BPLB2015-0018Tit,,
D VOICE (760) 777-7125
78-495 CALLF,TAMPleO I FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 2/9/2015
Application Number:
BPLB2015-0018
Owner:
Property Address:
56162 PEBBLE BEACH
JAMES A BROCKMAN/BROCKM �`:TR
APN:
775132019
56162 PEBBLE BEACH
z
Application Description:
BOB EDWARDS CONSTRUCTION/BROCKMAN/90LF OF GAS LINE FOR
LA QUINTA, CA 92253
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Property Zoning:
FUTUR
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Application Valuation:
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$1,000.00
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G>a
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Applicant:
Contractor:
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BOB EDWARDS CONSTRUCTION INCOR
BOB EDWARDS CONSTRUCTI
IRIN
51-455 DESERT CLUB DRIVE
51-455 DESERT CLUB DRIVE
LA QUINTA, CA 92253
LA QUINTA, CA 92253
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 Lic ns is in full force and effect.
License Cla s: C27 License No.: 68 5
� r
Date: 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).:
(_) 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.).
(_) 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 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 Name:
Lender's
(760)777-8202
Llc. No.: 684857
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 ork for which this permit is issued.
tun
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 manners to become subject to the workers'
compensation laws of California, and ogre that, i sho d beco s bject to the
workers' om ensation provisions of Sect on 37 of th L C I shall forthwith
comply 11h Pose provisions.
Date:JA411 1,6 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 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 an at w r to buildin
construc ion and hereby authorize representatives of is cit o e u the abo e•
mention d goperty for inspection purposes.
Date:10 6 Signature (Applicant or Agent):
FINANCIAL 1 -
+ DESCRIPTION , { ACCOUNT; . ��`: QTY, ,AMOUNT' . PAID',
'PAID DATE7
BSAS SB1473 FEE 101-0000-20306
0
$1.00 $0.00
_ '°PAID,. BY =; W ', , _ .,'METHOD ::,,,
; _RECEIPT # CHECK #.
CLTD BY
Total Paid forBUILDING STANDARDS ADMINISTRATION BSA: $1.00 $0.00
`• DESCRIPTION .',,
;ACCOUNT-'`
QTY
AMOUNT
" `PAID .
PAID DATE
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
1
l
PAID BY
; ' ' METHOD - r
' RECEIPT #'
CHECK #
CLTD BY
Total Paid for PERMIT ISSUANCE: $91.85 $0.00
-1 `DESCRIPTION
ACCOUNT;
QTY
AMOUNT '-_
PAID .
PAID DATE
GAS SYSTEM, 1-4 OUTLETS
101-0000-42401
•0
$12.09
$0.00
y, PAID BY.'-., .; :.
`:';' . METHOD . - ',
RECEIPT#• ,
..• CHECK#
CLTD BY,
- DESCRIPTION
r. ACCOUNT ., : ,''
QTY
" AMOUNT
PAID -
PAID DATE
GAS SYSTEM, 1-4 OUTLETS PC
101-0000-42600
0
$24.17
$0.00
PAID BY,
• _METHOD
REEIPT#
CHECK #
CLTD BY
Total Paid for PLUMBING FEES: $36.26 $0.00
TOTALS:00
�
Y
1
l
Description: BOB EDWARDS CONSTRUCTION/BROCKMAN/90LF OF GAS LINE FOR FUTUR
Type: PLUMBING Subtype: Status: UNDER REVIEW
Applied: 2/9/2015 SKH
Approved.
Parcel No: 775132019 Site Address: 56162 PEBBLE BEACH LA QUINTA CA 92253
Subdivision: TR 20717-2B CM 060/60-69 CM 060/51- Block: 'Lot: 1
Issued:
59
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: 90LF OF 11/4 INCH GAS LINE FOR FURURE USE AT BACKYARD. 2013 CALIFORNIA BUILDING CODES.
.CHRONOLOGY
CONDITIONS
CONTACTS
lNAMETYPE
NAME
ADDRESS1
-CITY
STATE
ZIP-
-•PHONE
EMAIL re'
�^
�--PHONE-
APPLICANT
APPLICANT
BOB EDWARDS CONSTRUCTION
51-455 DESERT CLUB
LA QUINTA
CA
92253
(760)777-8202
INCOR
DRIVE
CONTRACTOR
BOB EDWARDS CONSTRUCTION
51-455 DESERT CLUB
LA QUINTA
CA
92253
(760)777-8202
INCOR
DRIVE
OWNER
JAMES A BROCKMAN/BROCKMAN
56162 PEBBLE BEACH
LA QUINTA
CA
92253
(760)777-8202
TRUS
FINANCIAL INFORMATION
Printed: Monday, February 09, 2015 11:14:27 AM 1 of 2 CR
. GY.STFM.0
DESCRIPTION =
ACCOUNT
'QTY`
AMOUNT
PAID -'
PAID DATE;
RECEIPT#
# `
METHOD'
PAID BY
LTD
t
;CHECK
fBY;
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•
$91.85
$0.00
Total Paid forPERMIT 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:00
INSPECTIONS
SEQID- INSPECTION TkYrPE;€-r, -INSPECTOR SCHEDULED COMPLETED
..~i. -s
'R_ ESULT.M-< 'REMARKSNOTES .
DATDATE E
4 .
PLUMBING FINAL"
REVIEWS
:: .RETURNED STATUS REMARKS
REVIEW TYPE• REVIEWER . SENT DATE DUE DATE • XNOTES:
DATE _ ?
BOND INFORMATION
Printed: Monday, February 09, 2015 11:14:27 AM 2 of 2 Cff?
SYS7FM.S
i
Bin #.
Permit
Project Address: �j�b —
- City of La Q all] to .
• Building u Safety Division
P.O. Box 1504; 78-495 Calle Tampico.
La Quinta, CA 92253 - (760) 777-7012.
Building. Permit` Application and Trackin Shee
1 Z e Owner's Namc: l yy�
A. P. Number:
_•
Address:
Legal Des ' ti n:
City, ST, Zip:
Contractor:w
Telephone:
Address: �j(—
Proj " .Description:
City, ST, Zip:.
ljtj
Telephone:
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:
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Statc Lic. # :
City Lic. #;
qlA2
Arch., Engr., Designer:
Address: `t l
City., ST, Zip:
�-
Telephone: (' �—
`=`; ;: s:;z:;;:.>•.„”<?:::r,::;
Construction Type: Occupancy:'
State Lic. #:
Project type (circle one): New Add'n Alter. Repair Demo
Name of Contact Person: �k
Sq. Ft.:
# Stories:
Tcicphonc # of Contact Person:
7UC! —Z?Z —9201?�
Estimafed Value of Project: ,
V- oc
)Coo-
APPLICANT: DO NOT WRITE BELOW THIS LINE
# Submittal Rcq'd Rcc'd TRACMIG PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Struclural Cates.
Reviewed, ready for corrections
Plan C1uckDcposit
Truss Cala.
Called Contact Person.
Plan Cheek Balance.
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2'4 Review, ready for eorrcctionsfissue
Electrical
Subeontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
al
Plans resubmitted
Grading
HOUSE:-'r°
Rcyicw, ready for eorrcclionsrissuc
Developer Impact Fee
oval
KtA
Called Contact Person
A.T.P.P.
Wks.r
Date of permit issue
Total Permit Fccs
i