11-0067 (PLBG)P.O. BOX1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 11-00000067
Property Address: 80795 VISTA BONITA TR
APN: 777 -040 -016 -
Application description: PLUMBING
Property Zoning: VERY LOW DENSITY RES
Application valuation: 1000
T4tit 4 4 Q"
Architect or Engineer:
PIS
BUILDING & SAFETY DEPARTMENT
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 Professionals Code, and my License is in full force and effect.
License Class: C53 (�Lic o.: 614611
/at tractor:
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 ISec. 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 fora permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500)•:
(_) 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.).
(_ 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. , BAP.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: ir
LQPERMIT
Owner:
KERCHER
80-795 VISTA BONITA TRAI 0
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/19/11
V JqN Ro
Contractor: j%
MCINTYRE POOLS & SPA INC C%fly
83695 AVENUE 45 F�Nq�,'�Sib�NT-
INDIO, CA 92201
(760)342-3612
Lic. No.: 614611
----------------------------------------------—
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.
Y, 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 GOLDEN EAGLE IN Policy Number 2010010139097Z
_ 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
r3t_700 of the or Code, I shall forth comply wit) those provisions.
ate: av Applicant:
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 that the above information is correct. I agree to comply with all
city and c unty ordinances an -state laws relating to building construction, and hereby authorize representatives
of this u ty to enter upo he above-mentioned property fo ins tion eposes.
15'ate / ignature (Applicant or Agent)'
Application Number . . . . . 11-00000067
Permit
PLUMBING
Additional desc .
.
Permit Fee . . .
. 33.00 Plan Check Fee..
8.25
Issue Date . . .
. Valuation . . .
. 0
Expiration Date .
. 7/18/11
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 3.0000
EA PLB GAS PIPE 1-4 OUTLETS,
3.00
1.00 15.0000
EA PLB GAS METER
15.00
----------------------------------------------------------------------------
Special Notes and
Comments
INSTALL METER, 360
L.F. 2" POLY GAS LINE
(MEDIUM PRESSURE,
TRACER WIRE REQUIRED).
2010 CODES.
----------------------------------------------------------------------------
Other Fees . . .
. . BLDG STDS ADMIN (SB1473)
1.00
Fee summary
Charged Paid Credited
----------------------------------------
Due
-----------------
Permit Fee Total
33.00 .00 .00
33.00
Plan Check Total
8.25 .00 .00
8.25
Other Fee Total
1.00 .00 .00
1.00
Grand Total
42.25 .00 .00
42.25
LQPERMIT
CA� REQUEST FOR SCG USE ONLY
X'_ _ E RESIDENTIAL GAS SERVICE
ASSIGNED PLANNER
Please lupe or use legible BLOCK lettering to complete form
Lied b fr irn
go 7� V1 54r,
r& n I -H Tri« 1 I- a Gam,,`°` tlrmr C
Ram (Comp) /
000 Clothes Dryer Stab
�„
ne =Stub C� a sc oov mac, co
iWaffHeater - Tank (staadaQ.d)
k+� p Stub
NAME - As it sboald appear on the Contract
Ki m W- G
SOCIAL SE
lea 93
D PHONE # (w/Area Code)
-
STREET ADDRESS (Include Apt/Suite. or Bldg Info - No P.O. Box)
8o s �� s i3� v� ; 7A • V -J--
CITY
c -A O o , N A
ZIP C ODE
qa
PARENT COMPANY NAME
awn
MAILING ADDRES different than street address)
RS viSJa (kg,,/4
CITY
T i - kA QeJ N e�
STATE
"CA
CODE
25'3
CONTACT NAME & TITLE e7t&ffacotwe
DAY PHONE # (w/area code)
FAX # (w/area code)
EMAIL ADDRESS FOR CONTRACT DELIVERY (REQUIRED)
CELL I # (w/area code)_
CES 2 # (w/area codeLL
I
NAME TITLE
EMAIL ADDRESS DAY #(w/Ag CELL # w/AC
�EQUMTED GAS PIPE INSTALL DATE (REQUIRED)E- ' I REQUESTED GAS METER WRN ON DATE p1 a n
GAS INSTALLATION REQt1E3TED (Cheek Orin): I CONSTRUCTION TYPE (Check One):
INGas Line to Structure w/Meter(s) a Meters) Only ® Single Family ❑Condosrrownhomes,
❑ Subamsioo/fract Dev a Extend Swb(s) in Tract App ❑ Other
Lca polou
rC bbe0.1
INSTALLATION METHOD:
E] Gas Company Provided Cres Only Trench
5JApplicant Provided Gas Only Trench
ApphcaW Provided lent Trench
Planed # of Dwelling Units: SCG Marketing Representative, N known:
Planed # of Central or Community Facilities (Recreation Cent, Pool Heater, Spa, Laundry Roost, Eta-)
Gas Appliance Quantity
MBTU Gas Appliance Quantity MBTU
Ram (Comp) /
000 Clothes Dryer Stab
�„
ne =Stub C� a sc oov mac, co
iWaffHeater - Tank (staadaQ.d)
k+� p Stub
Heater - Taaldess
Natutal Gas Powered Sp&Tool Heater400 000Hee.
- Furnace. Wall Heater. etc
506. Gr'D Naknal Gas Powered Air Conditioning
Gas Appliances (Specify): ,�� ,6�E' Q v ooC_ Please provide information on: E)Applieant Design
Applicant Install - Rule 20 section G allows the SPPIiC nt to receive a oompektive gas installation bid, if desired. If the Al bid option is selected, a gas line
ext won may be installed by the Applicant's SoCalGas certified and approved h>,stallar and installed per SoCalGas design and installation specilicstl0m
If sdecb4 the Applicant is responsible for, but not limited to, all applicable pwmits, paving, trenching, aFproved material, and SoCalGas inspection.
SoCalGas does not refer or recommend Applicant Installer's to Applicants due to anti-competitive preferential treat rules.
Please select one (REQUIRED): g4ol- SoCalGas Install E]Opdon 2 - Recucst Applicant Install Competitive Bid Infwnatie
Appfiaatfo+rSubmitted By. ►(.wu t�,_: SGI,� Title. �.(,) t G / e' j1�c oZOCi
Please save form as 'Zip Code -Project Location" Le "90013-555 W 5th St." and °
Submit saved file to SoCalGas by either E-mail or Far:
'- 'Forma (09/201E-Ma
f/ to newbusinessprocessteam�a Le-WraudUdes coon or F 66) 593-7380
Bin #
City of La Quinta
Building Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
19
Project Address: — S Aoywk
Owner's Name:
A. P. Number:
Address: 130 —242S i EkL
Legal Description:
City, ST, Zip: C
Contracto r: e
Telephone: .."::>z;•s;'
�' rY �r s<' ,
Address:Q S
Project Description: i VI
City, ST, Zip: e
Telephone:•
• ..,.� • .
State Lie. #: C-51 61L/ '
City Lie. #;Cl 4S
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone: { , y. '
State Lie. #: rr`• %,
Name of Contact Person:
Construction Type: -Occupancy:
pro ect type circle one New Add'n Alter Repair Demo
Sq. Ft.:
#Stories:
#Units:
Telephone # of Contact Person: S - 6
Estimated Value of Project:
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 Che.1t Deposit
Truss Calcs.
Called Contact Person
Plan Chezk Balance
Title 24 Cales.
Plans.picked up
Construction
Flood plain plan
Plans resubmitted
MechanlLal
Grading plan
2i° Review, ready for correctionsfissue
I
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
Review, ready for correctionstissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees