BPLB2016-005524
78-495 CALLE TAMPICO 4.4 QVOICE (760) 777-7125
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011COMMUNITY DEVELOPMENT DEPARTMENT
INSPECTIONS (760) 777-7153
BUILDING PERMIT
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 Profe i ns Code,
and my License is in full force and effect.
License Class: B License No.: 966853
Date: Contract
OWNER -BUILDER DECLARATION
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.).
(� 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
Lender's Address:
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 Ske 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: _ Policy Number:
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 de, I shall forthwith
complywitht ose provisions.
Date: U Applicant:
WARNING: FAILURE TO SECURE KERS' 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 Building Official 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 city toe ;ru pon the
above-mentioned property for inspection purposes.
Date: Signature (Applicant or Agen
Date: 3/28/2016
Application Number:
BPLB2016-0055
Owner:
O
Property Address:
79280 CITRUS
ROBERT PITTS
APN:
776140006
4123 QUINLIN DR
Z
Application Description:
PITTS / GAS LINE FOR FUTURE USE
PLS VDS PNSL, CA 92253
n
Property Zoning:
m
Application Valuation:
$0.00
0O
N
o
6Z .
Applicant:
Contractor:
,o
r^ _=
00
ry
ANDERS HANSON REMODEL INC
ANDERS HANSON REMC
40550 POSADA COURT
40550 POSADA COURT
n n
o�
PALM DESERT, CA 92260
PALM DESERT, CA 9226 =1
(760)895-8186
rn
V
Llc. No.: 966853
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 Profe i ns Code,
and my License is in full force and effect.
License Class: B License No.: 966853
Date: Contract
OWNER -BUILDER DECLARATION
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.).
(� 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
Lender's Address:
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 Ske 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: _ Policy Number:
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 de, I shall forthwith
complywitht ose provisions.
Date: U Applicant:
WARNING: FAILURE TO SECURE KERS' 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 Building Official 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 city toe ;ru pon the
above-mentioned property for inspection purposes.
Date: Signature (Applicant or Agen
DESCRIPTION
FINANCIAL •• •
ACCOUNT QTY
AMOUNT.,
PAID
PAID DATE
PERMIT ISSUANCE
101-0000-42404 0
$91.85
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid for PERMIT ISSUANCE:
$91.85
$0.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
GAS SYSTEM, 1-4 OUTLETS
101-0000-42401
0
$12.09
$0.00 .
PAID BY
METHOD
=
RECEIPT#
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
GAS SYSTEM, 1-4 OUTLETS PC
101-0000-42600
0
$24.17
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid for PLUMBING FEES:
TOTALS:00
$36.26
$0.00
Description: PITTS / GAS LINE FOR FUTURE USE
ADDITIONAL
CHRONOLOGY
ACTION DATE COMPLETION DATE
Type: PLUMBING
Subtype: Status: UNDER REVIEW
Applied: 3/28/2016 SKH
Approved:
Parcel No: 776140006 Site Address: 79280 CITRUS LA QUINTA,CA 92253
Subdivision: TR 24890-7
Block: Lot: 16
Issued:
Lot Sq Ft: 0
Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $0.00
Occupancy Type: Construction Type:
Expired:
No. Buildings: 0
No. Stories: 0 No. Unites: 0
CONTACTS
Details: PLUMBING - GAS LINE FOR FUTURE USE. 2016 CALIFORNIA BUILDING CODES.
CHRONOLOGY TYPE STAFF NAME
ADDITIONAL
CHRONOLOGY
ACTION DATE COMPLETION DATE
NOTES
NOTE
STEPHANIE KHATAMI
3/28/2016
3/28/2016
ORIGINAL PERMIT BCOM2016-0007 (IS COMPLETING MORE
THAN 3 TRADES)
CONDITIONS
CONTACTS
NAME TYPE
NAME
ADDRESSI
CITY STATE
ZIP PHONE FAX EMAIL
APPLICANT
ANDERS HANSON REMODEL INC
40550 P.OSADA COURT
PALM DESERT CA
92260
CONTRACTOR
ANDERS HANSON REMODEL INC
40550 POSADA COURT
PALM DESERT CA
92260
OWNER
ROBERT PITTS
4123 QUINLIN DR
PLS VDS PNSL CA
92253
Printed: Monday, March 28, 2016 3:54:34 PM 1 of 2M
SYSTEMS
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID BY
CLTD
-
BY
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
Total Paid for PERMIT ISSUANCE: $91.85 $0.00
GAS SYSTEM, 1-4
101-0000-42401
0
$12.09
$0.00
OUTLETS
GAS SYSTEM, 1-4
101-0000-42600
0
$24.17
$0.00
OUTLETS PC -
Total Paid for PLUMBING FEES: $36.26 $0.00
TOTALS:• 0•
INSPECTIONS
ATTACHMENTS
Printed: Monday, March 28, 2016 3:54:34 PM 2 of 2
V?W.1YSTEti1S
Bin #
City of LQ Quinta
Building 8T Safety Division
78-495 Calle Tampico.
La Quinta, CA 92253 - (760) 777-7012
✓✓✓ Building Permit Application and Tracking Sheet
Permit #
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Owner's Name:
A. P. Number:
Address: w 2 � 7
Legal Description:
City, ST, Zip: 114 U� j
Contractor: s
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Project Description:
City, ST, Zip: A UV'& �c Y.V
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State Lic. # : g'
City Lie.
Arch., Engr., Designer:
Address:
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State Lic. #:
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Project type (circle one): New Ad n Alter air Demo p
Name of Contact Person: _
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: �°` ��
Estimated Value of Proje Q
APPLICANT: DO NOT WRITE BELOW THIS LINE
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Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cafes.
Called Contact Person
Plan'Check Balance.
Title 24 Cates.
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.
II.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 Fces,
Total Permit Fees
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CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
2 go
41