09-0389 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 09-00000389
Property Address: 54235 AVENIDA DIAZ
APN: 774-194-024-12 -000000-.
Application description: PLUMBING
Property Zoning: COVE RESIDENTIAL
Application valuation: 3000
Applicant:
Tiht 4 4 Q"
Architect or Engineer:
/_0_
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
--------------------- I------------------------------
UCE CON CTOR'S DECLARATION
I hereby affirm rider penalty of erjury that I a Ii ense der rovisions of Chapter 9 (commencing with
Section 000) f Division 3 the Business an P ofessionals e, and my License is in full force and effect.
Licen lass: C42 Licen 661018
Date Q C ntrac
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 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 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Seo.
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 Name:
Lender's Address:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/29/09
Owner:
KLIEN BARBARA
AVENIDA DIAZ
LA QUINTA, CA 92 (rJ
IJ APR 2 '� 2009
Contractor: {
HAMMER PUMPING I C CITY OF LA QUINTA !`
P 0 BOX 2448 FINANCE_DEPT.
CATHEDRAL CITY, CA 92235
(760)360-7448
Lic. No.: 661018
---------------------- - ------------------------
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 P licy Num 1828655-2009
I certify that, in t rmance of t e work hich j permit is issued, I shall not employ any
person in y manners is to be me subject to t rs' compensation laws of California,
and a j t beco subject to the workers co sation provisions of Section
(j/, I� 370 ofe I shal orthwith comply with t se provi
Date: �i '1 Ap
WARNING: FAILUR TRKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS 1$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 is a of suc ermit, or ce sation of work for 180 days will subject
permit to cancellation. -
I certify at I h ve read this applicatio nd state that the ab ve i rmation is correct. I agree to comply with all
city and,
nd ount ordinances and state I ws relating to buildin nstruction, and hereby authorize representatives
of this unty enter upon the abov -mentioned propert or inspection purposes.
Date:JDA Signature (Appli ant or A
r ti
LQPERn1IT
Application Number . . . . . 09-00000389
Permit ' . . . PLUMBING
Additional desc .
Permit Fee . . . . 30.00 Plan Check Fee
.00
Issue Date. Valuation . . .
. 0
Expiration Date 10/26/09
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 15.0000 EA PLB BUILDING SEWER
15.00
----------------------------------------------------------------------------
Special Notes and Comments
SEWER HOOK UP / SEPTIC ABANDONMENT
-----------------------------------------------'-----------------------------
Other Fees . . . . . . . . . .BLDG STDS ADMIN (SB1473)
1.00
_ Fee summary Charged Paid Credited
---------------------------------------------------------
Due
Permit Fee Total 30.00 .00 .00
30.00
Plan Check Total .00 .00 .00
.00
Other Fee Total 1.00 .00 .00
1.00
Grand Total 31.00 .00 .00
31.00
COACHELLA VALLEY WATER DISTRICT
P.O. BOX 1058, COACHELLA, CALIFORNIA 92236 (760) 398-2651
INVOICE Date: 4/10/2009
SUBJECT: 54-235 AVENIDA DIAZ, LA QUINTA
BARBARA KLEIN Project: 9-954
52-855 AVENIDA DIAZ Project Date: 4/10/2009
Amount Due: $3,995.00
LA QUINTA, CA .92253 GEO: 06-06-13-2
Planner: REBECCA MILWARD
TO INSURE PROPER CREDIT, PLEASE RETURN THIS PORTION WITH
REMITTANCE AND INCLUDE THE PROJECT ON YOUR CHECK
1.00 SCC -COLLECTION $1,658.00 $1,658.00
1.00 SCC -TREATMENT $2,337.00 $2,337.00
$3,995.00
APR 10 2009
CVVATERLD STR CTLA S
7
SUBJECT: 54-235 AVENIDA DIAZ, LA QUINTA 606132,215.0.2
COACHELLA VALLEY WATER DISTRICT
P.O.. BOX 1058, COACHELLA, CALIFORNIA 92236 (760) 398-2651
Page 1
Bin #
City of La Quinta
Building 8T Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
— 2J�
Project Address: J E
Owner's Name: rJ
A. P. Number:
Address: jZ S� !� S cz t
Legal Description:
City, ST, Zip: L�s (f,)U i-
Contractor:
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Telephone: ~'
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Address: C `
Project Description:
City, ST, Zip:
L
Telephone: v b
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State Lic. # :
City Lie. #:
Arch., Engr., Designer:.
Address:
City., ST, Zip:
Telephone: ;;?:<•::<:;:;>;<:>::.>;:::•::«<;:::. ;>:z:;<a<:
:.
;•:•;}};?i%:v:yvfi:•i:y}: i::. �:;Xvi%iiil: F�i%�� {:�: {i:;
State Lie. #: r
Construction Type: Occupancy:
circle one New Add'n Alter Repair Demo
Project type
Name of Contact Person:
Sq. Ft.: # Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project:—T C---) cS b `—
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd _
Rec'd
TRACIONG PERMIT FEES
Plan Sets
. Plan Check submitted Item Amount.
Structural Cates.
Reviewed, ready for corrections Plan Check Deposit
Truss Calcs.
Called Contact Person Plan Check Balance.
Title 24 Cates.
Plans picked up Construction
Flood plain plan
Plans resubmitted Mechanical
Grading plan
21d 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:-
Ud 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