BPLB2016-008578-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application Description:
Property Zoning:
Application Valuation:
Applicant:
RITETECH
80610 WILLOW LANE
INDIO, CA 92201
BPLB2016-0085
80940 VISTA GALOPE
U7 I ( (Lw _
ce,4 4 4�v
VOICE (760) 777-7125
FAX (760) 777-7011
COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
B�ILDING PERMIT
Date: 6/8/2016
Owner:
777020017
NUSSBAUM RESIDENCE / PROPANE TO GAS CONVERSION
$10,000.00
RECEIVED
JUN 0 8 2016
CITY OF LA QUINTA
COMMUNITY DEVELOPMENT
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: C36 License No..100018
Date;/ Contracto
I hereby affirm under penalty of perjurythat 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
VERNON NUSSBAUM
80940 VIA GALOPE
LA QUINTA, CA 92253 n
D A IJ
Contractor: JUN Q 8 2016
RITETECH
80610 WILLO Wci; y OF Lf, QUINTA
INDIO;CA92 l;;ip,{;a iTVCEIELOr+.-1JTDEP�FTh1ENT
(760)989-9695
Llc. No.: 1000185
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
ssued. 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 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 _ Applicant:
WARNING: FAILURE TO SECURE WORKERS' C PENSATiON 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 of this 0 to enter upon the
a bove-m entio nef property for inspection purposes_
Da Signature (Applicant or Agent
i
Description: NUSSBAUM RESIDENCE / PROPANE TO GAS CONVERSION
Type: PLUMBING Subtype: Status: ISSUED Applied: 6/8/2016 MFA , ~
Parcel No: 777020017 Site Address: 80940 VISTA GALOPE LA QUINTA,CA 92253 Approved: 6/8/2016 MFA
I
Subdivision: TR 14104 Block: Lot: 17 Issued: 6/8/2016 MFA
Lot Scl Ft: 0 Building Sq Ft: 0 Zoning: Finaled:
Valuation: $10,000.00 Occupancy Type: Construction Type: Expired: 12/5/2016 MFA
No. Buildings: 0 No. Stories: 0 No. Unites: 0
Details: PROPANE. TO GAS CONVERSION FOR ENTIRE MAIN HOUSE AND CASITA . GAS LINE TO BE SLEEVED WHERE REQUIRED. LEAVE LINES
EXPOSED UNTIL INSPECTED. PER 2013 CALIFORNIA BUILDING CODE.
_ 1 Applied to Approved
Iq Approved to Issued
NAME TYPE
NAME
ADDRESSl
CITY
STATE
ZIP
PHONE FAX
EMAIL
APPLICANT
RITETECH
80610 WILLOW LANE
INDIO
CA
92201
(760)863-1011
ritetech@gmail.com
CONTRACTOR
RITETECH
80610 WILLOW LANE
INDIO
CA
92201
(760)863-1011
ritetech@gmail.com
OWNER
VERNON NUSSBAUM
80940 VIA GALOPE I
LA QUINTA
CA
92253
(760)863-1011
FINANCIAL
INFORMATION
DESCRIPTION
ACCOUNT
QTY AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK # METHOD
PAID 13Y CLTD
BY
BSAS SB1473 FEE
101-0000-20306
0 $1.00
$1.00
6/8/16
R16074
191671 DEBIT
RITETECH MFA
Total Paid for BUILDING STANDARDS ADMINISTRATION
$1.00
$1.00
BSA:
Printed: Wednesday, June 08, 2016 11:44:30 AM 1 of 2'A!'liA
:�rsrrnts
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID BY
CLTD
.
BY
BY
PERMIT ISSUANCE
101-0000-42404
0
$91.8S
$91.85
6/8/16
R16074
191671
DEBIT
RITETECH
MFA
Total Paid for PERMIT ISSUANCE: $91.85 $91.85
GAS SYSTEM, 1-4
101-0000-42401
0
$12.09
$12.09
6/8/16
R16074
191671
DEBIT
RITETECH
MFA
OUTLETS
GAS SYSTEM, 1-4
101-0000-42600
0
$24.17
$24.17
6/8/16
R16074
191671
DEBIT
RITETECH
MFA
OUTLETS PC
WATER HEATER/VENT
101-0000-42401
0
$36.27
$36.27
6/8/16
R16074
191671
DEBIT
RITETECH
MFA
WATER HEATER/VENT
101-0000-42600
07
$$21.75
$21.7S
6/8/16
R16074
191671
DEBIT
RITETECH
MFA
PC
Total Paid for PLUMBING FEES: $94.28 $94.28
TOTALS:
INSPECTIONS
PARENT PROJECTS
BOND INFORMATION
ATTACHMENTS
Printed: Wednesday, June 08, 2016 11:44:30 AM 2 of 2 CR SYSTEti1S
Lain #
City of La Q uin to
G
Buifdfng & Safety Division
Permit # ( U 1
78-495 Caffe Tampico
La Quinta, CA 92253 - (760) 777-70I2
Building Permit Application and Tracking Sheet
'Prt Address: $
Owner's Name:
A. P. Number:
Address- CA ■ Q
Legal Description:
City, ST, Zip: L c&
Contractor:
Telephone: 7
Address: l t `l ow
L Project Descrip;'san
City, ST, Zip: U
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Telephone:i1i
-)
"%'`•,`
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State Lie. #
City
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
<;:; �:.: •�,�:a:-:,
r ;,;�>>F��e,�,c`�;F><;�•;:•• Construction Type: Occupancy:
State Lie. #:
Project type (circle one): New Add'n Alter Repair
Demo
Name of Contact Person:
Sq. Ft.: # Stories: # Units:
Telephone # of Contact Person:
Estimated Value of Project: ]o dd
APPLICANT: DO NOT WRITE BELOW THIS LINE
# Submittal Req'd Ree'd TRACKING PERMIT FEES
Plan Sets
Plan Check submitted Item
Amount
Structural Cales.
Reviewed, ready for corrections Plan Check Deposit
Truss Calcs,
Called Contact Person Plan Check Balance
Title 24 Calcs.
Plans picked up Construction
Flood plain plan
Plans resubmitted Mechanical
Grading plan
2"1 Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
''0 Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees,
Total Permit Fees
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