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09-1076 (PLBG)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA.92253 Application Number: ,Property Address: APN: Application description: Property Zoning: Application valuation: Applicant: --09-00001076 80760 VISTA-BONITA TR 777-040-010- - - PLUMBING VERY LOW DENSITY RES 3200 T4hf 4,4v Q" - Architect or Engineer: �L BUILDING & SAFETY DEPARTMENT BUILDING. PERMIT Owner: ALLEN AUSTIN 80760 VISTA BONITA-TRAIL LA QUINTA, CA 92253 Contractor: JD MECHANICAL INC 39665 ENTREPRENEUR PALM DESERT, CA 922 '(760)360-0711 Lic. No.: 519999 VOICE (760) 777-,7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7.153 Date: 10/07/09 LQPERMIT -------------------------------------------------- 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 Busing and ofessionals Rode, 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 Licen ass: C36 A L- ns No.: 519999 - Date: g ntractor: for by Section 3700 of the Labor Code, for the performance of the 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" OWNER -BUILDER DECLARATION insurance carrier and policy number are: I hereby affirm under penalty of perjury that 1 am exempt from the Contractor's State License Law for the Carrier GOLDEN EAGLE IN Policy Number WEN0011338-03 fallowing 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 theprovisions of the Contractor's State and agree that, if I sho .bec me subject he orkers' 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 C e I s f rt it omp with those provisions. - that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by �[J any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500): Date: (J pplicant: _ - (_) I; as owner of the properly, 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: FAILURE TO SECURE WORKERS' C PENSATION 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 -($1.00,000). IN ADDITION TO THE COST OF COMPENSATION, 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 -builder. will have the burden of proving that he or she did not build or — improve for the purpose of sale.).APPLICANT 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the t 7044, Business and Professions Code: The Contractors' State License Law does 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 personat 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 . , — - 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 Date: Owner: • - --. within 180 days from date of issuance.of such permit, or cessation of work for 180 days will subject , •CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the permit to cancellation. - I certify that I have read this application and state that the above information is correct. 1 agree to comply with all work for which this permit is issued (Sec. 3097, Civ. C.1. - _ city and county ordinances and state laws relating to buildi construction and reb uthorize representatives .- of this county to enter. up the above-mentioned proper[ f r i e tion Lender's Name: % - ate: �['� Signature (Applicant or Agentl: -" Lender's Address LQPERMIT Application Number . . . . . 09-00001076 Permit PLUMBING Additional desc . Permit Fee . . . . 18.00 Plan Check Fee 4.50 Issue Date . . . . Valuation . . . . 0 Expiration Date 4/05/10 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 RUN 289 L.F. 2" GAS LINE FROM METER LOCATION TO POOL HEATER ---------------------------------------------------------------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged Paid Credited -------------------- Due ------------------------------------- Permit Fee Total 18.00 .00 .00 18.00 Plan Check Total 4.50 .00 .00 4.50 Other Fee Total 1.00 .00 .00 1.00 Grand Total 23.50 .00 .00 23.50 LOPERMIT Bin # Qty of La Quinta Building &r Safety Division Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit #P.O. .0�1 Project Address: Owner's Name: E� Tf A. P. Number: Addresslo— Legal Description: City, ST, Zip: L 9aA573 Contractor: T ele Telephone: P Address: 44-5— N. Project Description: City, ST, Zip:A LIAA 1 Al 8 ". TeleP h0 ne ©— r0 Pro State Lic. City Lic. Arch., Engr., Designer: Address: City, ST, Zip: Telephone: Lic. #: - Name of Contact Person: Construction on TP e- Occupancy: Y roJe ct type (circle e one : New Acd'n Alter Repair Demo* Sq: Ft.: #Stories: #Units: Telephone # of Contact Person: ,tel) Estimated Value of Project: gag APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Chuck Deposit Truss Calcs. Called Contact Person Plan Check Balance Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechani-al Grading plan 2°" Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbim; Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- 3 d 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 Pe-mit Fees r Yr ,'7 .,, �.. t x .- ,� -') • ( f � ,•.Z •x IF :' 'F L�. �, ';��..'ry"-if "- .- ..7:Z-f•`![+.iv:'<i: fi�s,•"t" i ,, Y.! t'.Tw..i' .)�L .� : kt a .} - ff•.'gb�, ... "�+� ,�.� a• r� „�. ' •� y�tf K `;'�' Su ..: �{' .r.. Y� i x�"�',`�t e':+ y.^. 2 'O �' S'�."Ls-_ i).t'•` "4 T .^fir-.,' , , rr p.. F.'i•a �` i .• •�. •'S; -� �" - .� s• -i r 'J of '".�:� l�..�' : ifj .,f s� i.-. •.f it ,� �. _ , .:� . it+ S v «, rx � .- . "`_ 1 ,�. .��.-�•��?•Y• cam-b.i :moi>"�.y �-.,-:►.. �•- - iy4'•3. -p--.•+-. `-Tij?"„y'r. ra:.. �_:o-.gym-r...r ,n.N+- -- - '..t...•. ..o -"sem'. t �:¢k+�, • „�.�-�---•i:: � j ` _ . 4.. ,.: tn->��� cr�a mb...:1:.-9x"• yaL Z. 1`shTv f _ r ..f'�• vf' t T -i'✓ �� _ 1 e -' "-} _ .j ,t . -. .• t 1 r f -C• - ��•-y .s`'7 r`t 'i+9 "�`^ a +►. 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