BPLB2019-006478-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Permit Type/Subtype:
Application Number:
Property Address:
APN:
Application Description:
Property Zoning:
Application Valuation:
Twit 4 44 a"
DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
PLUMBING/
BPLB2019-0064
78010 CORONADOS CIR CIR
646210001
COLBURN / FIXTURE REPLACMENTS
Applicant:
QUALITY MECHANICAL PLUMBING
80533 VIRGINIA AVE
I N DI O, CA 92201
Q° DAPR 2 9 2019
CITY OF LAQUINTA
DESIGN & DEVELOPMENT DEPARTMENT
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.:
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
Lender's Address:
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/29/2019
Owner:
DAVID COLBURN
1250 ELM TREE RD
LAKE FOREST, IL 92253
Contractor:
QUALITY MECHANICAL PLUMBING
80533 VIRGINIA AVE
IN DI O, CA 92201
(760)610-3211
Llc. No.: 923620
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.
jl 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: EVEREST PREMIER INSURANQOjVIPANY 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 should become subject to the
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with those provisions.
Dow lej
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 and state laws relating to building
construction, and hereby authorize representatives ofthis citytoter on the above-
mentioned property for inspection purposes.
pplicant or
Application Number: BPLB2019-0064
Property Address: 78010 CORONADOS CIR CIR
APN: 646210001
Application Description: COLBURN / FIXTURE REPLACMENTS
Property Zoning:
Application Valuation:
Applicant:
QUALITY MECHANICAL PLUMBING
80533 VIRGINIA AVE
INDIO, CA 92201
Date: 4/29/2019
Owner:
DAVID COLBURN
1250 ELM TREE RD
LAKE FOREST, IL 92253
Contractor:
QUALITY MECHANICAL PLUMBING
80533 VIRGINIA AVE
INDIO, CA 92201
(760)610-3211
Llc. No.: 923620
Detail: REPLACE EXISITING PLUMBING FIXTURES IN BATHROOMS AND KITCHEN`SAME LOCATIONS k MASTER SHOWER DRAIN TO FLOOR LEVEL. NO
ADDITIONAL PLUMBING INSTALLATIONS ON THIS PERMIT. PER 2016 CALIFORNIA PLUMBING CODE.
FINANCIAL INFORMATION
DESCRIPTION ACCOUNT QTY AMOUNT
PERMIT ISSUANCE
101-0000-42404 0 $101.40
Total Paid for PERMIT ISSUANCE: $101.40
DESCRIPTION
ACCOUNT
CITY
AMOUNT
FIXTURE/TRAP
101-0000-42401
0
$133.40
DESCRIPTION
ACCOUNT
QTY
AMOUNT
WATER SYSTEM INST/ALT/REP
101-0000-42401
0
$13.34
DESCRIPTION
ACCOUNT
QTY
AMOUNT
WATER SYSTEM INST/ALT/REP PC
101-0000-42600
0
$13.34
Total Paid for PLUMBING FEES: $160.08
DESCRIPTION
ACCOUNT
QTY
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
ta
Qaffra
(At WORNIA
Project Address:
APN #:
Applicant Name: 04131�
Address: 9
46-53 U tix
City, ST, Zip:;
Telephone: 1W i7lfl -3z o -
Email:
CU120 t
to +.1.
Project Description:i
Sc� e
Valuation of Project $
-n &V-� C?
,P/4—A4
VA,
q):S 6),0
Architect/Engineer Name: Construction Occupancy:
Address: Grading:
City, St, Zip
Telephone: Bedrooms: Stories: # Units:
Email:
State Lic: City Bus Lic:
/6495 CALLE TAMPICO
LA QUINTA, CA 92253
760-777-7000
OFFICE USE ONLY
#
Submittal Required Received
I
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
DEMO
r-------------- — — — — —__ -j
PLV?**1N4 PLAN
1 /8"=1'-0"
PROJECT: David Colburn Residence
78101 Coronados Circle,
La Quinta, CA 92253
Date of Drawing: 2.27.19 REVISION 5
PAGE 1
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NICHOLAS LAWRENCE DESIGN, LLC
41-801 Corporate Way, #13
Palm Desert, CA 92260
310 274 8090
Drawn bv: Virginia Rrierlav