
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed 1 . Each person upon whose behalf this application is made, each person at whose request and for _
pursuant to the Contractors' State License Law.). - ' . whose benefit work is performed under or pursuant to any permit issued as a result of this -application,
(_ 1 I am exemptunder Sec. , B.&P.C. for this reason 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
r
'performed under or following issuance of this permit.
Date: Owner: - 2. Any permit issued as a result of this appli tion becomes null nd void if work is not commenced
within 180 days from date of issuance o such per i, or ss
of work for 180 days will subject
CONSTRUCTION LENDING AGENCY - , permit to cancellation.
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify that I have read this application and state t t the abo info ation is correct. I agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.). - - _ _ _ city and co my ordinances and state laws.relafin o building onstr ction, and hereby authorize representatives
Lender's Name: ..of thi$�o to r]Ier upon the above-men,'one� t r insp lion proposes.
Dat@// Y%1/Signature (Applicant �r 7/
Lender's Address:
LQPER1111T
Application Number . . . . 09-00001174
Permit . . PLUMBING
Additional desc .
Permit. Fee 18.00•' Plan Check Fee
4.50
Issue.. Date . . . Valuation
0
Expiration Date 5/05/10
Qty Unit Charge Per
Extension
BASE 'FEE
15.00
1.00' 3.0000 EA PLB'GAS PIPE 1 -4 -OUTLETS
;3.00
--------------------------------------------------------
-----------------
Special
Special Notes and Comments
'60 LN FT GAS LINE 1 1/2 PER APPROVED
PLANS & B.H.
_November 6,_'2009 9:25:49 AM-pJuarez..-
Other Fees BLDG STDS ADMIN (SB1473)
1.001.
Fee summary Charged Paid Credited
Due
Permit Fee Total 18.00 .00 .00
18.00
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.
LQPER lff -
.
Bin #
City Of La Quinta
Building &r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application -and Tracking Sheet
Permit #
l�
Project Address:
» Owner's Name: J G
A. P. Number:
Legal Descripti n:
Contractor:
`
City, ST, Zip:. 'f4t iA 5i L01r-1.
l' Telephone:
Address: z
tr-CIl, Project Description:
City, ST, Zip:
Telephone -7,/,p
i
/ 6
State Lic. # :
�
City Lic.:..:::::.•::.:L;>:.;;
Arch., Engr., Designer:
Address:
City, ST, Zip:
h
TeleP one:
Li
c. State L c. #:
Name of Contact Person:1
Construction Type: i;: Occupancy:
an
P Y•
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: # Stories: # Units:
Telephone # of Contact Person:
6 Estimated Value of Proje V O--
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2nd Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
•
DATAPPINT CORP, 700 So. CLAREMONT ST. SAN MATEO. CA- 94402
AAItc} j
o -
If ri
-77
7N
r
.r r
C7b tiff fir' r f�
Q 7
{
t1+,.';til\ '.i � `3; � � •;�,°•, f `+ ..
. t
r-
t
%v1
,.. .,. . _
:
� ,,1h1
i '.. ! � .-, � . t � ... � 5.�;+' '+k. � +�.. 1. ' /->-,,,' •. �' s � o ,:.
..._..{ .•�-J. ra, - ..< \war.._ .-' �, p.. -
f� �, r
-sf'.r\ Q /
�'.`�.—` _ f d f - #" r : :awµ✓ ;s.',- r L/�,'�^� Yy"�'� • L'' C.?�. _.L
is
yy ,
}
n�,r, 0 a� r. _ +1
.r„c, �,.�, t,�j �r_..�.�.� .� .,,.. � t .el
Ua
N
-`,
y Govt t Y.-c,�.P
r -� l t ► l>l % 3
Lh
•
(jfjjff ��
l
,
r
• _.•:.racesew�sae«�r> . ,� Iry - : ,� - � '
J
1
itr�,l Vit,r,=17�e`e. rT+`irs
L o�
a AL
to
1jl1ia,l.,. 4J ti t
e
'Pop
I ell
f T -x b`h a 1.. /. \
��_ tir , � A r = a, �.._ 1'. a .J'a;, _,' / V ' .C' 1 �/- /' _ t