BPLB2017-0147r
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Permit Type/Subtype:
PLUMBING/
Application Number:
BPLB2017-0147
Property Address:
54936 SHOAL CREEK
APN:
775141062
Application Description:
GAS LINE
Property Zoning:
Application Valuation:
$800.00
Applicant:
LEAK SPECIALTIES
1268 8TH ST
COACHELLA, CA 92236
Titit 4 ai� Qulgr(v
DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
zs
LOV fi 2Gt7
CITY OF LA QUIPITA
COMMMay 0ELOP"I'll D
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 {commencing with Section 70001 of Division 3 of the Business and Professions Code,
and my License is in full force and effect.
License Class: C36 License No.: 807812
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 contractors) 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 Na
Lender's Address:
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/8/2017
Owner:
MICHAEL LIBERT=LLA
54936 SHOAL CREEK
LA QUINTA, CA 92253
Contractor:
LEAK SPECIALTIES
12688 TH ST
COACHELLA, CA `32236
(760)564-9440
Llc. No.: 807812
WORKER'S COMPENSA7ION DECLARATION
I hereby affirm under penalty of perjury one cf the following declarations:
I have and will maintain a certifica�e of consent to self -insure for workers'
compensation, as provided for by Section 370 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 perfo'mance of the work for which this permit
is issued. My workers' compensation insuran-e carrier and policy number are:
Carrier: EXEMPT 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 sc 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.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UfQGWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMI JAL 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 ACKNC7WLEDGEMENT
IMPORTANT: Application is hereby made to the Building Official for a permit subject to
the conditions and restrictions set forth on the application.
1. Each person upon whose behalf this applcation is made, each person at whose
request and for whose benefit work is perforned under or pursuant to any permit
issued as a result of this application , the own 2r, 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 :he 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 sate 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 purpoZgge
Date ^ �Signatupli�can ont),¢��
: - Z /�L
r
Date: 11/8/2017
Application Number:
BPLB2017-0147
Owner:
Property Address:
54936 SHOAL CREEK
MICHAEL LIBERTELLA
APN:
775141062
54936 SHOAL CREEK
Application Description:
GAS LINE
LA QUINTA, CA 92-253
Property Zoning:
Application Valuation:
$800.00
Applicant:
Contractor:
LEAK SPECIALTIES
LEAK SPECIALTIES
1268 8TH ST
1268 8TH ST
COACHELLA, CA 92236 -
COACHELLA, CA 92236
(760)564-9440
------------------------------------------------------------------------------------•---------
Llc. No.: 807812
Detail: INSTALL 26 LF GAS
LINE TO FURNACE. DISCONNECT AT EXISTING STUB OUT AND REROUTE AND RECONNECT EXISTING FROM GARAGE TO FRONT OF
HOUSE. PER 2016 CALIFORNIA BUILDING CODE.
r
FINANCIAL INFORMATION
DESCRIPTION ACCOUNT QTY AMOUNT
BSAS SB1473 FEE
101-0000-20306 0 $1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PERMIT ISSUANCE
101-0000-42404
0
$98.83
Total Paid for PERMIT ISSUANCE: $98.83
DESCRIPTION
ACCOUNT
QTY
AMOUNT
GAS SYSTEM, 1-4 OUTLETS
101-0000-42401
0
$13.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
GAS SYSTEM, 1-4 OUTLETS PC
101-0000-42600
0
$26.01
Total Paid for PLUMBING FEES: $39.01
DESCRIPTION
ACCOUNT
QTY
v AMOUNT
RECORDS MANAGEMENT FEE
101-0000-42416
0
$10.00
Total Paid for RECORDS MANAGEMENT FEE: $10.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00,
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
hop CrdLe-k-
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CIV OF LA OL)1NiA
BUILDING & SAFETY�. DEPT.
DAPP.
FOR CONST CT60N
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Contractor Name:
PERMIT #
PLAN LOCATION
Project Address:_ y, -q 3 (o 560QI L"d`ee4
Project Description: Pool, Remodel, Add't, Elect, Plumb, Mech
APN #:
LG Fq Ir" C
Address:
Conditioned Space
Applicant Name: Afle
sw
Address: /2
City, ST, Zip: 10 C Z 2 ►o
Garage
Telephone: 6 0 e. '
'
�.
Email:
c
Valuation of Project $ ��y
Contractor Name:
New SFD Construction:
Address:
Grading:
City, St, Zip
Construction Type: O--cupancy:
Address:
Conditioned Space
SF
sw
Email:
City, St, Zip
Garage
_ SF
�.
Telephone:
Patio/Porch
SF -
Email:
Fire Sprinklers
SF
State Lic: D City Bus Lic:
Arch/Eng Name: -
Construction Type: Occupancy:
Address:
Grading:
City, St, Zip
Construction Type: O--cupancy:
Telephone:
Bedrooms:
Stories:
# Units:
Email:
State Lic: City Bus Lic:
Property Owner's Name:
New Commercial /Tenant Improvements:
Address: �j, e
Total Building SF
City, ST, Zip
Construction Type: O--cupancy:
Telephone 3 2 0 2
Email:
78495 CALLE TAMPICO
LA QU I NTA, CA 92253
760-777-7000