13-1217 (PLBG)i P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
13-00001217
Property Address:
54305 EISENHOWER DR
APN:
774-252-016-4 -000000-
Application description:
PLUMBING
Property Zoning:
COVE RESIDENTIAL
Application valuation:
850
Applicant:
1
V
T4t!t 4 4 "
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Architect or Engineer:
4
kv
LICENSED CONTRACTOR'S DECLARATION
I 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 License No.: 880103
Date: oPSJ &ontractor:
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, 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 (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 p6riury 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
Owner:
CHARLOTTE WANG
54305 EISENHOWER DRIVE
LA QUINTA, CA 92253
( D
Contractor:
ALVAREZ, JORGE A.
P.O. BOX 984
THERMAL, CA 92274
(760)777-3613
Lic. No.: 880103
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date:
SEP 25 2013
OF LA
9/25/13
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 EXEMPT Policy Number EXEMPT
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
3700 of the Labor Code, I hall forthwith comply with those provisions.
Date: '95-13 Applicant:
WARNING: FAILURE TO SECURE WORKER ' 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 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 construction, and hereby authorize representatives
of this county to enter upon the above-mentioned propert or ' spection purposes.
Date: 9 &OS -13 Signature (Applicant or Agent):
Application Number . .' . . . 13-00001217
Permit . . . PLUMBING 2013
Additional desc . .
Permit Fee . . . . 11.92 Plan Check Fee
.00
Issue Date . . . . Valuation . . .
. 0
Expiration Date 3/24/14
Qty Unit Charge Per
Extension
1.00 11.9200 EA PLBG WATER HEATER/VENT
11.92.
------------------------------------ ---------------------------------------
Special Notes and Comments
WATER HEATER CHANGE OUT -
40GALLON/ELECTRIC [2008 ENERGY] CARBON
MONOXIDE ALARM(S) TO BE INSTALLED PRIOR
TO FINAL INSPECTION. 2010 CALIFORNIA
BUILDING CODES.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . PERMIT ISSUANCE M/P/E
90.57
PLAN CHECK, PLUMBING
7.15
Fee summary Charged Paid Credited
Due
Permit Fee Total 11.92 .00 .00
11.92
Plan Check Total .00 .00 00
bo
Other Fee Total 97.72 .00 .00
97.72
Grand Total 109.64 .00 .00
109.64
LQPERMIT
BID #
Permit #
Project Address:
A. P. Number:
Address: V , C) r
City, ST, Zip —T� f�
Te1ephone:7Cc0_ 7? 7',--10 t
State Lic. # O
Arch., Engr., Designer.
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person:
Teleahone # of Contact Person:
N Submittal
Plan Sets
Structural Cala.
Truss Cala.
Title 24 Cala. .
Flood plain plan
Grading plan
Subeontacter list
Grant Dad
H.O.A. Approval
IN HOUSE: -
Planning Approval
Pub. Wks. Appr
School Fees
City Of La QUjnb
Building 8Z Safety Division
P.O. Box 1504, 78-495 Calk Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
lrtGlsJ� Owner's Name:
Address: SLI.3QS e�
City, ST, Zip: C
S'e_7 Telephone:
Project Description:
q
Lic. #,
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: # Stories: # Units:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS UNE
Reed
TRACKING
PERMIT FEES
Plan Check submitted
Item Amount
Reviewed, ready for corrections
Plan Check Deposit
Called Contact Person
Plan Check Balance.
Plans picked up
Construction
Plans resubmitted
Mechanical
V Review, ready for correctionsJiswe
Electrical
Called Contact Person
Plumbing
Plans picked up
Plans resubmitted
Grading
Review, ready for correctiousltasne
Developer Impact Fee
Called Contact Person
A.i.P.P.
Date of permit issue
Total Permit Fees
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