13-1224 (PLBG). . t
TA
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253= BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
.Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
13-00001224 Owner:
53607 VIA PALACIO KAVAS
772-560-046- - f. 53607 VIA PALACIO' -
PLUMBING LA QUINTA, CA 92.25.3
LOW DENSITY RESIDENTIAL
5000
Da ontractor: n '
Architect or Engineer: a ESERRA
SEP 2 ��/R13 .0: -BOX 1280
OACHELLA, CA 92236
(760) 398-9222. '
�INAN E 01
I '
LIC ED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury -that I licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business a' Professionals Code, and my License is in full force and effect.
License Class: C8, 10, 27, 2 License No.: 656128
�I ate: ' Contracto4
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 ofSection 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 theii 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 comple'tion, :the owner -builder will have the burden of proving that he or she did not build of
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
propertywho builds or improves thereon; and who contracts for the projects with a contractors) 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
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/26/13
VINTA Lic. 'No.: 656128
:pr
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.
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 EVEREST NATL IN Policy N�er 7600006481131
I certify that, in the performance of the w which this permit is issued, I shall not employ any
person in any manner so as to becom s t to the workers' compensation laws of California,
and agree that, if I.should become s ct to the workers' compensation provisions of Section
700 the Labor Code, I shall fo ith comply with those provisions.
Dater` t; �plican`t:
WARNING: FAILURE TO`SECURE 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
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 thisapplication becomes null and void, if work is not commenced -
within 180 days from date of issuancJabe
cessation of work for 780 days will subject
permit to cancellation.
I certify that I have read this application -and state ormation is correct. I agree to comply with all
city and county ordinances and state laws relating ruction, and hereby authorize representatives
of this county t nter upon the above/ -mentioned ction purposes.
Date: /sign iturelApp cent or Agent
F
d
Application Number. . . . 13-00001224
Permit ELECTRICAL'2013
Additional desc .
Permit_ .Fee 23.83 Plan Check Fee
.00
Issue Date Valuation
0
r Expiration Date 3/25/14
Qty Unit Charge Per.
Extension
1.00 23.8300 LS. ELEC DEVICES; FIRST 20
23.83
Permit . . PLUMBING 2013
Additional desc ..
Permit Fee . . . 11.92 . Plan Check Fee
.00
Issue Date Valuation . . .
. 0.
Expiration Date 3/25/14 ti
Qty Unit Charge Per,
Extension
1.00'. 11.9200 LS PLBG GAS SYS, 1-4 OUTLETS
11.92
Special Notes and Comments
,.
180 LF. OF 2 INCH POLYPROPELENE GAS
LINE AND ELECTRICAL FOR NEW BBQ AND
FIREPIT. 2010 CALIFORNIA BUILDING CODES.
-----------------_-_---------------------------------------------------
Other Fees _ :. . . BLDG STDS ADMIN (SB1473)
1.00
PERMIT ISSUANCE M/P/E
90.57
PLAN CHECK, PLUMBING
23.83
Fee summary Charged: Paid Credited
Due
Permit Fee Total 35.75 .00 .00
35.75
Plan Check Total .00 .00 .00.
.00'
Other Fee Total 115.40 .00.. .00
115.40
Grand Total 151.15 .00 .00
151.,15
.. LQPERMIT _.
-
Bin #
Qty Of is Quinta
Building &
r Safety 'Division
Permit.
h�
P.O. Box 1504, 78-4.95 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Project Address: K o -
Owner's Name:
A. P. Number:
Address: Sa. �, P, LA
Legal Description:
City, ST, Zip: LA Qj,,vT-A . C . Ik IF27-3
Contractor: -7E e
telephone:
V
Address: /0 p A -L_-
Project Description:
City, ST, Zip:
C 2Z2
Telephone:
9 ZZY"�
K.
eraA
State Lic. #
City Lic.
Arch., Engr., Designer:
Address:
CoAf, F41�
City., ST, Zip:
Telephone:
Construction Type: Occu PW/ d
State Lic. #:
Alter
Project type (circle one New Add'n emd'
Name of Contact Person* C(.4
Sq. Ft.:
I
# Stories: _T#
Units:
Telephone #,of Contact Person:
Estimated Value of Project- S _0 C) o
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Reqld
Rec'd
TRACKING
PERMIT FEES
Plan Sets,
Plan Check submitted
Item
Amount
Structural CaIcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss C21cs.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction.
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2' Review, ready for corrections/issue
Electrical
Subcontactor Lfit
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.T.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
—Callvd-CantactY-erson
Pub. Wks. Appr'
Date of permit issue
School Fees
Total Permit Fees