10-1030 (PLBG)TAtyl 4
P.O. BOX 1504 ^' VOICE (760) 777-7012
718-495 CALLE'TAMPICO s FAX (760) 777-7011
LA QUINTA; CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT = -
_ Date: 10/04/10
Application Number: r10=00001030._:7 Owner: /�Jj' j
Property Address: ti51775�RVENIDA VALLEJO PINGATORE SIGRID R' l�/, `�"
APN: 773-171-013-1 -000,000- 51775 AVENIDA VALLEJO '/�.) n
t Application description: PLUMBING LA QUINTA, CA 92253
Property Zoning': COVE RESIDENTIAL < (760) 799-5398 "� r
Application.. valuation:-. 3000 • ! 4 0� � C ��d .
` Contractor: - i:� , •_:';,; •itf ; \!! .
A lic nt: Architect or En ineer: HAMMER PUMPING INC " ``_�� .'Y"'>• ��'`'
PP -
/!(^+ i P 0 BOXCATHEDRAL
2448
CATHEDRAL CITY,` CA 92235
(760)360-7448 t
Lic. No: 661018
• 1 LICENSED TO S DECLAA TION- . 7 WORKER'S COMPENSATION DECLARATION `
I hereby affirm under penalt . -perjury that I' am licens d under 'ons of C apter 9 (commencing with ' I hereby affirm under penalty of perjury one of the following declarations: -
Section 7000).of ivisio .of the Business and Profe ionals ode, an Lic nse is in full force and effect. r _- I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided -
License Cla C 2 ,cense No:: 66 18 r - - - for by Section 3700 of the Labor Code, for the performance of the work for which this permit is, .
1 - - • - - issued. - ✓,
Date ,� �S ontractor: ' - _ 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
• - "'�` 1 - OWNER -BUILDER DECLARATION } - insurance carrier and policy number are: "
♦I hereby affirm under penalty'of perjurythat I am exempt from the Contractor's State license Law for the` Carrier SELF - INSURED - Policy Num -2246
' - following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to I certify that, in the-per4o ance of the work fo which this.per 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 4 person in any,manner so as become sub' ct to the worker ensation 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 beco a subj to the workers' c pensat rovisions of Section
License Law (Chapter 9 (commencing with Section. 7000) of Division 3 of the Business and Professions Code) or 3700 of the Labor Code, I sh or ith comply with th a provisions.
�• that•h'e or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031 4,.5 by • -
16
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: Date: A 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 (Sec. 7044, Business and Professions Code: The WARNING: FAILURE TO 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 IS 100,000).. IN ADDITIONTOTHE 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 e _ ' 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
• (_) 1, 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. ' M
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:): r '� - - - whose benefit work is performed under or -pursuant to any permit issued as a result of this application, ,
( ) tam exempt under Sec ,. B.&P.C. for this reason - - - the owner, and the applicant, eachagreesto, and shall defend, indemnify and hold.harmless the City -
" of La Quinta, its officers, agents and employees for any act or omission related tothe 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 issu uch permit, or'cessation of work for -180 days will subject `
CONSTRUCTION LENDING AGENCY - - a - - - permit to cancellation. - - - • " , `
1 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 d state that the ab a 'nformati is rect I agree to comply with all -
work for which this permit is issued (Sec. .3097., Civ. C.I. city 'and county ordinances and state la s relating to building o structi , and her thorize representatives ^
• • - - - . • ofthis county o enter upon the'above- entioned prope y f i spe n purposes.
Lender's Name: - -
- . • '' Date: t',S .Signature (Applica t or. Agent): r
• Lender's Address: - • -
LQPERMIT " f
Application Number.
10-00.001030
Permit
PLUMBING SEWER
Additional, desc ..-
' Permit Fee
30'. 00 Plan Check.
Fee.':
-Issue Date
Valuation
3000 ;
Expiration Date
4/02/11
Qty Charge Per
.'Extension
,Unit
BASE -FEE,
30.00:.
Special ;Notes .and Comments.
SEPTICABANDONMENT
/'SEWER HOOKUP: "
-------------------------------
Othe.r.Fees.
BLDG STDS ADMIN (SB1473).
,'
.1.00
Fee summary -Charged
Paid Credited
Due
}Permit.Fee;.Total.
30:O.o '.00
00
30:0'0..
Plan Check Total
00 .00.
:00
.00 '
Other Fee Total
1.0,0'' .00'
00
1.00
' `•; .Grand Total
31..00 .00
00
31:00
.' LQPERMIT ^., - �,...
.•
.. _ - •.
Bin #
Qty of LQ QuintQ
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 #
Project Address: E� r' A( -,L E3d
Owner's Name: I C e— 1 iii
A. P. Number:
Address: S( 11I NJII V (a, L < Ea
Legal Descrip 'on:
Contractor: ��
Address:
U r.rC
City, ST, Zip:
.... F.:.. ,
Telephone:'
Tel -46-() -4-9 `i 5378
Project Description:
City, ST, Zip: �C_
Lam. 'i Qli Li t✓1
Telephone% 40-5 q 4?,
State Lic. # : ) $ City Lic. #;
Arch., Engr., Designer.
Address:
City., ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person:
;;•,<�;,;,.�.,�:o
U ,• ; ;fit ; jw!
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.:
#Stories:
#Units:
Telephone # of Contact Person:
Estimated Value of Project: Qt�Q
APPLICANT: DO NOT WRITE BELOW THIS LINE
q
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cafes.
Called Contact Person
Plan Check Balance
Title 24 Cafes.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2°d 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:-
''d 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
r +e• _tib t. .. -s +. .. .. _ .`. , •
FROM.: PURRFECT'POOLS&CONSTRUCTION=`• 1 FAX, NO. 76036098294 Nov.' 10`•1999'03:47PM P5''
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PAD 1.1 5.10'
d P A" N 2 B ) 20' 4.
4 100.00
CITY OF A,RE..
a LA QUINTq. � IreTlola FEE OF a30
BUIL V�it� BE CHARGED IF THE
DING, & SAFETY'
°' p E APPROVED y
'AP _. LAMS AND JOB CARD ARE NOT
,. PROVED,, THE -SITE' FOR; A` MEMO
FOR CONSTRUCTION INSPECTtOi�.
DATE BY y •,
.19
s P SCALE t/16"=�.r'�Q..
ej
ELL�%r .VISTA ,..,,PHASE, 5;'
M-S OCI 1'C� l
+ Mfcuwnd Teams for Covtp�e Projetu '_ '. fL -i a '" , j
_4
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
y
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation „
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
steel
POOLS - SPAS
Set Backs
Footings
Electric Bond
Main Drain
_
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster _
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping -
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
I
i
'
LICENSED CONTRACTOR DECLARATION
I 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 # Lic. Class Exp. Date
,Date Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 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 & Professionals Code).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
( ) I am exempt under Section B&P.C. for this reason
Date Signature of Owner
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.
O 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 & policy no. are:
Carrier Policy No.
(This section need not be completed if the permit valuation is for $100.00 or less).
( ) 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
Code, I shall forthwith comply with those provisions.
Date: Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $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.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
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 applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
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 State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
96nature (Owner/Agent) Date
BUILDING PERMIT PERMIT#
DATE I VALUATION LOT TRACT
JOB SITE APN
ADDRESS `
OWNER CONTRACTOR / DESIGNER / ENGINEER
USE OF PERMIT