10-0535 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 10-00000535
Property Address: 81355 LEGENDS WY
APN: 762 -420 -036 -
Application description: PLUMBING
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 1000
Tiht 4 4 Q"
Applica ' Architect or Engineer:
------------------
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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: 748605 License No.: B
',.Date: 4111110, Contractor: A/
OWNER-BUI DE�RATION '
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).:
1—) 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.).
(_ 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 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
Owner:
CLARK TOM
81355 LEGENDS WAY
LA QUINTA, CA 92253
(
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/18/10
JUN 212010
D
Contractor: . _
LANG CONSTRUCTION C{T 0FFLAQUINTA
80590 CAMINO SAN GREGERIO Ft�EAX:tt)EET.
BERMUDA DUNES, CA 92203
(760)834-9020
Lic. No.: B
-----------------------------------------------
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 performonce of the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier EXEMPT Policy Number EXEMPT
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 shall forthwithcomplywith those provisions.
.Date: 6131 Ir Applicant: Xa4,&. (L/, G
WARNING: FAILURE TO SECURE WORK ERS'.COM PENSATION 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 property for inspection purposes.
. Date: L laill0 Signature (Applicant or Agent): X A!! y A/. a�M�
Application Number . . . . .
10-00000535
Permit . . . PLUMBING
Additional desc .
Permit Fee . . . . 18.00
Plan Check Fee
4.50
Issue Date . . . .
Valuation . . .
. 0
Expiration Date 12/15/10
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
INSTALL TWO (2) 1" DIAMETER GAS
LINES
-----�- — ----- ---- ---- - FOR 'FUTURE 'OUTDOOR 'KITCHEN AND. -FIRE
PIT__
--
PER APPROVED PLAN.APPROVED PER
S.T.
----------------------------------------------------------------------------
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
-
'r;.t, "�rCU� IUMEfi 1NF,t7 FiwMA7ION X P'
•c ■
R.
9
®■
�x• �*+s.6t� ��,
Fra PLAN;VIEW i.'• r t'j�Ji� i�'+ay.'�>��t �''�.�r-�o�:it�a a#;:
R.
9
®■
Bin #
City of La Quinta
Building 8r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit # j
Project Address: 81355 Legends Way - PGA West
Owner's Name: Tom Clark
A. P. Number: 76-242-0036
Address: 81355 Legends Way - PGA West
Legal Description: Lot 36, Tract 28838
Contractor: Lang Construction
City, ST, Zip: La Quinta, CA 92253
Telephone: (
Address: 80590 Camino San Gregorio
Project Description: Install two (2) 111 Diameter Gas
City, ST, Zip: Indio, CA 92203
Lines for future outdoor kitchen and fire pit.
Telephone: (760) 702-7744
State Lic. # : B-748605'
City Lic. #: 104571
Arch., Engr., Designer: Larry W. Lang
Address: 80590 Camino San Gregorio
City., ST, Zip: Indio, CA 92203
Telephone: 760 7 2-774 4 >�
State Lic.#: 35 7 49
Name of Contact Person: Russ Melcher
Constructi TYP e: Gas Line Occupancy: • SF D
Add'
nJect hPe �circle ne) Alter Repair Demo
Sq. Ft: N/A#Stories: N/A #Units: N/A
Telephone # of Contact Person: (76 0) 574-8687
Estimated Value of Projec 0 (�
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2nd Review, ready for corrections/issueElectrical
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