12-0657 (PLBG)P.O: BOX 1504
78-495 CALLE.TAMPICO '
LA QUINTA, CALIFORNIA 92253
Application Number: -
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
VOICE (760) 777-7012
FAX (760) 777-7011
BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 6/13,/12
12-0000065T Owner:
54060 AVENIDA VILLA RAGSDALE,TRACY ?
774-224-003-7 -000000- 5300 MUTINY BAY RD
PLUMBING FREELAND, WA 98249
COVE RESIDENTIAL J JUN 7 )
210 0 � � 1. �l
LQPERMIT
Contractor:
Applicant: Architect or Engineer:
EGGAN, • RICK EDWARD i,P�„��LryfUpldq,4
' 73680 HIGHWAY 111, STE #123
-PALM DESERT; CA 92260
►nywitXv
(760)404-6325
94
Lic. No.: 950244
LICENSED CONTRACTOR'S DECLARATION -
• . WORKER'S COMPENSATION DECLARATION
hereby affirm under penalty of perjury that I'am licensed under provisions of Chapter 9 (commencing with
I hereby affirm under penalty of perjury one of the following declarations: ”
Section 7000) of Division 3 of the Business and Professionals Code, and my. License is in full force and effect._
I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: C42 ',, License No.: 950244 ,.
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
? ,
7� Date: ,i7 —%�.� Contractor:
— 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
" OWN DER DECLARATION _
insurance carrier and policy number are: -
I hereby affirmvnder penalty of perjury that I am exempt from the Contracior's State License Law for the
Carrier EXEMPT Policy Number EXEMPT
- following reason (Sec. 7031 .5, Business and Professions Code: Any'city or county that requires a permit to
I certify that, in the performance of the work for which this permit is issued, I shall not employ any -
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
_
person in any manner so as to become s66ject to the workers' compensation laws of California,
" permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State ,.
and agree that, if I should become subject to the workers' compensation. provisions. of Section -
.. License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or -
3700 of the Labor Cod , I shallVfthwith comply with those provisions.
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).:
-Dater " —11i —lz Applicant: •.
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
WARNING: FAILURE TO SECURE WORKERS' CO TION COVERAGE IS UNLAWFUL, AND SHALL
• Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND -
. ` and who does the work himself or herself through his or her own employees, provided that the
DOLLARS ($100,000)"- IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN.
,. improvements are not intended or offered for sale. If, however, the building or improvement is sold within
SECTION 3706 OF THE LABOR CODE, .INTEREST, AND ATTORNEY'S FEES. ,
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.).
APPLICANT ACKNOWLEDGEMENT
• (_) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Seca
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
conditions and restrictions set forth on this application. '
- property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
1. Each person upon whose behalf this application is made,each person at whose request and for ,
" - pursuant to the Contractors' State License taw.).
whose benefit work is performed under. or pursuant to any permit issued as a result of this application,
I.am exempt under Sec. - , B.&P.C.. for this reason
the owner, and the applicant, each agrees to, and shall defend, indemnity 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. _
Date: Owner:
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
- CONSTRUCTION LENDING AGENCY.
permit to cancellation. _
" I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
I certify that I have read this application and state that the above information is correct. I agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.).
city and county ordinances and state laws relating to building construction, and hereby authorize representatives _
of this county to enter upon the above-mentioned property.Igr inspection purposes.
Lender's Name:-
J3'
ate:A /2 Signature (Applicant or Agent):-
- Lender's Address:
LQPERMIT
Application Number . . . . 12-00000657
Permit -PLUMBING SEWER
Additional'desc .
Permit Fee 30.00 Plan Check Fee
.00
Issue Date . . . . Valuation . . .
. 0 -
Expiration Date 12/10/12
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 15.0000 EA PLB BUILDING SEWER"
15.00
Special Notes and Comments
SEWER HOOKUP/SEPTIC ABANDON - 2010
CALIFORNIA BUILDING CODES.
" June 13, 2012 1:20:15 PM AORTEGA
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 .. ..
-
4
COACHE-LLA VALLEY WATER -01STRI,CT.
'P:O' BOX IOS', COACOELLA, CALj.FGftNIA'92236'(760) M�2651'
INVOICE Date,:. 6051 012
IOA -%!OU6
SUBJECT- S40-4 ASNIDAVILV-�JJ VrA LIfiD f.90222 "SCC.- FEE CWLY"
TRACY RAG-SDA�IE� ftoject
5.300 MUTINY BAY FROM.,
Amo'unt Min*
.FREE -LAND. 90,249
Planner GANDRANILIALOO-OS
1,6L IiRbi P
NSU�E
REKVTTkx' -E. MDfNCLUDE ll4tpU)FCT(S"v R.OJECK
9.
GC-TREA
SUBJECT,;-54n6b AVENIDA VILLA, LA OUNTA—LID RUNS 7-SC.C. PER MI, Y"
co-AcmELLA 'VALLEY. WATER OISTRICr
P 0 BOX 21.58' COACH ELLA,,.'CALIFORNIA. ,522
'Rep I
JON O'$ '2017.
'fo X_'I 0� .0.
C-OAG HELLA VALLEY.
+ )c
WATERDIMICT
ao
SUBJECT,;-54n6b AVENIDA VILLA, LA OUNTA—LID RUNS 7-SC.C. PER MI, Y"
co-AcmELLA 'VALLEY. WATER OISTRICr
P 0 BOX 21.58' COACH ELLA,,.'CALIFORNIA. ,522
'Rep I
Bin #
Pennit # ' :
► I • W51
Project Address:
• . .
C1�y ou1n�a
Building tat Safety Division (j
P.O. Box .1504,"78-4 95 Calle Tampico
LA •Quints, CA 92253 -:(760) 777-7012
Building Permit .4plication'and Tracking Sheet
Owner's Name:. Z
A P. Number:
Address: 5_4-� 1-ty Tl .
Legal Description:
ContracWr. (6,L !
qvG iJ.�GO/iu�
City, ST, Zip:
Telephone: &D 3 - CD
Address:7 D
Z
Project Description: L OA)AD ,CC
City. ST, Zip: %/% Q
Z O
C, L�yL S
Telephone.,-7
6p b cl
State Lia #:425p Z
LStty Lir: /p$
Ate, Bag., Designer.
Address:
City, ST. Zip:
Telephone:
State Lia #:
Name of Contact Person:
JllCorutruction
Type:. Oxupancy:
Project type (circle one): New Add'n Repair Demo
Sq, Ft # Stories: # Unitp
Telephone # of Contact Person:
# Submittal Wd
Plan Sets
Estimated Value of Project: Z,
APPLICANT: DO NOT WRITE BELOW THIS LINE
Reed PERNU FEES-
Pian Check submitted. Item Amount
Strgdurai dries.
Reviewed, ready for conwdons Plan Chic Deposit. .
Truss Cala.
Called Contact Person Plan -Meek'Balance
Title 24 CRIaL
Plana picked up Construction
Flood plain plan
Plans resubmitted.. Mectiarikal
Grading plan
Z'! Review, ready for correctionsrissue ElecMeal
Snbcontactor List
Called Contact Person Plumbing
Grant Deed.
Plans picked up Sly.
H.O.A. Approval
Plans resubmitted Grallog
IN ROUSE:-
''a Review; ready for correctiona/issne Dev'-toper Impact Fee
Planning Approval
Called Contact Person
Pub. talcs. APPr
Date of permit issue
School Fees
Total Permit Fees