BPLB2015-0096Applicant:
RESCUE ROOTER
OUTSIDE CITY LIMITS
LA QUINTA, CA 92253
LICENSED CONTRACTOR'S DECLARATION -
I hereby affirm under penalty of perjury that I am licensed under provis' �of Chapte
9 (commencing with Section 7000) of Division 3 of the Busin an r'ofessions�
and my License i in full force and effect.
License Class: License No.: :LIC -0111366
Date: '3 S 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 Divisio
of the Business and Professions Code) or that he or she is exempt therefrom and they
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.).
( ) I, 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 co6struction lending agency for
the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's
Lender's
Contractor:
RESCUE ROOTER
OUTSIDE CITY LIMITS
LA QUINTA, CA 92253
(901)271-9700
Llc. No.: :LIC -0111366
WORKER'S COMPENSATION DECLARATION .
yhereby 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.
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 and policy number are:
Carrier: _ Policy Number:
_ I certify that in the performance of the work for which this permit is i ued, I
shall not employ any person in any manner so as to become subject he wo ers'
compensation laws of California, and agree that, if I should bec a subje o the
workers' compensation provisions of Section 3700 of the r Cod all fo h
2mply with hos pr(ovvisions.
Date: 8 (� I J Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($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.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT: Application is hereby made to the Building Official for a permit subject to
the conditions and restrictions set forth on this 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 application , 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.
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 informatio corre
I agree to comply with all city and county ordinances and state laws rela to b ' ding
construction, and hereby authorize representatives of this city to en poove
mentioned rope y finspection purposes.
pte: V ` / S Signature (Applicant or Agent)
-a�
78-495 CALLE TAMPICO
4
VOICE (760) 777-7125
LA QUINTA, CALIFORNIA 92253
FAX (760) 777-7011
COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 8/13/2015
Application Number:
BPLB2015-0096
Owner:
Property Address:
78193 INDIGO DR
GAYLE LONG
APN:
604021041
78193 INDIGO DRIVE
Application Description:
GAYLE LONG WATER SERVICE METER TO BUILDING
LA QUINTA, CA 92253
Property Zoning:
Application Valuation:
$9,100.00
Applicant:
RESCUE ROOTER
OUTSIDE CITY LIMITS
LA QUINTA, CA 92253
LICENSED CONTRACTOR'S DECLARATION -
I hereby affirm under penalty of perjury that I am licensed under provis' �of Chapte
9 (commencing with Section 7000) of Division 3 of the Busin an r'ofessions�
and my License i in full force and effect.
License Class: License No.: :LIC -0111366
Date: '3 S 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 Divisio
of the Business and Professions Code) or that he or she is exempt therefrom and they
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.).
( ) I, 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 co6struction lending agency for
the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's
Lender's
Contractor:
RESCUE ROOTER
OUTSIDE CITY LIMITS
LA QUINTA, CA 92253
(901)271-9700
Llc. No.: :LIC -0111366
WORKER'S COMPENSATION DECLARATION .
yhereby 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.
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 and policy number are:
Carrier: _ Policy Number:
_ I certify that in the performance of the work for which this permit is i ued, I
shall not employ any person in any manner so as to become subject he wo ers'
compensation laws of California, and agree that, if I should bec a subje o the
workers' compensation provisions of Section 3700 of the r Cod all fo h
2mply with hos pr(ovvisions.
Date: 8 (� I J Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($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.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT: Application is hereby made to the Building Official for a permit subject to
the conditions and restrictions set forth on this 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 application , 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.
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 informatio corre
I agree to comply with all city and county ordinances and state laws rela to b ' ding
construction, and hereby authorize representatives of this city to en poove
mentioned rope y finspection purposes.
pte: V ` / S Signature (Applicant or Agent)
FINANCIAL INFORMATION
DESCRIPTION ACCOUNT `
QTY AMOUNT PAID
PAID DATE
BSAS SB1473 FEE 101-0000-20306
0 $1.00 $0.00
PAID BY METHOD
RECEIPT # CHECK #
CLTD BY
Total Paid for BUILDING'STANDARDS ADMINISTRATION' BSA $1.00 $0.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid forPERMIT ISSUANCE: $91.85 $0.00
DESCRIPTION
ACCOUNT'
QTY
AMOUNT
PAID
PAID DATE
WATER SYSTEM INST/ALT/REP
101-0000-42401
0
$12.09
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT.
QTY
.AMOUNT
-PAID
PAID DATE
WATER SYSTEM INST/ALT/REP PC
101-0000-42600
0
$12.09
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid for PLUMBING FEES: $24.18 $0.00
TOTALS:••
Description: GAYLE LONG WATER SERVICE METER TO BUILDING
Type: PLUMBING
Subtype:
Status: UNDER REVIEW
Applied: 8/13/2015 PJU
Approved:
Parcel No: 604021041 Site Address: 78193 INDIGO DR,CA
Subdivision: TR 18915
Block: Lot: 4
Issued:
Lot Sq Ft: 0
Building Sq Ft: 0
Zoning:
Finaled:
Valuation: $9,100.00
Occupancy Type:
Construction Type:
Expired:
No. Buildings: 0
No. Stories: 0
No. Unites: 0
Details: WATER SERVICE REPLACEMENT 72 LN FT X 1 "COPPER PIPING. METER TO BUILDING. 2013 CALIFONIA PLUMBING CODE.APPROVED
JAKE FUSON
ADDITIONAL SITES
CHRONOLOGY
CONDITIONS
DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY CLTD
BY
BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00
Total Paid forBUILDING STANDARDS ADMINISTRATION $1.00 $0.00
BSA:
Printed: Thursday, August 13, 2015 12:30:25 PM 1 of 2 J
SYSTEMS
Permit Details PERMIT NUMBER'
BPLB
Cit of La Quin ta... „,...241f57: -0Q§, Vis,
y�
PARENT PROJECTS
Printed: Thursday, August 13, 2015 12:30:25 PM 2 of 2 C
SYSTEMS
CLTD
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID BY
BY .
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
Total•Paid for PERMIT ISSUANCE: $91.85 $0.00
WATER SYSTEM
101-0000-42401
0
$12.09
$0.00
INST/ALT/REP
WATER SYSTEM
101-0000-42600
0
$12.09
$0.00
INST/ALT/REP PC
Total Paid for PLUMBING FEES: $24.18 $0.00
TOTALS:00
PARENT PROJECTS
Printed: Thursday, August 13, 2015 12:30:25 PM 2 of 2 C
SYSTEMS
Bill #
City of La Quinta
Building u Safety Division
P.O. Box 1504,78-495 Calle Tampico
La.Quinta, CA 92253.:(760) 777-7012
Building Permit Application and Tracking Sheet
Perinit #
Project Address: -76
q3
Owner's Name:. ALI 1. E
A P. Number.
Address: p D 2
Legal Description: 4 W.--(-2- Z I
City, ST, Zip: A aza
Contractor: (Z
Telephone: h,>• ` f s ;: '
Address: i S"2LD4 L 1 NDc.N Sr
Project Description:
City, ST, Zip: LJ14- Zed �i
Telephone:
City Lic.
State Lie. # S
Arch., Engr., Designer.
Address:
City., ST, Zip:
Telephone:
.fiir�
State Lic. #: '.<,w "A' » r :,
Name of Contact Person:
Construction Type:. Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: #Stories:
# Unity:
Telephone # of Contact Person:
Estimated Value of Project: D (�
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Pian Cheek submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechartical
Grading plan
2°' Review, ready for correctionsfissue
Electrical
Subcoatactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
SALL
H.O.A. Approval
Plans resubmitted
Grading
IPM HOUSE:-
'^' Review, ready for correetionslissue
Developer Impact Fee
Planning Approval.
Called Contact Person
A.I.P.P'.
Pub. Wks. Appr
Date of permit issue
School Fees
I
Total Permit Fees
(�o)C�o p�
(�%� ► E2 S�iL�/i�` �cPL- EN
i
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DAT 3
IF—