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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—