06-1008 (PLBG)P.O. BOX 1504 ^' VOICE (760) 7777012
- 78-495 CALLE TAMPICO , FAX,(760) 777-7011
LA QUINTA; CALIFORNIA 92253 BUILDING &SAFETY DEPARTMENT INSPECTIONS (760) 777-7153.
_..
BUILDING. PERMIT -• ..
Date: 3/13/06 .
Application Number:, 06000003008 Owner.
Property Address:. .47560 VIA. MONTIGO DEVELYN RICHARD
APN: 643-320.-056=251 -26152 - 47560'VIA MONTIGO!
Application description: PLUMBING LA QUINTA, CA.92253 -
Property Zoning: LOW ,DENSITY RESIDENTIALS
Application valuation: 800 '
Applicant: Architect or Engineer: HYDES APPLIANCE PLBG & A/ Q
77825 WILDCAT STREET
PALM DESERT, CA 92211
(760) 360-2202 MAR 1 3Z�O�
I Lio:: No.:- 598768
.. :. rry►qOFCLA pUIA9F,4
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LICENSED CONTRACTOR'S DECLARATION - - WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with - 1 hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business and Professionals C de, 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
LicenseClass: C20 C36
L.
s No.: 98768 - for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
�� •� issued. - -
at ontractor: 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
OWNER-BUILDE DE RATION insurance carrier and policy number are:
Ihereby affirm under penalty of perjury that I am exempt from the tractor's State License Law for the. Carrier CLARENDON INS Policy Number 04KR0026985
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 subject to the workers' compensation laws of California;
permit to file a signed statement that he or she is licensed pursuant to the pruvisiuns of the Contractor's State and agree that, if IP become subi -nt to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division of the Business and Professions Code) or 3700 of the Labor ode I. shall forthwith co ith th a provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by 7 /� e -
any applicant for a permit subjects the applicant to a civil penalty of noTmore than five hundred dollars ($500).: te. ✓8-71 � cant: _ ,
(_) 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: FAI URE TO SECURE WORKERS' COMPENSATIO CO ERAGE 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 IN 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 COMPE SATION, 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-builderwill have the burden of proving that he or she did not build or
improve for the purpose of sale.). r APPLICANT ACKNOWLEDGEMENT
(_) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 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 Law.). whose benefit work is performed under or pursuant to any permit issued as a result of this application,
I—) I am exempt under Sec. B.&P.C. for this reason 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. - • +
• 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 here y authorize representatives
of this unty to enter upon the bove-mentioned pro or nspection purp esi, .
Lender's Name: -
- - - - ate: 3 / Si ture (Applicant or Agent): .
Lender's Address: -
.LQPERMIT f -
Application Number 06-00001008
Permit PLUMBING
Additional desc ..
Permit Fee. 22.50
Plan.Check.Fee
00.
Issue Date . . . .
Valuation
. .
. 0
Expiration Date 9/09/06
Qty Unit Charge Per
Extension
BASE
FEE
15.00
'1.00 7.5000 EA PLB WATER HEATER/VENT
7.50
Special Notes and Comments
WATER.HEATER CHANGE OUT
Fee summary Charged
Paid Credited
Due
Permit Fee Total 22.50
.00
.00
22.50
Plan Check Total .00
.00
.00'.00
Grand -Total 22.50
.00
.00
22.50
Bin #
City of La Quinta
Building & Safety Division
P.O. Box 1504, M-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Permit Application and Tracking Sheet
Permit :#
61
0Building
Project Address: A,,7- 560 ) A M,prJ�Gv
Owner's Name: fZ i gA-e�i> P6 V (,:- L'/.,J
A. P. Number:
Address: 4 ! (� -V i Ar t4V J 7
Legal Description:
Contractor: I oe tpL, LcJdff3�.J(�
City, ST, Zip:, A Q V 1 jL) 7 %k (—"A
Telephoner%7 % -7875 z
Address: — eZS. LiG�j�
Project Description.
City, ST, Zip: f A-u'V\ L C_iL7 ZZ�
Telephone:
State Lic. # :6 �) S 7 (178.
City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
Construction Type: Occupancy:
State Lic. #:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project: Sine
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
Energy Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading, plan
2°" Review, ready for corrections/issue
Electrical
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