06-1363 (PLBG)4.
P.O.'BOX 1504 W
I{1��
O VOICE (760) 777-701'2
;.478-495 CALLE.TAMPICO _ FAX (760) 777-7011
LA QUINTA,. CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT _ INSPECTIONS (760) 777-7153
a BUILDING"PERMIT
Date: 4/04/06
Application Number: 05`00001363 ° `Owner:
Property Address: 51020 A N DA',VALLEJO GARCIA ALBERT F.
APN: 773-063-023-- - 51040 AVENIDA VALLEJO
Application description: PLUMBING LA QUINTA, CA 92253
Property Zoning: COVE RESIDENTIAL .
Application valuation: 200 D a
Contractor: p c
Applicant: Architect or Engineer: SOUTHWEST PLUMBING, INC., APR. 0 4 2006
P.O. BOX 2006 r
0. .w THOUSAND PALMS, CA 92276
(760)343-2345' CIOF QUINTA
FINANCE DEPT
Lic. No.: 731805 "
-- - - - - - - - - - - - - - - - - -- - - - - —
LICENSED CONTRACTOR`S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I 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 Business and Professionals Code, 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 CI a s: C36 _ Licenso.: 731805 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
ate:. ontractor: 7have 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:
hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier STATE FUND - Policy Number FN332024 - 01
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to _ I certify that, in the performance of 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 manner so as to become subject 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 and agree that, if I should become subjeftthe workers' compensation provisions ofSectionLicense Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3 bo of the Labor Code all forthwitply wit those provisions. '
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).: -Era te: W Applica '
(_) I, as owner of the property, or my employees with wages as their sole compensation, .will do the work, and 100,
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The WARNING: FAIL O 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 _ I 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 Piofessions 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 1 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 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 -
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 above information is correct. I agree to comply with -all
work for which this permit is issued (Sec. 3097, Civ. C.). city and county.ordinances and state laws relating to bu'I'd construction, and here y authorize representatives
of th�counjvter uponth •above-mentioned propert f r inspection poses Lender's Name: S' ature (Applicant or Agent): -
Lender's Address: � -
LQPERMTT -
Application Number 06-00001363
Permit . . . PLUMBING
Additional desc .
Permit Fee 30.00'. Plan Check
.Fee
7:50
Issue Date Valuation
0
Expiration Date 10/01/06
Qty Unit Charge Per
Extension
BASE FEE
15.00
" - 1.00 15.0000 EA PLB GAS METER
15.00
----------------------------------------------------------------------------
Special Notes and Comments
CONVERSION FROM PROPANE TO NATURAL GAS
' Fee summary Charged Paid Credited
Due.
-Permit Fee Totals 3'0.00 .00 -.00
30.00
Plan Check Total. 7.50 00,
.00
7.50
Grand Total 37.50_ 00
.00
37.50
LQPERMIT
Bin #
.City of La Quinta
Building a Safety Division
Box 1504, 787495 Calle Tampico
La Quinta, CA 92253,- (760) 777-7012
<Building Permit Application and Tracking Sheet '
Permit Of e'�P.O.
Project Address:' I _0a,0
Owner's Name:
A P. Number:
Address:
v
Legal Description:.
Contractor: /A) C
City, ST, Zip:
Telephone:
Address:
Project Description:
City, ST, Zip:
V v o
Telephone:
State Lic. # : 0,5 CityLic. #:
Arch., Engr., Designer..
tJ
Address:
City, ST, Zip:
Telephone:.
State Lic. #:
Name of Contact Person:
f'
Construction -Type: / o ccupancy:C.
Project type (circle 9ne): New Add'n Alter Repair Demo
Sq. Ft.:
# Stories:
# Units: .
Telephone # of Contact Person: p — . Q ��
Estimated Value o�Project: 0
APPLICANT: DO NOT WRITE BELOW THIS LINE"i
#
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
Energy Calcs.
Plans picked up
Construction,
Flood plain plan
Plans resubmitted
Mechanical
Grading, plan ,
2"' Review, ready for correctionsrissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant DeedPlans
picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'rd 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