09-1106 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: t 00001106/ _
Property Address: `50325 VISTA MONTANA
APN: 772-260-004- -
Application description: - PLUMBING
Property Zoning: VERY LOW DENSITY RES
Application valuation: 1621
4•���VINW
- VOICE (760) 777-7012
FAX (760) 777-7011
BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 10/16/09
Owner:
HAMMOND DANIEL E
- 50325 -VISTA MONTANA
LA QUINTA, CA 92253.
--------------------------------
Applicant:, Architect or Engineer:
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 Professionals Code, and my License is in full force and effect.
License Class: License No.:
Date: Contractor:
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, 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 said (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.).
(_ 1 I am exempt under Sec. _. _ _ �B.&P.C. for this reason
Date: vyOwner:
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: PIP
LQPERMIT
Contractor:
Owner
---------------------
WORKER'S COMPENSATION D
I hereby affirm under penalty of perjury one of the following declaration
I have and will maintain a certificate of consent to self-insu
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
_ 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
insurance carrier and policy number are: ,
Carrier Policy Number
I c=at, 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 forthwith comply with those provisions.
ate: A cant: '
WARNING: FAILURE TO SECURE WORKERS' 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 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 t t t above inf rmation is correct. I agree to comply with all
city and county ordinances and state law relating t buil ing con coon, and hereby a ize representatives
of this coun to nter upon the ab •mentioned pr ert for ins etionlpurposes. ..
6ign a (Applicant or Agentl: " ' • _
G
Application Number 09-00001106
Permit PLUMBING "•
Additional desc .
Permit Fee 36.00 Plan Check
Fee
9.00
• Issue Date Valuation
. . .
. 0.
Expiration Date 4/14/10
. Qty Unit Charge Per
Extension
BASE FEE
15.00
8.00 .7500 EA PLB GAS PIPE >=5
6.00
1.00. 15.0000 EA PLB GAS METER
1.5.00
-----------------------------------------------------------------------------
omments
Special Notes and Comments-
INSTALL
INSTALL 2" HOUSE GAS LINE FROM METER TO
EXISTING LINE FROM PROPANE TANK (FOR NEW
NATURAL GAS SERVICE)
---------------------------------------------------------------------------
Other Fees . . .. . BLDG STDS ADMIN (SB1473)
1.00
F.ee.summary Charged Paid Credited
Due
Permit,Fee Total ..36.00 00..
.00
36.00
Plan.Check Total 9.00 .00-
.00
9.00
Other Fee Total 1.00 .00
.00
1.00
Grand Total 46.00 .00
.00
46.00 -
LQPERMIT "-
- -
V
1 �
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Notes:
4
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Propane
Conversion Preinspectio
orksheet
Daft o,�
—
'
Name.
'� secaon:
"area.:
ff,.fD4 N Q
Appliance:
14 Location:
BTU's:
(am.
Convertible?
Yes
Needs Kit?
Yes No
/
Appliance:Location:
i
¢ 's: I
(dmdgoo
Convertible?
o
Needs Kit?
Yea No
Ok,
Appliance:
(
Location- '
Y
BTU's: 15 �)
Convertible?
asNo
j
Needs Kit 7
/l 4 y
e,4-
Appliance:
Appliance:
Location
/O0- - TU's: —/ y d�
"0"")
Convertible?
No
Needs Kit ?
o
[
/T .
Appliance:
LSO
K a Location:
�ewj BTU's:
(a a. a.)
Convertible?
VAD No
Needs Kit ?
Yea ME=)
Ot
Appliance:
O location:
�� . BTU's: O f. O c7
Convertible?
'.
( No
Needs Kit?
Yes No
Applienoe:
(a`
Location:
BTU's: O
Convertible?
No .
Needs Kit ?
No
Appliance:
-✓44 Locatlon:
BTU's:
Convertible?
o b
Needs Kit T'"�
Appliance:L(icatlon:
s:. dd0
-
Convertible?
es No
Needs Kit ?
Yea N90
C&-fw 19,e 4 //(// e
Appllance: -
Location: o-�STU'ec
(amssns)
Convertible?
ZDNo
Needs Kit ?
Yes o
n
G cfl
Appliance:
Location: OO
oOa
BTU's: �
tams" -
Convertible?
Yea 4C>'�-
+ ��
Af
/ .
a
Needs Kit ?
Yea No
`� H �dlU h 1 / , (
`
Appliance:
Location: 41 BTU's: I 40U
Convertible?
(drdeorid
Yes Nd�;?
Needs Kit ?
Yes LIr2
14 4
Appliance:
Location:
BTU's:
(dm.ar)
Convertible?
Yea No
Needs Kit ?
Yes . No
Appliance:
#
Location: .'
BTU's:
(drop sns)
-
Convertible?
Yes No
'
Needs Kit ?
'Yes No
Appliance:
Location:
BTU's:
Convertible?
Yes No
Needa Kit ?
Yes No
,1
Notes:
4
)
e
Bin #
Qty Of Lal Quinta
Building & Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Qulrita, CA 92253 - (760) 777-7012
Building- Permit Application and Tracking Sheet
Permit # 1
o
Project Address: ISO 3� ; o n i a n G Rn
Owner's Name G>
A. P. Number: _
Address: D 3aS j (nM 0 G1.
Legal Description: _
City, ST, Zip: U 1(\A.<- �� 3
Contractor: to Gas W m dl h
Telephone: >:%:' <f s <`'�':. ': `n:?`•:
Address: 15- Cvl�S- J I I J;q(ty- r(
Project Description:
City, ST, Zip:
S _ n'
Telephone:' b
State Lic. # : City Lic.
Arch., Engr., Designer. S
OCAAE "� 00 k ,, c
F6 V- � J KAL Sr � 64
Address:
City., ST, Zip:
Telephone:
;<:v:},"s"<>z:::•::»:}.;...>.,:;:.,:}:<. ,.
'i•`}t:};}<Cf!•.4:1i<:}iT;i<'r'i.Ylun}iY'�:*:E�};.
Construction Type: Occupancy:
State Lic. #:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:
# tones:
#h
Telephone # of Contact Person:
-Units:
Estimated Value of Proj (p o -/V
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Coles.
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
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:-
3' Review, ready for corrections%ssue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. App r
Date of permit issue
School Fees
Total Permit Fees