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09-1184 (PLBG)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 09-00001184 „ Property Address: 52465 AVENIDA VALLEJO APN: 773 -262 -022 -11 -000000 - Application description: PLUMBING Property rZoning: COVE RESIDENTIAL Application valuation: 1700 ApplI ant: Architect or Engineer: .4 44 Qumt BUILDING & SAFETY DEPARTMENT - BUILDING PERMIT Owner: VAGELS VLADI 52-465 AVENIDA VALLEJO LA QUINTA,, CA 92253 (760)289-6873 Contractor: SHECHINAH DEVELOPMENT 41830 LIMA HALL ROAD BERMUDA DUNES, CA 922 (760)200-7558 Lic. No.: 924873 VOICE (760) 777-1012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 11/16/09 U 170Y 1 6 2009 t _ LQPERAIIT CITY OFI-A4UiN-- TA ----------------------------------------=------ ------------------------oo,,--„_F,_4��''st�!�.J'I:-- ---- 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: s' 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 Class: B License No.: 924873 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. .,/ Dater Contractor: . -r CAlpA��,� - _ 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 under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier STATE FUND Policy Number 2381212809 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 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 Code, I shall forthwith com with 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).: Date: / Applicant: 1 _ 1 1, 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 SECURE WORK MPENSATION 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 NA TIES 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, 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 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, I _ 1 I am exempt under Sec. BAP.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 180days 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 building construction, and hereby autho ze representatives . of this county to enter upon the above-mentioned propert inspection purposes/ Lender's Name: - - Date: u(!b(og Signature (Applicant or Agent): ' Lender's Address: LQPERAIIT Application Number . . . . . 09700001184 Permit . . . PLUMBING Additional desc . Permit Fee' 18.00 Plan Check Fee 4.50 Issue Date Valuation . . . . 0 Expiration Date 5/15/10 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 INSTALL 1 1/4 GASLINE APPROXIMATELY 881IN LENGTH APPROVED BY B.H. ----------------- 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 i vIvr, F . 7 �. t� f, - ,. #" .i • " `, t . -'+� r a .i I +: s - .:�' s -7 • ..i � �;�Y i ? _ :�' - � .tr , `•t • f M, ` { , (,. �-+♦' �,f.« ��, w, , 3 of ,^ r / • t !! + 1" ref' a •"�T x i.g ,..� 7.: . t:. . 'k `8 •i' �k, .�� �' t5.+ � .'t' ti, .:`ilS� +•,�•.r+.r t�ir.� :a+�w� II''�.-+ 1' .:4s'. "" ;. 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SUITE A PALM DE E�"R, CA 92211 /!I /0T+/19999 erV 4-77,J f' ,,,,7��L;;ryt > �.;.r ; is`.s} . � t - .i'i ..�.•. w :r, •-1t{�{ _ �' ' d t�~�N C .fir � ^�• in }` ', _ i + �p . '?,•iia 7 t 4.' Bin # Qty Of La QLuinta 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-� ....L VA Owner's Name,_04 ' A. P. Number: Address�c� - G ` Legal Description: Contractor:# C City, ST, Zip: L Telephone: O — ,2k Address: S'�_ .� Project Description: t S City, ST, Zip: f� ele h ne: Telephone: 0 P O State Lic. # : City Lic. #.- Arch., Engr., Designer: Address: City, ST, Zip: Telephone: Co Construction Type: e: P Y P Occu anc Y: State Lic. #: e circle one : New Add'n Alter Repair Demo Name of Contact Person: Sq. Ft.: #Stories: #Units: Telephone # of Contact Person: Estimated Value of Project: 0 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 Cales. Called Contact Person Plan Check Balance Titte 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2" 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:- '`" 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