BPLB2015-011678-495 CALLE TAMPICO 4
LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number:
Property Address:
APN:
Application Description:
Property Zoning:
Application Valuation:
Applicant:
OROZCO OMAR K
51260 CALLE PALOMA
LA QUINTA, CA 92253
BPLB2015-0116
51260 CALLE PALOMA
770173001
OROZCO/CONVERT FROM PROPANE TO NATURAL GAS
$1,000.00
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing with Section 7000) of Division 3 of the Business and Professions Code,
and my License is in full force and effect.
License Class: License No.::CONV:140528301254133339
e: Contractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State
License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
city or county that requires a permit to construct, alter, improve, demolish, or repair
any structure, prior to its issuance, also requires the applicant for the permit to file a
signed statement that he or she is licensed pursuant to the prcvisions of the
Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division f
3 of the Business and Professions Code) or that he or she is exempt therefrom and the
basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a
permit subjects the applicant to a civil penalty of not more than five hundred dollars
($ 00).:
41111111111M. 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.).
(V) 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.).
((V) I am exempt under Sec. . B.&P.C. for this reason
Date: Ib' OwIft
CONSTRUCTION LENDING AGENCY
1 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:
26
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
OROZCO OMAR K
51260 CALLE PALOMA
LA QUINTA, CA 92253
Contractor:
OROZCO OMAR K
51260 CALLE PALOMA
LA QUINTA, CA 92253
LIC. No.::CONV:140528
Date: 10/16/2015
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.
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: Policy Number:
!&�ertify 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 3700 of the Labor Code, I shall forthwith
comply with those provisions.
Dae: U L Applicant-
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAG 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 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 county ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
Date: ri Signature (Applicant or Agent):
Avp
FINANCIAL • 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
r Total Paid for PERMIT ISSUANCE: $91.85 $0.00
DESCRIPTION
ACCOUNT '
QTY
`AMOUNT
PAID
PAID DATE
GAS SYSTEM, 1-4 OUTLETS
101-0000-42401
0
$12.09
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
GAS SYSTEM, 1-4 OUYLETS 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
TOTALS:00
Permit Details PERMIT NUMBER
��. City of La Quinta BPLB201(5'0116
Description: OROZCO / CONVERT FROM PROPANE TO NATURAL GAS
Type: PLUMBING Subtype: Status: APPROVED
Applied: 10/16/2015 SKH
Approved: 10/16/2015 LUR
Parcel No: 770173001 Site Address: 51260 CALLE PALOMA LA QUINTA,CA 92253
Subdivision: DESERT CLUB TR UNIT 5 Block: Lot: 178
Issued:
Lot Sq Ft: 0 Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $1,000.00 Occupancy Type: Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0 No. Unites: 0
Details: 115LF OF V GAS LINE FROM METER TO HOUSE OUTLET. 2013 CALIFORNIA BUILDING CODES.
Printed: Friday, October 16, 2015 2:31:02 PM 1 of 2 CrIff
SYSTEMS
ADDITIONAL
CHRONOLOGY
CONDITIONS
CONTACTS
NAME TYPE
NAME
ADDRESSI
CITY
STATE
ZIP PHONE FAX EMAIL
APPLICANT
OROZCO OMAR K
51260 CALLE PALOMA
LA QUINTA
CA
92253
CONTRACTOR
OROZCO OMAR K
51260 CALLE PALOMA
LA QUINTA
CA
92253
OWNER
OROZCO OMAR K
51.260 CALLE PALOMA
LA QUINTA
CA
92253
Printed: Friday, October 16, 2015 2:31:02 PM 1 of 2 CrIff
SYSTEMS
Permit Details PERMIT NUMBER
s Cit of La Quinta BPLB20IMS01, 6
PARENT PROJECTS
Printed: Friday, October 16, 2015 2:31:02 PM 2 of 2 CRF
SYSTEMS
CLTD
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID BY
BY
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$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:i0
PARENT PROJECTS
Printed: Friday, October 16, 2015 2:31:02 PM 2 of 2 CRF
SYSTEMS
REVISIONS
DATE DESCRIPTION OF CHANGE
9/10
PLANT PALLET
9/16
3BQ LOCATION
9/29
CHANGES PER
HOA MEETING
10/1
HANGES PER
HOA MEETING
10/1
PAVER AREA
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REVISIONS
DATE DESCRIPTION OF CHANGE
9/10
PLANT PALLET
9/16
3BQ LOCATION
9/29
CHANGES PER
HOA MEETING
10/1
HANGES PER
HOA MEETING
10/1
PAVER AREA
DRAWN
GARZA CONCEPTS
DESIGNED ON:
5/8/15
REVISED DATE:
SCALE
1/81f _ 8'-0"
LOT
SHEET
OF
P
1