BPLB2016-004278-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
c&'.r 44Qu;.m
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number:
BPLB2016-0042
Property Address:
78170 CALLE FORTUNA
APN:
770154003
Application Description:
"TAYLOR / APPROVE GAS LINE FOR METER INSTALL
Property Zoning:
Application Valuation:
$250.00
Applicant:
SCOTT COMPANY
P 0 BOX 6196
LA QUINTA, CA 92248-6196
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 Pr ssions Code,
and my License is in full force and effect.
License Clay:C3 License No.: 589994
131 ell—
Date: 0 ! G Contractor:
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 (Sec. 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 for a
permit subjects the applicant to a civil penalty of not more than five hundred dollars
($500).:
(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 foi 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 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 Na
Lender's
11111111111111111111
10
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
TONY TAYLOR
P 0 BOX 73
LA QUINTA, CA 92253
Contractor:
SCOTT COMPANY
P 0 BOX 6196
LA QUINTA, CA 92248-6196
(760)342-2635.
Llc. No.: 589994
Date: 3/8/2016
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 1be work for which this permit is issued.
�� 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: _ Policy Number: _
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 ouId become subject to the
workers' comp sation provisions of Section 3700 the Labor Code, I shall forthwith
comply with th se isions.
P41
Date: v Applicant:
WARNING: FAILUR 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 Building Official 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 art 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 county ordinances and state I s relating to building
construction, and hereby authorize representatives of this cit o enter u on the
above -menti Ined troperty for inspection purposes.
Date: Signature (Applicant or Agent):
FINANCIAL i 1
DESCRIPTION ACCOUNT QTY AMOUNT
PAID PAID DATE
BSAS SB1473 FEE 101-0000-20306 0 $1.00
$0.00
PAID BY METHOD RECEIPT #
CHECK # CLTD BY
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 $0.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid for PERMIT ISSUANCE: $91.85 $0.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
GAS SYSTEM, 1-4 OUTLETS
101-0000-02401
0
$12.09
$0.00
' PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
CITY
AMOUNT
PAID
PAID DATE.
GAS SYSTEM, 1-4 OUTLETS PC
101-0000-42600
0
$24.17
$0.00
PAID BY
'METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid for PLUMBING FEES: $36.26 $0.00
• 1 00
Description: TAYLOR / APPROVE GAS LINE FOR METER INSTALL
NAME TYPE
NAME
Type: PLUMBING Subtype:
Status: UNDER REVIEW
Applied: 3/8/2016 SKH
Approved:
Parcel No: 770154003 Site Address: 78170 CALLE FORTUNA LA QUINTA,CA 92253
Subdivision: DESERT CLUB TR UNIT 1 Block: 8
Lot: 3
Issued:
Lot Sq Ft: 0 Building Sq Ft: 0
Zoning:
Finaled:
Valuation: $250.00 Occupancy Type:
Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0
No. Unites: 0
Details: PLUMBING - GAS LINE FOR METER INSTALL. 2013 CALIFORNIA BUILDING CODES.
SCOTT COMPANY
ADDITIONAL SITES
CONDITIONS
NAME TYPE
NAME
ADDRESSI
CONTACTS
CITY
STATE
ZIP
PHONE
FAX
EMAIL
APPLICANT
SCOTT COMPANY
P O BOX 6196
LA QUINTA
CA
92248-
6196
(760)413-4708
CONTRACTOR
SCOTT COMPANY
P O BOX 6196
LA QUINTA
CA
92248-
6196
(760)413-4708
OWNER
TONY TAYLOR
P O BOX 73
LA QUINTA
CA
92253
1 (760)413-4708
Printed: Tuesday, March 08, 2016 4:08:35 PM 1 of 2 NAff
MUMS
INSPECTIONS
PARENT PROJECTS
ATTACHMENTS
Printed: Tuesday, March 08, 20164:08:35 PM 2 of 2 cp
LYLY SYSTEMS
CLTD
DESCRIPTION
ACCOUNT.
CITY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID BY
BSAS SB1473 FEE
101-0000-20306 _
0
$1.00
$0.00
Total Paid for BUILDING STANDARDS ADMINISTRATION
$1.00 $0.00
:BSA:
PERMIT ISSUANCE
101-0000-42404
0 .
$91.8S
$0.00
Total Paid for PERMIT ISSUANCE: $91.85 $0.00
GAS SYSTEM, 1-4
101-0000-42401
0
$12.09
$0.00
OUTLETS
GAS SYSTEM, 1-4
101-0000-42600
0
$24.17
$0.00
OUTLETS PC.
Total Paid for PLUMBING FEES: $36.26 $0.00
TOTALS: $129ill 00
INSPECTIONS
PARENT PROJECTS
ATTACHMENTS
Printed: Tuesday, March 08, 20164:08:35 PM 2 of 2 cp
LYLY SYSTEMS
Bin #
City of La Quinta
Building Si" Safety Division
78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: g 1 — CkJe
—
Owner's Nameloml I nY IO
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
act r•
Contro .
ele hone:
TP
Address: %'�
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Project Description:
City, ST, Zip:
a Vel•el 'Z yy
Tele P hone: D
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State Lic.
cotial.
Arch„ Engr., Designer:
Address:
City., ST, Zip:
hone:
Telephone:
P
aneY
Construction Occupancy:
Type: I •
TYP
State L ic. #
Project tYPa (circle one): New Add'n AlterRe air Demoo
Name of Contact Person:
Sq. Ft.:
Stories: {
# Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
tf
Submittal
Req'd.
Rec'd
TRACKING
PERMIT FEES
Plan Sets
'Plan Check submitted
Item
Amount
Structural Calcs..
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 .
2nd Review, ready for corrections/issue a
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
I-I.O.A. Approval
Plans resubmitted
Grading
IN IIOUSE:-
Review, ready for correctionsfissue
Developer Impact Fee
Planning Approval
Called Contact Person
Pub. Wks. Appr
Date of permit issue
School Fees,
Total Permit Fees
Ir
COMMUNITY DEVELOPMENT DEPARTMENT
LUIS URIBE
BUILDING INSPECTOR
DIRECT (760) 777-7015
OFFICE (760) 777-7125
78-495 CALLE TAMPICO
FAX (760) 777-7011
LA QUINTA, CA 92253
EMAIL: luribe®la-quinta.org
? � - � 7 o CaP,P g �,�. �•�.
CITY ®F LA C UINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION o,
• DATE=�'�BY �\�
400,00 6-rL.L,
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