13-1640 (PLBG)-PA
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
13-00001640
Property Address:
51310 CALLE JACUMBA
APN:
770-166-004-21 -000000-
Application description:
PLUMBING
Property Zoning:
MEDIUM DENSITY RES
Application valuation:
1000
Applicant: Architect or Engineer:
------------------
LICENSED CONTRACTOR'S DECLARATION
4•
VOICE (760) 777-7012
FAX (760) 777-7011
BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
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 Bus: ess and Professionals Code, and my License is in full force and effect.
License Class: B / icense No.: 514045
Date:0- Contractor:
/d.Sn
UILDER DECLARATION
I hereby affirm under penalty y !ne
hafrom the Contractor's State License Law for the
following reason (Sec. 7031. , Bss anCode: Any city or county that requires a permit to
construct, alter, improve, demolisr repa, prior to its issuance, also requires the applicant for the
permit to file a signed statement the or 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).:
(_ 1 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.).
(_ 1 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 Name:
Lender's Address:
LQPERMIT
Date: 12/18/13
Owner:
KIP FYEE
(
Contractor: JPDL ZX "
FREDERICKS, JEFF R.
28 10TH COURT
z
HERMOSA BEACH, CA 90 54
(310) 918-7548 Czo�3
ITY OF LA QUINTA
Lic. No.: 514045 FINANCE DEPT.
-----------------------------------------------
WORKER'S COMPENSATION DECLARATION
I 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' 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 PT Policy Number EXEMPT
I certify that, in the performance of the work for which this permit is issued, I shall not employ any
person in any manner so as to become subject to the workers' compensation laws of California,
and agree that, if I should become subject to orkers' compensation provisions of Section
/t7 3700 of the Labor Code, all with with those provisions.
Dat✓e:!s-19-/ Applicant:
WARNING: FAILURE TO SECUR 0 S' coM SATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CR MINAL ENALTI 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 Director of Building and Safety 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 information is correct. I ree to comply with all
city and county ordinances and state laws relating to building construction, and here uthorize representatives
of this my to enter upon thea e -mentioned property f 'nspe ion purpo -
Date: i� __2e Signature (Applicant or Agent):
Application Number . . . . . 13-00001640
Permit . . . PLUMBING 2013
Additional desc . .
Permit Fee . . . . 11.92 Plan Check Fee
.00
Issue Date . . . . 'Valuation . . .
. 0
Expiration Date 6/16/14
Qty Unit Charge Per
Extension
1.00 11.9200 LS PLBG GAS SYS, 1-4 OUTLETS
11.92
----------------------------------------------------------------------------
Special Notes and Comments
SET PROPANE TANK AND RUN NEW GAS LINES
TO HOUSE (PER APPROVED PLANS). 2010
CALIFORNIA BUILDING CODES.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
PERMIT ISSUANCE M/P/E
90.57
PLAN CHECK, PLUMBING
23.83
Fee summary Charged Paid Credited
----------------------------------------
Due
-----------------
Permit Fee Total 11.92 .00 .00
11.92
Plan Check Total .00 .00 .00
.00
Other Fee Total 115.40 .00 .00
115.40
Grand Total 127.32 .00 .00
127.32
LQPERMIT
Bin #
City of La Quin to
Building &r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
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Project Address: , f 3)0 Cil-L%R J�<wM (a,4
Owner's Name: k/ P
A. P. Number:
Address: )
Legal Description:
City, ST, Zip: /
Contractor: ��7f� ��L(��� /c%''
Telephone: %
Address: 2"�- a�?'{' �.��
Project Description:
City, ST, Zip: o .s B4/1 4 o A S�
5"-Z-1 PAD
Telephone:
ur4iN 6P
State Lic. # : sj V S
City Lie. #:
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
hone
y.:.f:::::':•ii%vii:....%;':
Construction n T
o e: Occupancy:
type: ane Y:
State Lic. #
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:
#Stories:
#Units:
Telephone # of Contact Person:
Estimated Value of Project: & pa
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Coles.
Called Contact Person
Plan Check Balance
Title 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 correctionstissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
P
Gas out lets
A-- cook top
B— grill
C-- FAU
D-- dryer
E-- fire place
F-- water heater
Job address: 51310 calle jacumba
Job description:
Install propane tank and new gas lines.;
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