13-0075 (PLBG)" P -O. BOX 1504
78-495 CALLE'TAMPICO
LA QUINTA, CALIFORNIA 92253
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BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number:
(13- 000O0T5
Owner:
Property Address:
80961 VISTA
DEL MAR
LAWSON RESIDENCE
APN: .'
772-260-021-
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80961 VISTA DEL MAR
Application description:
PLUMBING
LA QUINTA, CA 92253
Property Zoning:
VERY, LOW DENSITY RES
issued.
Application valuation:
2200,
1 have and will maintain workers'. compensation insurance, as required by Section 3700 of the Labor
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,Code, for the performance of the work for which this permit is issued. My workers' compensation .
OWNER -BUILDER DECLARATION
Contractor:
Applicant:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
Architect or Engineer:
STEFFEN PLUMBING 'IN
G/�
/
81337 AVENIDA GAVIO A,,
person in any manner so as to become subject to the workers' compensation laws of California,
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INDIO, CA 92201
and agree that, if I should become subject to the workers' compensation provisions of Section '
' License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
R/
(760)775-3659
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
,
LiC..No.: 801343
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: - 1/23/13
Jura 44:09� D
LQPERMIT
. LICENSED CONTRACTOR'S DECLARATION'
WORKER'S COMPENSATION DECLARATION -
I hereby affirm under penalty of perjury that I am licensedunder provisions of Chapter 9 (commencing with .
I hereby affirm under penalty of perjury one of the following declarations: '
Section 7000) of Division 3 of the Business and Professionals Code, 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 ,
" License lass: C36 license No.: 801343
for by Section 3700 of the Labor Code, for,the performance of the work for which this permit is
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issued.
.. Date, /Contra or.
1 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 -BUILDER DECLARATION
insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
Carrier TOWER INS Policy Number WCCO0303360
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 provisions of the Contractor's State
and agree that, if I should become subject to the workers' compensation provisions of Section '
' License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
3700 of the Labor Cc I all fo ith comply with those provisions. -
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).:
- (W
Date~ PPl,can -
I _ I I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
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the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
WARNING: FAILURE TO SEC WORKERS' COMPENSATION COVERAGE.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 FINES 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 COMPENSATION, DAMAGES AS PROVIDED FOR IN
.. improvements are not intended or offered for sale. If, however, the buildingorimprovement is sold within
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
. - 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.).- -
-
- APPLICANT ACKNOWLEDGEMENT -
(_ 1 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 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 ,.
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of La Ouinta, its officers, agents and employees for any act or omission related to the work being
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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 -
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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 herebyaffirm under penalty of perjury that there is a construction lending agency for the performance of the
P Y P I Y 9 9 Y P
I certify that I have read this application and state that the above information is correct. I agree to comply with all -
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work for which this permit is issued (Sec. 3097, Civ. C.).
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city andcountyordinances and state laws relating to building constructi ,and hereby authorize representatives
of this county to enter upon the above-mentioned proper r t i spec j purposes.
_
. -Lender's Name:
-
�
• -
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Date: Signature (Applicant or Age 1:
- Lender's Address:'
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LQPERMIT
Application Number` . . . . . 13-00000075
Permit PLUMBING
Additional desc .
Permit Fee` 18.00 Plan Check Fee
4.50
Issue Date . . . . Valuation . . .
. 0
Expiration 'Date 7/22/13
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
--------------
REPLACE EXISTING GAS LINE PER APPROVED
PLANS PER A.J. 2010 CODES.
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Other Fees BLDG STDS ADMIN.(SB1473)
1.00
Fee summary. Charged -Paid Credited
Due
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Permit Fee Total 18.00 .00 .00
18:00
Plan Check Total 4.50 o0 .00
4.50
Other Fee Total 1.00 .00 00
1:.00
Grand Total 23.50 .00 .00
23.50
LQPERMIT ,.
City of La Quinta
MkOng 8C Sarety Division
P.O. Box 1504, 78-495 Calle Tampko
4-Quinta, CA 92253 -:(760) 777-7012
Building Permit Application'and Tracking Sheet
Permit #
'
Project Addtrss
Owner's Name:. G Y�
A. P. Number
Address: L1 - W ftyr
Legal Description:
Contractor.) i ,
City, ST, Zip: J � � C �'} C� �j7>•
Telephone:
Address: % V` rel
Project Description:
city, ST, Zip: -a
bL
Telephone: 10
a
State Lia N : WCity Lic, 9,
Arc , Eag, Designer.
Address:
City., ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person:Sq.
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
FL:
# Swries a
q Units:'
Telephone # of Contac Petsvn
Estimated Value of Project fl Q
APPUCA111T: DO NOT WRITE BELOW THIS UNE
q
Sobntlttal
Req'd
Reed
TRACKDVG
PERMIT FEES
Pian Seb,
Plan Cheek submitted
Item Amount
Structural Calcs
Reviewed, ready for corrections
Plan Chcck Deposit. .
Tttyss Cates.
Called Contact Person
Plan Cheek Salanee
'title 24 Cates
Plass picked up
Construction
Flood plata plea
Plans resubmitted..
Mechariical
Grading plan
2•! Review, ready for correctionsfissue
Electrical
Subcontector List
f
Called Contact Person
y
Plumbing
Grant Deed
Pians picked up
S -KL
H.O.A. Approval
;
Plans resubmitted
Gradlag
IN HOUSE:- .
3r4 Review; ready for correttiondissac
Dcvdoper Impact Fee
Planning Approval
Called Contact Person
AA.P.P.
Pub. Wks. Appr '
Date of permit Issue
school Fe"
V
Total Peroiit Fees
Y
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