BPLB2019-011778-495 CALLE TAMPICO Dai.ifrr,J VOICE (760) 777-7125
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011
DESIGN & DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 8/22/2019
Permit Type/Subtype: PLUMBING/ Owner:
Application Number: BPLB2019-0117 Dow Bruce / Dow Sharman
Property Address: 80385 VIA VALEROSA
APN: 777250010 LA QUINTA, 92253
Application Description: DOW / (1] GAS STUB OUT
Property Zoning:
Application Valuation: $1,000.00
Applicant: Contractor:
MAUI POOL SERVICE MAUI POOL SERVICE
P 0 BOX 5639 DL/� ��\ P 0 BOX 5639
LA QUINTA, CA 92248 LA QUINTA, CA 92248
AUG 2 2 2019 (760)400-9967
Llc. No.: 1030478
CITY OF LA QUINTA
-------- - - - - ------ --D Sk N+ DEIMOPMENTfMRTfi1IM-------__----------------------------
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: C53 License No.: 1030478
Date: 0 Contractor. y�Cl 7 I
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.).
O 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 Address:
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 th Iwork for which this permit is issued.
ve and will maintain workers' compensation insurance, as required by
Secti❑ 70D 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: STATE PMP6NSATiON 1kSLR6NCF 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 th de, I shall forthwith
comply with those provisions.
Date o� ry I 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 and state laws relating to building
construction, and hereby authorize representatives of this city o e upon the
above -mentioned property for inspection purposes,
Date: Signature (Applicant or Agent):. __.
I
Application Number:
Property Address:
APN:
Application Description
Property Zoning:
Application Valuation:
Applicant:
MAUI POOL SERVICE
P 0 BOX 5639
LA QUINTA, CA 92248
BPLB2019-0117
80385 VIA VALEROSA
777250010
DOW / [1] GAS STUB OUT
$1,000.00
Detail: [1] NEW GAS STUB OUT FOR PORTABLE FIRE PIT. PER 2016 CALIFORNIA BUILDING CODES
Owner:
Dow Bruce / Dow Sharman
LA QUINTA, 92253
Contractor:
MAUI POOL SERVICE
P 0 BOX 5639
LA QUINTA, CA 92248
(760)400-9967
Llc. No.: 1030478
Date: 8/22/2019
DESCRIPTION ACCOUNT CITY AMOUNT
BSAS SB1473 FEE 101-0000-20306 0 $1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION
ACCOUNT CITY
AMOUNT
PERMIT ISSUANCE
101-0000-42404 0
$101.40
Total Paid for PERMIT ISSUANCE: $101.40
DESCRIPTION
ACCOUNT
CITY
AMOUNT
GAS SYSTEM, 1-4 OUTLETS
101-0000-42401
0
$13.34
DESCRIPTION
ACCOUNT
CITY
AMOUNT
GAS SYSTEM, 1-4 OUTLETS PC
101-0000-42600
0
$26.68
Total Paid for PLUMBING FEES: $40.02
DESCRIPTION
ACCOUNT
CITY
AMOUNT
RECORDS MANAGEMENT FEE
101-0000-42416
0
$10.00
Total Paid for RECORDS MANAGEMENT FEE: $10.00
DESCRIPTION ACCOUNT CITY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE 502-0000-43611 0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
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ta
CALIFORNIA -
n
PERMIT# �Ld�1.G6el-oJ!
PLAN LOCATION:
Project Address: 03�- - -
Project Description:
APN #:
Applicant Name:
Address:
City, ST, Zip:
Telephone:
Email:
Project Valuation $T
Contractor Name: Gz
New SFD Construction:
Address: <� 3 r
Conditioned Space SF
City, St, Zip olt, C a �
Garage SF
Telephone: J �(a� a�C6L
Patio/Porch SF
Email: 1L , �L�c v (ij 1� ��l'1'�[i++L C,,,nf�
Fire Sprinklers SF
State Lic: l 301.11� City Bus Lic:
Architect/Engineer Name:
Construction Occupancy:
Address:
Grading:
City, St, Zip
Telephone:
Bedrooms:
Stories:
# Units:
Email:
State Lic: City Bus Lic:
Property Owner's Name:, cw
New Commercial / Tenant Improvements:
Address: c�,/D 3F5 \,f ifs ��l{ roS ��
Total Building SF
City, ST, Zip 0,_ W' C� c�
Construction Type: Occupancy:
Telephone:
Email:
78495 CALLE TAMPICO
LA QUINTA, CA 92253
760-777-7000
OFFICE USE ONLY
Submittal
Required
Received
Plan Sets
Structural Calcs
Truss Calcs
Title 24 Calcs
CVWD Fire Flow Letter
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
tI�W'NL\RTIN DESIG.X CORP
TRANSMITTAL
August 22, 2019
To: City of La Quinta Design & Development
78-495 Calle Tampico, La Quinta, CA 92253
Email: at ragallon@laquintaca.gov
Project Name: Dow Residence
To whom it may concern,
Please find the attached for Dow Residence.
• (2) Copies 11x17 Gas line Plumbing Plan
If you have any questions, please call our office.
Thank you,
Bruce Raymond
R. M. D. C.
78-060 Calle Estado
La Quinta, CA 92253
Ph: 760-698-9696
Received By: Date:
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RAY MARTIN DESIGN CORP.
Landscape Design / Management
78
-060 Calle Estado Suite #16
La Quinta, California 92253
(760) 696-9696
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80385 VIA VALEROSA Cj-1
LA QUINTA, CA 92253
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