11-1094 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
11=0:0-001094
Property Address:
52-99-0 AVENIDA DIAZ
APN:
773-312-013-14 -000000-
Application description:
PLUMBING
Property Zoning:
COVE RESIDENTIAL
Application valuation:
1500
Applicant:
T4ht 4 4v Q"
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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 Professionals Code, and my License is in full force and effect.
Lic se Class: C36 - License No.: 506475
Date
- OWN 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 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.).
1 _ 1 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—) 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
Owner:
GYULA BODROGI
52990 AVENIDA DIAZ
LA QUINTA, CA 92253
Contractor:
PEREZCHICA CONSTRUCTION
68380 VERANO ROAD
CATHEDRAL CITY, CA 92234
(760)328-9398
Lic. No.: 506475
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/06/11
D� uIL
-C-1
�o
LO -C
L - I
CITY OF LA QUINTA
FKANCE (}EPY
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 STATE FUND Policy Number 1932216-2011
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 healtl"6ECt1tn ub'e to the workers' compensation provisions of Section
3700 of the or Code, I sh thf hwith co with those provisions.
C)a, Ap a
WARNING: FAIL RE TO SECURE WORK ' CO ENSATION 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 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 stat t the above infor ion is correct. I agree to comply with all
city and county ordinances and state laws rel ng to building constructio , and hereby authorize representatives
of �is,ccouunnty to enter upon the above -men oned property for inspe s.
Dq/E/ vq S/ign��i�u r/a (Applicant or A t):
Application Number . . 11-00001094
Permit . .
. PLUMBING SEWER
Additional desc .
Permit Fee
30.00
Plan Check Fee
00
Issue Date
Valuation . . .
. 1500
Expiration Date
4/03/12
Qty Unit Charge' Per
Extension
BASE FEE
30.00
-=----=---------------------------------------------------------------------
Special Notes and
Comments
SEPTIC ABANDON, SEWER CONNECT. 2010
CODES.
----------------------------
Other Fees . . .
------------------------------------------------
. . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary
Charged Paid
-------------------=
Credited
--------------------
Due
-----------------
Permit Fee Total
30.00
.00 .00
30.00
PlanCheck Total
.00
.00 .00
.00
Other Fee Total
1.00
.00 .00
1.00
Grand Total
31.00
.00 .00
31.00
LQPERMIT
COACHELLA VALLEY WATER DISTRICT
P.O. BOX 1058, COACHELLA, CALIFORNIA.92236 (760) 398-2651
INVOICE Date: 10/4/2011
SUBJECT: 52990 AVENIDA DIAZ, LA QUINTA, LID 685056, "SCC FEE ONLY"
GYULA BODROGI Project: 11-3192
21005 DONORA AVE, APT 15 Project Date: 10/4/2011
Amount Due: $4,231.00
TORRANCE, CA 90503 GEO: 06-06-12-2
Planner: SANDRA VILLALOBOS
TO INSURE PROPER CREDIT, PLEASE RETURN THIS PORTION WITH
REMITTANCE AND INCLUDE THE PROJECT ON YOUR CHECK
c r
5&'_ '7 o 0 ' e e • otu
1.00 SCC -COLLECTION $1,836.00 $1,836.00
.00 SCC -TREATMENT $2,395.00 $2,395.00
1 0
$4,231.00
PAI® /. 00
OCT 0.14-20 * 11
COACHELLA VALEY
WATER DISTRICT
SUBJECT: 52990 AVENIDA DIAZ, LA QUINTA, LID 685056, "SCC FEE ONLY"
COACHELLA VALLEY WATER DISTRICT
P.O. BOX 1058, COACHELLA, CALIFORNIA 92236 (760) 398-2651
Page 1
Bin,#. ....
:
Permit #
Project Address; — !
.. .:
Cit}r ta
of La Quin
BulkUng a. Safety Division
P.O. Box 1SO4, 78-495 Ca11e Tampico
La.Quinta, CA 92253 -:(760) 777-7012
Building Permit Application' and Tracking Sheet
Owner's Name:.
A. P. Number.
Address:
Legal Description:
(�
City, ST, Zip:
Contactor G
Address:%
S G Telephone W
U Project Description:
City, ST, Zip:
C ��
Telephoned 3
U'
State Lie.
City Lic. #;
Arch, Engr., Designer
Address:
City, ST, Zip:
Telephone:
State Lie. #:
Construction Type:. Occupancy:
: 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:
M Submittal Req'd
Plan Sets
APPLICANT: DO NOT WRITE BELOW THIS UNE
'Rec'd .. TRA(3GNVG PERMIT FEES
Plan Check submitted Item Amount
Structaw Cales.
Reviewed, ready for corrections Thu Check Deposit. .
Truss Caju.
Called Contact Person Plan Checkilalaace •
Tithe 24 Calci.
Pians picked up Construction
Flood plain plan
Plans resubmitted Mechanical
Grading plan
V Review, ready for correctionstissue Electrical
Subeontactor 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 correctionvUsac Developer Impact Fee
Planning Approval •
Called Contact Person A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees