10-0061 (PLBG)4 P.O. BOX 1504 ^' VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 1/25/10
Application' Number: ,10-0000006 Owner:
Property Address: 49515 VISTA LUNA RITTLER
APN: 602-180-999-4 -29457 - 49515 VISTA LUNA
Application description: PLUMBING LA QUINTA, CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL
0 0
Application valuation.
1 0
• - LICENSED CONTRACTOR'S DECLARATION
'WORKER'S COMPENSATION DECLARATION .. -
Contractor:
Applicant:
Architect or Engineer-
TESERRA
- _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided -
P.O. BOX 1280
_ for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
COACHELLA,"CA 9223
OL
issued.
I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
(760098-9222
Lic. No..: 656128
Code, for the performance of the work for which this permit is issued. My workers' compensation
OWNER -BUILDER DECLARATION -
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
I hereby affirm under penalty of perjury one of the following declarations: -
Section 7000) of Division3 of the Busine 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 Cla s: C,8, 10, 27,2 License No.: 656128
_ for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
at 1 en -tractor,-
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 I am exempt from the Contractor's State License Law for the
Carrier SEABRIGHT INS -Policy Number BB1100510
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
- - 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 -
' of the Labor C e, I shall forthwith comply with thoseprovisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 byo`d\
�370
/any
applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: u
- (_) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
Date: Appl' "nt:c
~
$ t. -
- - - the structure is not intended or offered for sale (Sec. 704.4, Business and Professions Code:' The '. -
WARNING: F E TO SECURE 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 1$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 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 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 fora 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(sl 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;
1 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 Ouinta, its officers, agents and employees for any act or omission related to the work being -
_
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
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.
hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the -
I certify that I have read this application and state that the bove information is correct. I agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.)• -
city and county ordinances and state laws relating to build; construction, and hereby authorize representatives
-
-of this county o en r upon the above-mentioned property f inspection purposes.
Lender's Name:
D to ature (Applicant or Agent):
- 'Lender's Address:
.
LQPERMIT _
I•y
lull
Application Number
10-00000061
Permit . . . PLUMBING
Additional desc .
Permit Fee 19.50
Plan Check Fee
4.88
Issue Date . . . .
Valuation
0
Expiration Date 7/24/10
Qty, Unit Charge Per
Extension
BASE
FEE
15.00
6.00 .7500 EA PLB
GAS PIPE >=5'
4.'50
-----------------------------------------------------------------------
Special Notes and Comments
190 L.F. 2" GAS LINE & 6 STUBS.
2007
CODES
--- - - - - - - - - - - - - - - - - - - - - - - - - -- -- - - -
Other Fees
- -- -- - - -- -
BLDG STDS ADMIN (SB1473)
- --
_ 1.00,
Fee summary Charged
----------
Paid Credited
-------------------------------
-Due
-----------------
Permit Fee Total- 19.50
.00 00
.4.
19.50'.
Plan Check Total 4.88
.00 .00
'4 88
Other Fee Total 1.00
.00 .00
1.00
Grand Total 25.38
.., :00 .0.0
25.38 _ ..
LQPERMIT
Bin #
Permit # t n�.
�V
Project Address:
Cit/ Of La Quinta
Building 8z Safety Mislon
P.O. Box 1504, 78-495 Calle Tamplco
La Qulnta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Owner's Name: L-
A. P. Number.
Address: Y'? -V-5 1 S T (—V, -J,%, -
Legal Description:
City, ST, Zip: LA aw A CA 9Z 2 S 3
Contractor:
CQA
Telephone:
z<�s , • .:
w:.
Address: 8 6 —100 AVE
� C.��2-�
Project Description: go L
City, ST, Zip:
z ►�
6
Tel hone 6 �%8 /r2
eP O Z 2
k;^
State Lic.
Arch., Engr., Designer.
City Lic. #: - -
Address:
City., ST, Zip:
Telephone:
State Lic. #:�.:�,,
Name of Contact Person
a -
o nn
Construction Type: Occupancy:
Project" (circle o4: New) Add'n Alter Repair Demo
Sq: FL:
# Stories:
# Units:
Telephone # of Contact Person: . 0 ;7 23 1 8 Estimated Value of Project: /00 0.
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Plan Sets
RN'd
Rec'd
TRACIONG
Plan Check submitted
PERMIT FEES
Item Amount
Structural Cities.
Reviewed, ready for corrections
Plan Check Deposit
'Fuss Calcs.
Called Contact Person
Plan Check Balance
Tide 24 Caics.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
V Review, ready for correctionsitissue
Electrical
Subcobtactor Liat
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'`� Review, ready for correctionsfissue
Dcveloper Impact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
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I 'F STREET 49-515 VISTA LUNA
JOBADDRESS RANCHO LA OUINTA - MONTARAS ICITYLA OUINTA
DAT • •O BY 1 ', - y - LOT
TPHONE D� RES
TRACT PAGEBOOK .
• + . MAP BOOK PAGE NO. lCm
. )M ADDRESS
• - - .l :. - _ _ ry A ` - CONSTRUCTION OFFICE PHOIJE NO.
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--
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REPRESENTATION ONLY, FIELD LAY I - A�tss MASONRY PEEIVIA ^l'°"r3` k'g`xTt`
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PRE -PE BLE - DRAINAGE NOTETIArpMr�BeldpoM, ly Delaz, .