11-0366 (PLBG)r
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: t,_-11-00000366
T4tyl 4 4 a"
Property Address:
54300 AVENIDA DIAZ
APN:
774-234-026-23 -000000-
Application description:
PLUMBING
Property Zoning:
COVE RESIDENTIAL
Application valuation:
3400
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of pe740WMNER-B=UILDER
prowswn hapter 9 (commencing with
Section 7000) of Division 3 e'nd my Lic rise is in full force and effect.
License C ss: 42 se No.: 18
Date:A 2 � Co tractor:
R 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).:
(_) 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 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: 4/12/11
Applicant:
oie�
Archite o gineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of pe740WMNER-B=UILDER
prowswn hapter 9 (commencing with
Section 7000) of Division 3 e'nd my Lic rise is in full force and effect.
License C ss: 42 se No.: 18
Date:A 2 � Co tractor:
R 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 ($500).:
(_) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
and who does the work himself or herself through his or her own employees, provided that the
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
one year of completion, the owner -builder will have the burden of proving that he or she did not build or
improve for the purpose of sale.).
(_) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: The Contractors' State License Law does not apply to an.owner of
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.). '
( ) I am exempt under Sec. , B.&P.C. for this reason
Date: - Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificate of consent to self•insure for workers' compensation, as provided
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
Code, for the performance of the work for which this permit is issued. My workers' compensation
insurance carrier and.policy number are:
Carrier SELF - INSU$ED= Policy Number 2246
I certify m the performance the work fo is permit is issued, I shall not employ any
on in any manner so as to
agree that, if I should bec(
0 of the Labor Code„4"s%a
Dater ll'�" � Applicant:
le ” o the wor rs' compensation laws of California,
to the workers' c % mpensation provisions of Section
comply with t to provisions.
WARNING: FAILUA TO SECU ORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER70 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 m. for 180 days will subject
permit to cancellation. -
I certify that I have read this application state above i formatio - orrect. I gree to comply with all
city and co my dinances and state 1 s relating to building con ruc ' rand here orize representatives
of this cow ty to nter upon the abov mentioned propertX.f ion purposes.
Date: Signature (Appli ant or Agent):
Date: 4/12/11
Owner:
TARZWELL ERNEST ALLEN
54300 AVENIDA DIAZ
LA QUINTA, CA 92253
a
�p
Contractor:
APR 12 Z� f�
HAMMER PUMPING INC
P O BOX 2448
CATHEDRAL CITY, CA 92235
` CIfYOE>AnS T .
Fi�I��CEREPT.----___
(760)360-7448
L
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 SELF - INSU$ED= Policy Number 2246
I certify m the performance the work fo is permit is issued, I shall not employ any
on in any manner so as to
agree that, if I should bec(
0 of the Labor Code„4"s%a
Dater ll'�" � Applicant:
le ” o the wor rs' compensation laws of California,
to the workers' c % mpensation provisions of Section
comply with t to provisions.
WARNING: FAILUA TO SECU ORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER70 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 m. for 180 days will subject
permit to cancellation. -
I certify that I have read this application state above i formatio - orrect. I gree to comply with all
city and co my dinances and state 1 s relating to building con ruc ' rand here orize representatives
of this cow ty to nter upon the abov mentioned propertX.f ion purposes.
Date: Signature (Appli ant or Agent):
4!' i
Application Number . . 11-00000366
.Permit . .
. PLUMBING SEWER
Additional desc .
Permit Fee . . .
. 30.00
Plan Check Fee
.00
Issue Date . . .
.
Valuation . .
. 3400
Expiration Date
10/09/11
Qty Unit Charge Per
Extension
BASE FEE
30.00
----------------------------------------------------------------------------
Special Notes and
Comments
SEPTIC ABANDONMENT/ SEWER HOOK UP.
----------------------------------------------------------------------------
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
LQPERMIT
rp►TF COACHELLA VALLEY WATER DISTRICT
P.O. BOX 1058, COACHELLA, CALIFORNIA 92236 (760) 398-2651
INVOICE Date: 4/11/2011
SUBJECT: SCC ONLY -54300 AVENIDA DIAZ, LA QUINTA, CA 92253, APN 774234-026
TARZWELL, ERNEST ALLEN, Project:
54300 AVENIDA DIAZProject Date:
Amount Due:
LA QUINTA, CA 92253 GEO:
Planner:
TO'IN9URE PROPER CREDIT, PLEASE RETURN THIS PORTION WITH
REMITTANCE AND INCLUDE THE PROJECT ON YOUR CHECK
11-2866
4/11/2011
$4,231.00
06-06-13-2
CAROLPFANNKUCHE
SUBJECT: SCC ONLY -54300 AVENIDA DIAZ, LA QUINTA, CA 92253, APN 774-234-020
COACHELLA VALLEY WATER DISTRICT
P.O. BOX 1058, COACHELLA, CALIFORNIA 92236 (760) 398-2651 Pagel
Bin #
City of La Quinta
Building 8r Safety Division
P.O. Box 1504, 78-495 Calle Tampico�\—
La Quinta, CA 92253 - (760) 777-7012
BuildingPermit Application and Tracking Sheet
Permit #
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Project Address:
Owner's Name:
A. P. Number:
Address: S -.3&_>
Legal Descriptioq:
City, ST, Zip: (2�3'J,
Contractor: , t fZ__ v Jl r.l"cam
Address:
Telephone:<>:<?::•:5.:xa,.;:;;:::g:>:><:},sfu=:<
Project Description: �` �� �6
City, ST, Zip:.
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J C--'..— r_—J2� llv ws t
Telephone:
State Lic. # :
City Lie. #;
Arch., Engr., Designer:
Address:
City, ST, Zip:
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Tele hone: :.�:•:.:�.�':::•r•«•
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State Lic. #: �=;:`•:%�sa`',•'•�<:•':.: >;;:�<�::.:�.;?type
Construction Type: Occupancy:
Project a circle one New Add'n Atter Repair Demo
� )�
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: Estimated Value of Project: �U
APPLICANT: DO NOT WRITE BELOW THIS LINE
It
Submittal
Plan Sets
Req'd
Rec'd
TRACKING PERMIT FEES
Plan Check submitted Item Amount
Structural Cates.
Reviewed, ready for corrections Plan Check Deposit
Truss Cates.
Called Contact Person Plan Check Balance.
Title 24 Cates.
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 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