12-1239 (PLBG)P.O. BOX 1504. VOICE (760) 7=7ur�_
78-495 CALLE TAMPICO FAX (760) 77
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT . E
Date: 10'/ 17/ 12
Application Number: 12-00001239 Owner:
Property Address: 81565.TIBURON DR KENT MARSHALL
APN: 767-523-004- - .81565 TIBURON DRIVE
Application description: PLUMBING r LA QUINTA, CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL '
Application valuation: 2500
Contractor:
Applicant: Architect or Engineer: EDWARDS CONSTRUCTION INC,
51455 DESERT CLUB DRIVE a
LA QUINTA, CA 92253 4 ria:.
(760) 777-8202 WI i all
Lic. No..: 684857,
' • • Ci NAPE � JBPrta�
4 LICENSED CONTRACTOR'S DECLARATION , - WORKER'S COMPENSATION DECLARATION -
I hereby affirm under penalty of perjury at am licensed under provisions'of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations:
.Section 7000) of Division 3 of the Busi ss and Pr s i nalsCode, and my License 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: C27 License.: 684857 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
/�^q issued.
I Date: �:J 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 underpenaltyof perjury that I amexempt from the Contractor's State License Law for the Carrier GRANITE STATE Policy Number WC1914223
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to I certify that, in the Msas
the work for which this permit is issued, 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 maco ject to the workers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State �pp eethat, ie u c to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 7f the Labo it comply with thgse r 'sions.
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)•: Date: licant:
(_) 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 ISec. 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 SECTION3706!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 i . 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 exempt under 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
- • - performed under or following issuance of this permit.
Date: - Owner: 2. Any permit issued as a result of this application ecomes null and void if work is not commenced
within 180 days from date of issuance of su permit, or cessation 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 that the, abo i fo ' n i orrect. I agree to c mply with all
work for which this permit is issued (Sec: 3097, Civ. C.). ' city and c unty ordinances and state laws relating to b ilding ns r ion a d ereby authorize re esentatives
of this o my o enter upon the above-mentioned pro e - i s e ti pu o S.
Lender's Name: _
Signature (Applicant or Agent): '
Lender's Address: � \ e •
.r'
LQPERMIT
Application Number .. 12-00001239
Permit. . • PLUMBING
' Additional desc
Permit Fee 18.00_ Plan Check�Fee
4.50
Issue Date. Valuation . . .
. 0
Expiration Date 4/15/13,
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
1"GAS•LINE FROM METER TO.FIREPIT BY -,POOL
120 LN FT ON BACK PATIO 2010 CODES-. '
------------------- I
. . . . . BLDG STDS ADMIN.(SB1473)
1.00
Fee summary Charged Paid Credited
- - - ------ - - - - -- -
Due
- ----------- - - - ------ -
Permit Fee Total 18.00 .00 .00
Plan Check Total 4.50 .00 .00
4.50
Other Fee.Total "7.00 .00 .00'
1.00
Grand Total 23.50 .00 .001
23.50
- LQPERMIT
.
e,rt. #
:. Cit/ Of ' . a Quinta
Bulift er Safety Division
P.O Box 1504,78-495 Calle Tampico
La.Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
�Z
11
Project Address: 8 1 (I
Owner's Name:. Yl/i0tnrs
A. P. Number.
Address:
Legal Description:City,
ST, Zip: Lo ou k -a–, c, Z ZS3
Contractor.T" ,r— .
Telephone: .� • '
Project Description:
pp
Address: �l \ 6l O�
t.�
city, ST, Zip: 1 a �t)� �. '%� R Zzs; 3
MAW �o
Telephone: -.(c0•777 $ao�-
: v ✓� 01n.
City Lie. #:
State Li¢ # : g S%
Arch, Engr., Designer.
f
Address:
City. ST. Zip:
Telephone:
State Ltc. #:
Construction Type:. Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: # Stories:
Name of Contact Person: t J�
Telephone # of Contact Person: 6E) ,. l ��: �"
Estimated Value of Project: b
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Reed
TRACK9gG
PERMIT FFES
Plan Sets
Plan Cheek submitted
Item Amount
Strqctural Cales.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Cales.
. Called Contact Person
Putt Check Balance
Title 24 Calci.
Plana picked up
Construction
Flood plain plan
Plans resubmitted..
Mechanical
Grading plan
r! Review, ready for correctionsftssue
Electrical
Sobcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
&M,I,
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'^` Review; ready for eorrsctlonsAssue
Developer Impact Fee
Planning Approval
Called Contact Person
ALP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees