12-0200 (PLBG)` P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address: .
APN:
Application description
Property Zoning:
Application valuation:
12-00000200'
48891 WASHINGTON ST
646-150-010- - -
PLUMBING
LOW DENSITY RESIDENTIAL
700
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
FULLER LINDA
48891 WASHINGTON STREET
LA QUINTA, CA 92253•'
Applicant: Architect or Engineer:
--------------------------------------------- - - ----
LICENSED CONTRACTOR'S DECLARATION -
1.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.
License Class: C36 �Licens : 930133
ate: ontracLgL.•�--^'
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that 1 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 1, as owner of the property, am exclusively contracting with licensed contractors to construct theproject(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. BAP.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:
,
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date:3/06/12
Contractor.
TOMMY ROOTER
42335 WASHINGTON STREET #i~'42, 3
PALM DESERT, CA "92211
(760)574-4444
Lic. No. 930133. '
WORKER'S COMPENSATION DECLARATION
1 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 NORGUARD INS Policy Number THWC220257
-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 the workers' compensation provisions of Section "
337700 of the Labor Code, I shall for mpty with those provisions.
ale
WARNING:• FAILURE TOS WORKERS' COMPENSATION 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 s
.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 agree to comply with all
city and county ordinances and state laws relating to building construc 'reby authorize representatives
of this county toe ter upon the above-mentioned grope spa urposes.
/e: nature (Applicant or Agent)
LQPERMIT - '
Application Number . . . . 12-00000200
Permit PLUMBING
Additional desc`.
Permit Fee . . . . 18.00 Plan Check Fee
4.50
Issue Date . . . . Valuation . . .
. 0
Expiration Date 9/02/12
Qty, Unit Charge Per
Extension
BASE FEE
15.00
1.00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS
3.00
-----------------------------------------------------
Special Notes and Comments
76 L.F: 3/4" GAS LINE FROM METER TO FAU.
2010 CODES.
------ - --------------
Other Fees BLDG STDS ADMIN.(SB1473)
1.00
Fee summary Charged Paid Credited
Due
---------------------------
Permit Fee'Total 18.00 .00 .00
-- - - --- -
18.00.
Plan Check Total 4.50 00 .00
4.50
Other Fee Total 1.00 .00 .00
1.00
Grand Total 23.50 .00 .00
23.50•
' LQPERMIT
Bin #
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Of .'ia 0U6tI ; .
Bufkfing si Sarety
P.O. l3ox.1504 p
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La.Qufnta, 6A.92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit # ` .
I
Project,Add= / -_. /
'c
Owner's Name:. 41 `1 , C
A P. Number.
Address: eA S
Legal Description:
Contractor.
City, ST, Zap: 27 S'3
Telephone:
Address: 9.i`1rJi� ��L e 3
Project Description:
City, ST, Zap: -Fi7 9/0
AA \e.,t
Telephone.,-? -L/_
7l0 . n
State Lia #: R 3//.73 City Lic
Arch., Eng., Designs ..
Address:
City., ST, Zap: .
Telephone:
State Lia #:
Conduction Type:. Occupancy:
Project type (ewe one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. FL•;
# Stories:
# Unit$:
Telephone # of Contact Person:. -1(6,0.- c5 7q - 4 q tf ,y' Estimated value of Project$ 700
APPLICANT: DO NOT WRITE BELOW THIS. UNE
#
Submittal
Plan Sets
Req'd
'Rec'd
TRACENG PERMIT FEES
Plan Check submitted.Idem Amount
Structural CaIes.
Reviewed, ready for corrections Plan Check Deposit. .
Truss Cales.
Called Contact Person Pian Cheek 8alanee
Tide 24 Cales.
Pians picked up Construction
Flood plain plan
Plans resubmitted.'. Mechafikal
Grading plan
2'! Review, ready for correctiownsue Electrical
Subeontaetor List
Called Contact Person Plumbing
Grant Deed
Plans picked up S.M.I.
&O A. Approval
Plans resubmitted Grading
IN IIUUSE.-
Review; ready for correctionslissae Developer Impact Fee
Planning Approval-
Called Contact Person A".P.
Pub. talks. Appr -
Date of permit issue
School Fees
Total Permit Feer