11-0220 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 1 11-00000220
Property Address: 47355 VIA CORDOVA
APN: 643-100-025-204 -26152
Application description: PLUMBING
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 28000
Applicant:
667At TeA< T o X
Tdy °f 4Q"
Architect or Engineer:
---_---------------------------
LICENSED CONTRACTOR'S DE
I hereby affirm under penalty of perjury that I am licensed under provisi
Section 7000) of Division 3 of the Business and ofessionals Code, a
�LicenseClass: C35 C53 _
Y Date:0Wk__1C'.ntracto
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
:hapter 9 (commencing with
sense is in full force and effect.
483
I hereby affirm under penalty of perjury t)6t I am ex rom a ntractor's State License Law for the
following reason (Sec. 7031.5, Busines and Pro ions Cod A city or county that requires a permit to
construct, alter, improve, demolish,' r epair any structure, p r to its issuance, also requires the applicant for the
permit to file a signed statement that he or she is licensed p suant 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 (5500).:
(_) 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.).
(_) 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: 1 4 n
Lender's Address:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011 f
INSPECTIONS (760) 777-7153
D Date: 3/03/11
Owner: d
CRIS BENNETT
1210 S IRENA AVE
REDONDO BEACH, CA 2 7 MA 0.4 2011
(310)619-0040
CITY OF QUINTA
F(N _y DEPT.
Contractor:
WESTFALL PLASTER SRVCS, KENT
74823 VELIE WAY
PALM DESERT, CA 92260
(760)779-0639
Lic. No.: 664483
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 CNCLD/ST FUND Policy Number 0009927-2009
_ I certify that, in the performance of the work for which this pe it is issued, I shall not employ any
person in any manner so as to become subject to thew rs' compensation laws of California,
and agree that, if I should become su jact to the wort ' co pe ns
provisions of Section
�0 of the Labor Code, I shall f wi comply w' ho r visions.
/e� pplicant:
WARNING: FAILURE TO SECURE WOR COM TI ERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRI P ALTIES AND INES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000) IN ADDITION T HE COST OF NSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR COD NTEREST. AND TORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety fora 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 agree comply with all
city and county ordinances and state laws relating to building con tr ion, and here u[hori representatives
of�=,Signature
n the above-mentioried property for i tion purposes.
Dat (Applicant or AgenL}-
Application Number . . . . . 11-00000220
Permit . . . PLUMBING
Additional desc . .
Permit Fee . . . . 18.00 Plan Check Fee
4.50
Issue Date . . . . Valuation . . .
. 0
Expiration Date . . 8/30/11
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
RE -PLASTER AND TILE EXISTING POOL & SPA.
REMOVE EXISTING DECK AND RE -POUR WITH
BONDING GRID INSTALLED. 41 LF. 3' HIGH
RET WALL AND INSTALL NEW GAS LINE FOR
APPROVED FIREPIT.,
----------------------------------------------------------------------------
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 #
City of La Quinta
Building & Safety Division
Permit # P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Project Address:J�- vi q C&OLY114 Owner's Name: C
A. P. Number: Address: 1219 S'-XIVA14 NF
Legal Descri tion•
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City, ST, Zip: RFD" 0 134" CA 992 7 7
Contractor: Ai iW WE�U /0Z,4S-1E+2\
Telephone: 310 &/%
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Address: �Z �Gl / W/J L/
Project Description:
City, ST, Zip: f LM J)Q C
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State Lie. # :66q4/e3
City Lic. #;
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Arch., Engr., Designer:
Address:
City, ST, Zip:
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Telephone:
'i.>.'��?>'>.`: t >•'�?:>:::
Construction Type:
State Lac. #::'>�w�t
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Project type (circle one): New Adc n Alter Repair Demo
Name of Contact Person:
Sq. Ft.: #Stories: #Units:
Telephone # of Contact Person:
Estimated Value of Project:
Z
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted 1 3
Reviewed, ready for corrections
Item Amount
Plan Check Deposit
Structural Calcs.
Truss Cales.
Called Contact Person
Plan Check Balance
Construction
Mechanical
Title 24 Calcs.
Plans picked up
Flood plain plan
Plans resubmitted
Grading plan
2” Review, ready for correctionslissue
Electrical
Plumbing tin
Subcontactor List
Called Contact Person
Grant Deed
Plans picked up
S.M.I.
Grading
D mac e
H.O.A. Approval
Plans resubmitted
IN HOUSE:-
3" Review, ready for corrections/issue
Planning Approval
Contact Person
Pub. Wks. Appr
ECalled
Date of permit issue
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APPROUrm
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School Fees
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CITY OF LA QUINTA
BUILDING & SAFETY PT.
APPROVED
FOR CONSTRUCTION
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