09-0894 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
VOICE (760) 777-7012
r — FAX (760) 777-7011
BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Application Number: 09=000008941,,
Property Address: 48239—VISTA DE NOPAL'
APN: 646 -110 -006 -
Application description: PLUMBING
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 400 y
Applicant: Architect or Engine
Date: 8/21/09
Owner:
HOLLIUSHEAD RESIDENCE
48-239 VISTA DE NOPAL O
LA QUINTA, CA 92253
(403)286-3430
�4
Contractor: 4110 O
5 855 WASHINGTON STR CINC
LA QUINTA, CA 92253 J 1iq ;r✓ y
(760) 485-9269 ar .• %�sj,:
S rC•�a ✓p.Q
Lic. No.: 781,834 � r
--- -------------------------------------------- - ---------- - ------------- ---- ----
LICENSED CONT R' DECLARAT ON _ - WORKER'S COMPENSATION DECLARATION '
1 hereby affirm under penalty of perjury that I am licen under pr vi ' hapter 9 (commencing with 1 hereby affirm under penalty of perjury one of the following declarations: - -
Section 700 1 of D' ision 3 of the Business and Pr si aIs td 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 CIa : B, - o.: 781834 - - for by Section 3700 of the Labor Code, for the. performance of the work for which this permit is _
issued.
D-afe:• �/ ontractor:� 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 EXEMPT Policy Number EXEMPT
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 wh' f s ermit 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 . 'AWARNING:
n any.manner so as to become sub' o t ers ompensation -of. California,
r permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State e that, if I should become sub' t rkers' ion provisions•'of Section -
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or "f the Labor Code, I shall fo co provisions.
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 (5500).: - lpplicant. i1, as owner of the property, or my employees with wages as their sole compensation, will do [he work, and !the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The O SECURE W ERS' 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 ($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, ANDATTORNEY�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 for a 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(s) 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 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.
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 dale of issuance of such permit,ar
at
o work for 180 days will subject
CONSTRUCTION LENDING AGENCY permit to'cancellation.
1 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 ab informatio r gree to comply with all
'work for which this permit is issued (Sec. 3097, Civ. C.). city and co ty or finances and state laws relating to build' co tr y authorize representatives
• of this Zt upon the above-mentioned prop y for ' es.
Lender's Name:ignature IApplican[ or Agent)
Lender's Address:
w
LQPERMiT - -
Application Number 09-00000894
Permit . . . PLUMBING
-
Additional desc .
Permit Fee . . 18.00.
Plan Check Fee
4.50
Issue Date
Valuation . . .
0
Expiration Date 2/17/10
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
GAS LINE FOR FUTURE FIRE PIT PER
" APPROVED PLANS & S.T.
----------Q-------------------------------------
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
LQPERMIT
City of La, Quinta
Building 8T Safety Division
Permit # P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
v Building Permit Application and Tracking Sheet
4Pro'eci'Address: q r x �''sNa
Z� C �b �� e_4`i O 4 \ Owner s Name:
A. P. Number:
Addres"s:` 'qgl3 1 V",-S+A ea_ qO PAS
Legal Description:
City, ST, Zip: ;j 0(22.S3
Contractor: —Ft`
c.tr
<3
Telephone: .,
Address: SO
2-7-7Projectbes`cription:
(,Iq S (I3vrr k
City, ST, Zip: J L wTa�•
Telephone: ?(.0 LN �i�7 !
State Licaa# : 931 g3 I
°� 2Z
su` `.f r•,,: <:a;;.:r «x>„. .
City Lic. #;
Tl� v f'e—
Arch., Engr., Designer.
Address:
City, ST, Zip:
Telephone:
x
�.-,•. '"}.
yyr> �<
Construction Type: Occupancy:
State Lic: #:
-
Project type (circle one): New Add'n Alter Repair Demo -
Name of Contact Person:
Sq. FL-
# Stories: T# Units:
Telephone # of Contact Person: ' �-
- o• a0
Estimated Value of Project:
APPLICANT: DO. NOT WRITE. BELOW THIS LINE
# Submittal Req'd Read TRACMG PERMIT FEES
Plan Sets
Plan Check submitted
Item Amount
Structural Caics.
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
tae Review, ready for correctioustissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up.
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'rd Reyiew,.ready for correctionsfissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees