BPLB2017-009578-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-71 ZS
FAX (760) 777-7011
INSPECTIONS (760) 777-71.33
Date: 8/1/20.17
Application Number:
BPLB2017-0095
Owner:
Property Address:
53390 AVENIDA VALLEJO
STEPHANIE RAINWATER
APN:
774083008
53396 AVENIDA VALLEJO'
Application Description:
RAINWATER/ABANDON SEPTIC/CONNECT TO SEWER.
LA QUINTA, CA 92253
Property Zoning:
Application Valuation:
$2,700.00
Applicant:
Contractor:
LA QUINTA COVE PLUMBING INC
LA QUINTA COVE PLUMBING INC
PO BOX 1207
PO BOX 1207
LA QUINTA, CA 92247
LA QUINTA, CA 92.247
(760)777-9916
Llc. No.: 910274
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LICENSED CONTRACTOR'S 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 Professions Code, and
my License is in full force and effect.
License Class: C36 License No.: 910274
Date:
Contractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor'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.).
( 11, 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 contractor(s) licensed pursuant to the
Contractors' State License Law.).
(� 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 permit is issued (Sec. 3097, Civ. C.).
Lender's Na
WORKER'S COMPENSATION DECLARATION
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'
)mpensation, as provided for by Section 3700 of the Labor Code, for the performanc2
F the work for which this permit is issued:
r _ I have and will maintain workers' compensation insurance, as required by
action 3700 of the Labor Code, for the performance of the work for which this permit is
sued: My workers' compensation insurance carrier and policy number are:
arrier: FALLS LAKE FIRE AND CASUALTY COMPANY Policy Number: FLA001054
_ I certify that in the performance of the work for which this.permit is issued, I
call not employ any person in any manner so as to become subject to the workers'
)mpensabon laws of California, and agree that, if I should become subject to the .
orkers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
)mply with those provisions.
ate: Applicant:
IARNING: FAILURE -TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUI.,
ND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
NE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF -
OMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
ITEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
APORTANT: Application is hereby made to the Building Official for a permit subject to
ie conditions and restrictions set forth on this application.
1.* Each person upon whose behalf this application is made, each person at whose
tquest and for whose benefit work is performed under or pursuant to any permit issued
s a result of this application ; the owner, and the applicant, each agrees to, and shall]
efend, indemnify and hold harmless the City of La Quinta, its officers, agents, and' .
,nployees for any act or omission related to the work being performed under or
)Ilowing issuance of this permit.
2. Any -permit issued as a result of this application becomes null and void if work is rot
)mmenced within 180 days from date of issuance of such permit, or cessation of woo k
)r 180 days will subject permit to cancellation. .
:ertify that I have read this application and state that the above information is correct.
agree to comply with all city and county ordinances and state laws relating to building
instruction, and hereby authorize representatives of this city to enter upon the above-
ientioned property for inspection purposes.
Lender's Address: Date: Signature (Applicant or Agent):
Date: 8/1/2x17 -
Application Number:.
BPLB2017-0095:
Owner:
Property Address:
53390 AVENIDA`VAtLUb
STEPHANIE RAINWATER
APN:
774083008
53390 AVENIDA VALLEJO
Application Description:
RAINWATER/ABANDON SEPTIC/CONNECT TO SEWER
LA QUINTA, CA 92253
- Property Zoning:
Application Valuation:
$2,700.00
Applicant:
Contractor:
LA QUINTA COVE PLUMBING
INC
LA QUINTA COVE PLUMBING INC,
PO BOX 1207
PO BOX 1207'
LA QUINTA,•CA 92247
LA QUINTA, CA 92247
(760)777-9916
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Llc. No.: 910274
Detail:
P
M1
411 FINANCIAL,",INFORMATION f
DESCRIPTION.. .. ACCOUNT •
QTY
•AMOUNT
BSAS SB1473 FEE 101-0000-20306
0
$1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
Credit Card Fee
101-0000-43505
0
$2.62
Total Paid for Credit Card Fee: $2.62
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PERMIT ISSUANCE
101-0000-42404
0
$96.27
Total Paid for PERMIT ISSUANCE: $96.27
DESCRIPTION
ACCOUNT
QTY
AMOUNT
SEWER CONNECTION/SEPTIC ABANDON
101-0000-42401
0
$25.33
DESCRIPTION
ACCOUNT
QTY
AMOUNT
SEWER CONNECTION/SEPTIC ABANDON PC
101-0000-42600 I.
0
$17.73
Total Paid for PLUMBING FEES: $43.06
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY. ENHANCEMENT FEE: $5.00
u