BPLB2014-102878-495 CALLE TAMPICO TO � 44VOICE (760) 777-7125
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011
COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
' BUILDING PERMIT
LICENSED CONTRAC ATl N
I hereby affirm under penalty of perjury that I a en d u def provisio of Chapter
9 (commencing w th Section 7000) of Division 3 f he sin ssLdPmolf sions Code,
and my Lie nse is full force and effect. ]
/D.t-.5
Cl ass nse No.: v dntracter•
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 fora
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 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 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
is issued. My workers' compensation insurance carrier and policy number are:
Carrier: Policy Number:
I certify that in the performance of the wor w is tis permit is issued,
shall not employ any person in ahy manner so a a b c me u ]ect to the workers'
com en t]on aws of California, and a ree that, f I ho Id a subject to the
workers omhensatlon provisions of Section 37 ttE l b r�de, I shall forthwith
comply �
licant:
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 per it, or cessation of
work for 180 days will subject permit to cancellation.
I certify that I have read this application and state thatthe ove for aan is correct.
I agree to comply with all city and county ordinances' nd t to la sr ati g to buildi
construct' n, Ind hereby authorize representatives o t s [ t to u on the ab
merrtione pr perty r inspection purposes. 1 J
r 1 I � �n
pate: L•� �� gnature (Applicant or Agent L a
Date: 10/20/2014
Application Number:
BPLB2014-1028
Owner:
Property Address:
55245 RIVIERA UNIT F-43
HENRY ANDERSON
APN:
775153027
1021 EAST CARTM ILL AVE.
r
Application Description:
GAS LINE FOR FIRE PIT
TULARE, CA 93274
0
Property Zoning:
Application Valuation:
$6,000.00
r o
O
r==1 N
Z r
C3w
Applicant:
Contractor:
C3
BOB EDWARDS CONSTRUCTION, INC.
BOB EDWARDS CONSTRUCTION,
IN
o
51455 DESERT CLUB
51455 DESERT CLUB
F-
o
U �
LA QUINTA, CA 92253LA
QUINTA, CA 92253
CD
a
LIc. No.:
LICENSED CONTRAC ATl N
I hereby affirm under penalty of perjury that I a en d u def provisio of Chapter
9 (commencing w th Section 7000) of Division 3 f he sin ssLdPmolf sions Code,
and my Lie nse is full force and effect. ]
/D.t-.5
Cl ass nse No.: v dntracter•
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 fora
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 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 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
is issued. My workers' compensation insurance carrier and policy number are:
Carrier: Policy Number:
I certify that in the performance of the wor w is tis permit is issued,
shall not employ any person in ahy manner so a a b c me u ]ect to the workers'
com en t]on aws of California, and a ree that, f I ho Id a subject to the
workers omhensatlon provisions of Section 37 ttE l b r�de, I shall forthwith
comply �
licant:
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 per it, or cessation of
work for 180 days will subject permit to cancellation.
I certify that I have read this application and state thatthe ove for aan is correct.
I agree to comply with all city and county ordinances' nd t to la sr ati g to buildi
construct' n, Ind hereby authorize representatives o t s [ t to u on the ab
merrtione pr perty r inspection purposes. 1 J
r 1 I � �n
pate: L•� �� gnature (Applicant or Agent L a
DESCRIPTION
FINANCIAL •1•
ACCOUNT QTY AMOUNT PAID
PAID DATE
BSAS SB1473 FEE
101-0000-20306
0
$1.00 $0.00
PAID BY
METHOD
RECEIPT # CHECK #
CLTD BY
Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $1.00 $0.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid for PERMIT ISSUANCE: $91.85 $0.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
GAS SYSTEM, 1-4 OUTLETS
101-0000-42401
0
$12.09
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
GAS SYSTEM, 1-4 OUTLETS PC
101-0000-42600
0
$24.17
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid forPLUMBING FEES: $36.26 $0.00
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City of La Quinta
Building &r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Applicatiop and Tracking Sheet
Permit ## , f _
r=fin i`f
Project Address: 157;E� — Zq6 -(U
Owner's Name: `,
6
A. P. Number: 7
Address:
Legal Dcscrip ' n:
City, ST, Zip:
Contractor: L
Telephone:
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Address: �j I U
Project Description:
City, ST, Zip: LA LA q�
Telephone: -'?60ZZ1
<�*11;
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State Lic. # :
City Lic. #:r
Arch., Engr., Designer:
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Address: '- k, t,
City., ST, Zip:
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Tele hone:' L rjr
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State Lic_ #:
F,sA
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Construction Type: Occupancy:
Project type circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.: # Stories:
# Units:
Tclephonc #,of Contact Person: —�M2�_
Estimated Value of Project: DDD -
APPLICANT: DO NOT WRITE BELOW THIS LINE
# Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Scts
Plan Check submitted
Ay
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cala.
Called Contact Person
Plan Check Balance
Title 24 Cales.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2°' Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Dccd
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN ROUSE:-
'rd Review, ready for correctionsfissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fecs
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