10-1180 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: (;-19-00001180 �,.'
Property Address:_ 50475 VISTA MONTANA
APN: 772-260-007-
Applicant: -1, Architect or Engineer:
plia
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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 _ II force and effect.
Lice sse ass: A B' C36 icense No.: 79348
l' v NER-BUILDER DECLARATION
I hereby affirm and ty Of p at I am exempt from the Contractor's State License Law for the
following reason (Sec. 7031. , usiness 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 _ 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—) 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: + .
Lender's Address:
LQPERMIT
Owner:
CHUCK FRASE
50-475 VISTA MON
LA QUINTA, CA 92
Contractor.(__
SO CAL & ASSOCIA ES PIC
P.O. BOX 955
YUCCA VALLEY, CA 92286
(760)369-4104
LiC. No.: 793482
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/04/10
NOV 04 2010 ID
------------------
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. t
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 STATE FUND Policy Number 1820769-2010
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 tfbd Labor Code p y wi
WARNING: FAILURE 1'CjJj3 EAS` COMPENSATION COVERAGE IS UNLAWFUL, AND -SHALL
SUBJECT AN EMPMYER 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 that the above information is correct. I agree to comply with all
city a d county ordinances and state laws relating to building construction, and hereby authorize representatives
of t We,(A
he above-mentioned propert
at ppli r Agen
- -
Application description:
PLUMBING
Property Zoning:
VERY LOW DENSITY RES
Application valuation:
4200
plia
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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 _ II force and effect.
Lice sse ass: A B' C36 icense No.: 79348
l' v NER-BUILDER DECLARATION
I hereby affirm and ty Of p at I am exempt from the Contractor's State License Law for the
following reason (Sec. 7031. , usiness 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 _ 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—) 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: + .
Lender's Address:
LQPERMIT
Owner:
CHUCK FRASE
50-475 VISTA MON
LA QUINTA, CA 92
Contractor.(__
SO CAL & ASSOCIA ES PIC
P.O. BOX 955
YUCCA VALLEY, CA 92286
(760)369-4104
LiC. No.: 793482
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/04/10
NOV 04 2010 ID
------------------
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. t
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 STATE FUND Policy Number 1820769-2010
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 tfbd Labor Code p y wi
WARNING: FAILURE 1'CjJj3 EAS` COMPENSATION COVERAGE IS UNLAWFUL, AND -SHALL
SUBJECT AN EMPMYER 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 that the above information is correct. I agree to comply with all
city a d county ordinances and state laws relating to building construction, and hereby authorize representatives
of t We,(A
he above-mentioned propert
at ppli r Agen
Application Number . . . .
10-000.01180
Permit . . . PLUMBING
Additional desc
Permit Fee 60.00
Plan Check Fee
15.'00
Issue Date
Valuation . .
0
Expiration.Date 5/03/11
Qty- Unit Charge Per.
Extension
BASE
FEE
15.00
1.00.,'45.0000 EA PLB
SEPTIC
45:00
Special Notes and Comments
REPLACE 1500 GALLON FIBERGLASS
SEPTIC
TANK WITH NEW CONCRETE_TANK OF
LIKE
SIZE. 2007 CODES.
Other Fees ' ..
BLDG " STDS _ ADMIN - (SB1473)
Fee summary Charged
Paid Credited
`Due
Permit Fee Total 60.00
.00 .00
60.00
Plan,Check'Total 15-.00
.00 00
15.00
Other Fee ;Total 1.00
.00* .00
1.00
Grand Total 76,.00
.00 .00.
76: 0-0.
Bin #
_ - -ce
jay of UQ
uin
Building & Safety DivWm
Permit # P.O. Box 1504, 78-495 Calle Tampko
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Proje« Address: � � 2
$ ces Name
A. P. Number:
Ate:
Legal Desaipaon: City. ST. Zip:
Contractor Telephpnt:
Address:
Project Des<riPtioh:
.City. ST. Zip:
Telephone:
State Lic. #
Arch., EW.. Designer.
AdQ =:
City. ST. Zip:
Telephone:
State L10,- .#: .
Name of Comact person:
Tclephoap # of Contact person:
# Submittal Ra
Plan Sets
Strnetaral ales.
Truss: ales.
Title 24 Calls.
Flood plain plan
Grading plan
Subeoatactor List
Grant Deed
H.O.A. Approval
IN HOUSE: -
Planning Approval
Pub. Wks. Appr
School Fees
Lie. M
c
-" 1
Plan Cheek
Reviewed.
Called Con
Plans picked
Plans resub
2'! Revkw,
called con
Plana pick
Plans resa
Review,
Called Con
Date of
albmitoed Item Amount
ready for corrections Pian Check Deposit
Conti Person Plan Check Balance
up Coostrueson
mitted MechaNeal
ready for correetionwissue Electrical
taet Person Plambing
ed Cap S 14LI.
bmitted Grtdiog
ready for eorrections/iasde Developer Impact Fee
tact Person AXP.P.
permit Issue
Total Permit Fees