BPLB2019-003978-495 CALLE TAMPICO Df" VOICE (760) 777-7125
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011
DESIGN &DEVELOPMENT DEPARTMENT
INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 3/21/2019
Permit Type/Subtype: PLUMBING/ Owner:
Application Number: BPLB2019-0039 GARY CRIPE
Property Address: 78900 VIA CARMEL 2507 SPRING TER
APN: 646400001 UPLAND, CA 92253
Application Description: CRIPE / GAS LINE ADDITION FOR NEW FIREPIT
Property Zoning:
Application Valuation: $1,000.00
Applicant: f �j Contractor:
MAUI POOL SERVICE I
MAR
POOL SERVICE- FRANCISCO NUNEZ
P 0 BOX 5639 MAR 2 0, r; • „ P O BOX 5639
LA QUINTA, CA 92248 � nn'' LA QUINTA, CA 92248
I x OJ� (� p�T `` '
� gAAfxr,nl �AQUIhIT�; V r (760)989-2984
117.tpr.".r Llc. No.: 1030478
LICENSED CONTRACTOR'S DECLARATION
I herebyaffirm under penalty of perjury that I am licensed under provisions of Chapter
9 {commencing with Sectlon 70001 of Division 3 of the Business and Professions Code,
and my License is in full force and effect.
License Class: C53 License No,: 1030478
Date i '
Contractor:(�nC►jC�
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, dernolish, 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 70001 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 net 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 Add
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
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 th work for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by
Sect,❑ 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: ATE C MPENSATION INSURANCE FUND Policy Number: 9212027
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 should become subject to the
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with those provisions.
Date r• 1•� — Applicant: c C t t,V-� L 't
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINESUP 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,
IN1'tkM, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT: Application is herobV made to the BuildfngOfficial for a permit subject to
the condltlons and restrictions setforth 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 pjty to enter upon the
above -mentioned property for inspection purposes.
f
Date-:• Signature (App nt or Agent)
Date: 3/21/2019
Application Number:
Property Address:
APN:
Application Description:
Property Zoning:
Application Valuation:
Applicant:
MAUI POOL SERVICE
P 0 BOX 5639
LA QUINTA, CA 92248
BPLB2019-0039
78900 VIA CARMEL
646400001
CRIPE / GAS LINE ADDITION FOR NEW FIREPIT
$1,000.00
Owner:
GARY CRIPE
2507 SPRING TER
UPLAND, CA 92253
Contractor:
MAUI POOL SERVICE - FRANCISCO NUNEZ
P 0 BOX 5639
LA QUINTA, CA 92248
(760)989-2984
Llc. No.: 1030478
------------------------------------------------------
Detail: INSTALLATION OF 22' LF OF 1" POLY GAS LINE AT REAR YARD. -THIS PERMIT DOES NOT INCLUDE ANY ELECTRICAL PER 2016 CALIFORNIA BUILDING
CODE.
DESCRIPTION
PERMIT ISSUANCE
DESCRIPTION
GAS SYSTEM, 1-4 OUTLETS
DESCRIPTION
GAS SYSTEM, 1-4 OUTLETS PC
ACCOUNT
CITY
AMOUNT
101-0000-42404
0
$101.40
Total Paid for PERMIT ISSUANCE:
$101.40
ACCOUNT
CITY
AMOUNT
101-0000-42401
0
$13.34
ACCOUNT
CITY
AMOUNT
101-0000-42600
0
$26.68
Total Paid for PLUMBING FEES:
$40.02
I
(4t(v / PERMIT # PL,76
CAI 11.ORNIA
PLAN LOCATION:
Project Address: v' l Project Description:
APN #:
Applicant Name:i-w�net>c�
Address:
City, ST, Zip:
Telephone:
Email:
Valuation of Project $ ) -9 �O
/6495 CALLE TAMPICO
LA QUINTA, CA 92253
760-777-7000
OFFICE USE ONLY
# Submittal I Required I Received
Plan Sets
Structural Calcs
Truss Calcs
Title 24 Calcs
Soils Report
Grading Plan (PM10)
Landscape Plan
Subcontractor List
Grant Deed
HOA Approval
School Fees
Burrtec Debris Plan
Planning approval
Public Works approval
Fire approval
City Business License
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