07-1436 (PLBG)P.O. BOX 1504 ;^� VOICE760 777-7012•
( )
78-495 CALLE TAMPICO FAX (760) 777-7011
LA,QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS -(760) 777-7153
BUILDING PERMIT
Date_: 5/14/07 -
Application Number:` 07-00001436 Owner:
Property Address:, 519,60 AVENIDA VALLEJO APRIL SCOTT
APN: -� •773'-172-011-14 000000-41775 WARD DRIVE
Application description_: PLUMBING PALM DESERT,' CA 92211
Property Zoning: COVE *RESIDENTIAL s.
Application -valuation: 3000
-----------------
Contractor: D
Applicant: " Architect or Engineer: - ALMS UNDERGROUND CONST C., ,
38703; VISTA DRIVE MAY 14 2OOl
CATHEDRAL` CITY, ;CA 922
I(760)324-1911'
Lic- No.: 482180 CITY OF LAQUINTA
FINANCE DEPT,
--------------------- ----------'---- -------------------- -----------------
n+. -. -
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 - 1 hereby affirm under penalty of perjury one of the following declaration -
-� Section 7000)of Division 3 of the B siness 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 Class: C21 C42 .r 'censeNo. 482180 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is .
issued." : ; • ,�'
r - at :y14'n/0L 0 ontractor: _ - r - 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 thispermitis 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 CALIFORNIA INS Policy Number 460093580103
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' compensationlaws 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 subject 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 3700 of the Labor e, I shall fort 'th co� =hovisions.that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by'7 any applicant for a permit subjects the applicant to a civil penalty of not, more than'five hundred dollars (5500).: Dater // A nt:
owner of the property, or my employees with wages as their•sole compensation, will do the work, and a '
the structure is.not intended or offered for sale (Sec. .7044, Business and Professions Code: The " WARNING: RE TO SECURE WORKERS OMPENSATION 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 - -
r„ and who does the work himself or herself through his orher own employees, provided that the .DOLLARS (5100,000).. 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
1 _ 1 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: + T -
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 A 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 becomes null and void if work is not commenced
a 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.
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 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 building construction, and hereby authorize representatives.
• _ - - - - of this county to enter upon the above-mentioned pro for inspect' purposes.
Lender's Name: `� , - b - 1 ~
• rjV 16► M Date• n Signa a (Applicant or Agent): F
' Lender's Address: /
LQPERMIT
Application Number 07=0.0'001436
-Permit :' PLUMBING°SEWER•-.-,
Additional desc '.
t
Permit Fee 30:00
Plan Check
Fee
:00
Issue Date
Valuation
3000
Expiration Date. 11/10/07
- ' Qty Unit - Charge Per.: ' ..
Extension
BASE FEE
30.0-0
Special Notes.'and Comments '
SEPTIC ABANDON,, SEWER'CONNECT'
Fee summary,,,:: Charged Paid
;. Credited
Due
Permit Fee Total 30.00
.00
.00
30.00
Plan Check Total :00
00
.00
.00 -
Grand.Total' 30.00
.-00
.00
30.00
LQPERMIT
City, of to Quinb
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Building tai Safety' Division' '
, . P.O. Box 1504,-78=495�Calle Tampico
Permit'# . '
La Quinta, CA 92253 -`(760)777=7012
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Building Permit Application and -Tracking Sheet ;.
Project Address:'!j 1960 A ve. um I V e ' j
Owner's Name:: i 'J t
A. P. Number: y '
Address: / 7 5 Wd re/
g P ,.
Legal Description:,
'
City, ST, Zip:.; %�a:1 1(
Contractor: Al V,;, s 0 ci e � d C " �
ruav, ov,s.
Telephone:
P 321 — �(j'S /
Address:, , 3 87 03 s%.._ r' A
Project Description:
pV)
City, ST, Zip: Co fined r� l C �� i ► 9 Z Z 3
$ I�✓ Gr' G o >7 r\ zz!0 '
Telephone: 3
City Lia #: 6"
State Lic. # L/ 8"` / $ a'
Arch., Engr., Designer: . +.
Address:.
City, ST, Zip:
,
Telephone:.
Construction Type: Occupancy:
Project.type (circle one): New ,v Add'n. Alter Repair Demo
State Lic: #: r r r
Name of Contact Person: , ti ms -
Sq. FL
#Stories: - j `
#Units:
.Telephone # of Contact Person: S 70 � % ,5 / U ,.r
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
�. = TRACKING •
► PERMIT FEES
Plan Sets ,
Plan Check submitted "
;
Item
Amount '
Structural Coles.
_
Reviewed,•ready for corrections
Plan CheckDeposit
;
Truss Calcs.
Called Contact Person
,`
Plan Check Balance
Energy Coles.
Plans picked up
Construction
Flood plain plan'.
Plans resubmitted
Mechanical
Grading. plan . ,'
2°" Review, ready for'correctionsdssue
Eleetri'
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up.
S.M.I.
H.O.A. Approval
(
Plans resubmitted `
k '
Grading
IN HOUSE:-
* wh
?� Review, ready for correctionsrssue
Developer Impact Fee
Planning Approval
Called Contact Person'
Pub: Wks. Appr'
Date of permit issue
w.
'
School Fees
'
Total Permit Fees
SANCO - 2502 Morongo Trail
PUMPING SERVICE Palm Springs, CA 92264
NO. 01279
(760) 327-8859
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