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BWFE2015-025378-495 CALLE TAMPICO U LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT Application Number: Property Address: APN: Application Description: Property Zoning: Application Valuation: BWFE2015-0253 51420 CALLE JACUMBA 770166024 JACKSON RESIDENCE BI $500.00 Applicant: GARY & SON'S LEAK DETECTORS IN 67621 CACTUS APPLE DRIVE DESERT HOT SPRINGS, CA 92241 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under rovisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business a d Professions Code, and my License is in full force and effect. License Class: C53 License No.: 866518 _Date: 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).: ( ) 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 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.). (� 1, 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 Lender's Add VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 7/30/2015 Owner: RICK JACKSON 51420 CALLE 14CUMBA LA QUINTA, CA 92253 Contractor: GARY & SON'S LEAK DETECTORS IN 67621 CACTUS APPLE DRIVE DESERT HOT SPRINGS, CA 92241 (760)251-8945 Llc. No.: 866518 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:_ Policy Number: _ I certify that in the performance of the work forwhich this p rmit is issued, shall not employ any person in any manner so as to become subject to he it compensation laws of California, and agree that, ifA should becomes jest to the workers' compensation provisions of Section 3706f the Labor Cod , I shall forthwith comply with those provisions. L11V/ Date: U'( C Applic WARNING: FAILURE TO SECURE WORKERS' COMPENSAMION 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 an act or omission related to the work being Y g 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. ri I certify that I have read this application and state that the above inf �ination is c I agree to comply with all city and county ordinances and state law elating to b construction, and hereby authorize representatives of thiscit o e er upon the mentioned property for inspection purposes. / J Date:Signature (Applicant or Agent): DESCRIPTION FINANCIAL INFORMATION 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 WALL/FENCE - FIRST 100 LF 101-0000-42404 0 $47.86 $47.86 7/30/15 PAID BY METHOD RECEIPT # CHECK # CLTD BY GARY & SON'S LEAK DETECTORS IN CHECK R8108 4737 EVA DESCRIPTION - ACCOUNT QTY AMOUNT PAID PAID DATE WALL/FENCE - FIRST 100 LF PC 101-0000-42600 0 $60.91 $60.91 7/30/15 PAID BY METHOD RECEIPT # CHECK # CLTD BY GARY & SON'S, LEAK DETECTORS IN CHECK R8108 4737 EVA Total Paid for FENCE OR FREESTANDING WALL $108.77 $108.77 TOTALS:0• Description: JACKSON RESIDENCE BLOCK WALL TO COVER EQUIPMENT Type: WALL/FENCE Subtype: Status: UNDER REVIEW Applied: 7/30/2015 EVA Approved: Parcel No: 770166024 Site Address: 51420 CALLE 1ACUMBA LA QUINTA,CA 92253 Subdivision: DESERT CLUB TR UNIT 2 Block:. 2 Lot: 16 Issued: Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $0.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0. Details: INSTALL 13 LF OF BLOCK WALL TO COVER EQUIPMENT PER CITY STANDARD DRAWING ESCRIPTIO N ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY CLTD BY WALL/FENCE - FIRST 101-0000-42404 0 $47.86 $47.86 7/30/15 R8108 4737 CHECK GARY & SON'S LEAK EVA 100 LF DETECTORS IN Printed: Thursday, July 30, 2015 1:19:13 PM 1 of 2 C SYS7EAnS DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY CLTD BY WALL/FENCE - FIRST COMPLETED DATE RESULT REMARKS NOTES BOND BEAM BLD GARY & SON'S LEAK 101-0000-42600 0 $60.91 $60.91 7/30/15 R8108 4737 CHECK EVA 100 LF PC BLD DETECTORS IN Total Paid for FENCE OR FREESTANDING WALL $108.77 $108.77 TOTALS:0:$108.77 PARENT PROJECTS ATTACHMENTS Printed: Thursday, July 30, 2015 1:19:13 PM 2 of 2 C SYS7ENiS INSPECTIONS SEQID INSPECTION TYPE INSPECTOR SCHEDULED DATE COMPLETED DATE RESULT REMARKS NOTES BOND BEAM BLD FINAL" BLD FOOTINGS BLD PARENT PROJECTS ATTACHMENTS Printed: Thursday, July 30, 2015 1:19:13 PM 2 of 2 C SYS7ENiS ClCITY OF LA QUINTA BUILDING & SAFETY DEPT. BU APPROVED FOR CONSTRUCTION -J. LATE Z, BY 6�/ �-/-yzo cum CQ "T� Bin # City of La Quinta 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 # �F�Zv Itsv2�� Project Address: — � Owner's Narne: A. P. Number: Address: Legal Description: City, ST, Zip: Contractor: c,- n �lJ Tel ePhone• . Address: to —W Project Description: J? City, ST, Zip: ,5.....................99n,eF X U-4 Telhone — e P o! State Lic. # : City Lic. #t Arch., Engr., Designer: Address: City, ST, Zip: Telephone: hone #<':'[.> ?><':�:;>;•`'<>�>��:> Con structi on Type:Occupancy: State • S te Ltc. # PrJ ct tYPa (circle one):: Nev Add'n Alter Repair. r Demo Name of Contact Person: Sq. Ft.: #Stories: # Units: Telephone # of Contact Person:—Estimated Value of Project: dj UU- APPLICANT:�DO NOT WRITE BELOW THIS LINE /1 I Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cafes. 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 Mechanical Grading plan 2"a 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:- 'rd 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