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11-0818 (PLBG)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: , 11-00000818 Property Address: 54837 SOUTHERN HILLS APN: 775 -101 -077 - Application description: PLUMBING Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 500 Applicant: �6 Tit!t 4 4 Q" '' Architect or Engineer: y� BUILDING & SAFETY DEPARTMENT BUILDING PERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760)'777-7153 Date: 8/01/11 Owner: COOPER RESIDENCE 54-837 SOUTHERN HILLS LA QUINTA, CA 92253 p t f a if Contractor: TOPMAN BUILDERS INC P:O. BOX 10202 %�} 9y s j PALM DESERT, CA 92255 1 — L013 •(760)497-7654 Lic. No.: 455121GITY.f=iA�GFNTA ------------------------------7-------------- LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm under penalty of perjury that I 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 ass: B C29 C53 License.No.: 455121 ' Date: Contractor: S \r - OW R•BU DECLARATION I hereby affirm under penalty of perjury that I am exempt from'thontractor'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.). , (_ 1 I, 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 contractors) 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 per is issued (Sec. 3097; Civ. C.). Lender's Name: Lender's Address: LQPERMIT -------------------------------------------- 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 _ 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 3700 of the Labor qg5e, I shall forthwith comply with those provisions. Date. Applicant: WARNING: AILURE TO SECURE WORKERSWOP40SATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIiS'AAQ 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 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 construction, and hereby authorize representatives of thi c unty to enter upon the above-mentioned pert -for inspection purposes. f -;Date + Signature (Applicant or Agentl^ ' f 4- , ' rte. � _ u. . . • t. Application Number 11.-00000818 Permit . . . . PLUMBING - Additional•desc " Permit Fee .18.00 -Plan Check'Fee. 4.50 .Issue Date c. -Date Valuation„ 0 Expiration 1/28/12 Qty' .Unit Charge Per Extension • ` BASE FEE 15.00 . t 1:00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS 3.00 Special Notes and Comments, , - INSTALL -80 'LN'FT OF 1" GAS LINE 40,000 • BTU FOR BBQ. 2010 CODES: _ ---------=---------------------------------------------------------.-------- Other Fees . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 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 LQPERMIT — . t �06 o .40 . 4 c 'cool .3 n 1 `� z r Bin # Qty of La Quinta Building 8z 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: Owner's Name:. dpi A. P. Number: Address: 3 Sou r wz-'.i Legal Description: City, ST, Zip: Contractor: Telephone: Address: 3 ^- Project Description:L�C FO City, ST, Zip:P Telephone: :. �w ► l 5 IJP k State Lic. # .. City Lic. f: Arch., Engr.,. Designer: Address: City., ST, Zip: Telephone: :$,.r;:'Lv n'::•!?b::vC.ti\,/++4 •:2mi'p:•rK',7'Av}`C. SC: $r%.j� y4$31�n'3.3j`n'4:i>{r¢$??$$$�: i�:.7.•??1^: Construction Type: Occupancy: State Lic. #:is Project a ' J type one): New Addn Alter Repair Demo Name of Contact Person: ©t y Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: Estimated Value of Project: 150(!>' 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 Cates. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 200 Review, ready for correctionsrissue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked'up S.M.L 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