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BPLB2019-014778-495 CALLE TAMPICO D 1+N[f VOICE (760) 777-7125 LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011 DESIGN & DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 11/13/2019 Permit Type/Subtype: PLUMBING/ Owner: Application Number: BPLB2019-0147 Hardy John W / Hardy Valerie E Property Address: 79615 CETRINO 79615 CENTRINO APN: 776250036 LA QUINTA, CA 92253 Application Description: HARDY / REPLACE 3/4" GASLINE Property Zoning: Application Valuation: $2,600.00 Applicant: Contractor: D AMERICAN LEAK DETECTION INC AMERICAN LEAK DETECTION INC 77551 EL DUNA CT 77551 EL DUNA CT PALM DESERT, CA 92211 NOV 13 2019 DD PALM DESERT, CA 92211 CITY OF LA QUINTA (760)320-9991 DESIGN & DEVELOPMENT DEPARTMENT Llc. No.: 527380 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. D12_ D64_ D35 License 0 [:arttp:' f1 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 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. Q. Lender's Lender's 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 [hc for which this permit is issued. I have and will maintain workers' compensation insurance, as required by Section 370U 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: AESTAMERICAN INSURANCE, COMPANY Policy Number: XWW59299498 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 370Q of Labor Code, I shall forthwith comply with th se provisions, d"J WO �( r WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECTAN 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 agree to comply with ail city and county ordinances and state laws lating to building construction, and hereby authorize representatives of this city er upon the bove- mentioned pro arty €or inspection purposes, "� I+-, 4i1"ppiicant or Agent): Date 11/13/2019 Application Number: BPLB2019-0147 Property Address: 79615 CETRINO APN: 776250036 Application Description: HARDY / REPLACE 3/4" GASLINE Property Zoning: Application Valuation: $2,600.00 Applicant: AMERICAN LEAK DETECTION INC 77551 EL DUNA CT PALM DESERT, CA 92211 Owner: Hardy John W / Hardy Valerie E 79615 CENTRINO LA QUINTA, CA 92253 Contractor: AMERICAN LEAK DETECTION INC 77551 EL DUNA CT PALM DESERT, CA 92211 (760)320-9991 Llc. No.: 527380 Detail: REPLACE EXISITNG GAS LINE TO POOL HEATER AND BBQ WITH 81-F OF 3/4" POLY GAS LINE. PER 2016 CALIFORNIA BUILDING CODES FINANCIAL INFORMATION 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 $101.97 Total Paid for PERMIT ISSUANCE: $101.97 DESCRIPTION ACCOUNT CITY AMOUNT GAS SYSTEM, 1-4 OUTLETS 101-0000-42401 0 $13.42 DESCRIPTION ACCOUNT CITY AMOUNT GAS SYSTEM, 1-4 OUTLETS PC 101-0000-42600 0 $26.83 Total Paid for PLUMBING 2019: $40.25 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 ta 4 CALIFORNIA PERMIT # h[t p (mil PLAN LOCATION: Project Address: IlkR�� + Prole�Description ool, Remodel, Add't, Elect, Plumb, Mech APN #: S A L 14' VZ 171AaT PaM -U4 e Applicant Name:CIL Address:] O City, ST, Zip: Telephone: Email: Valuation of Project Contractor Name: New SFD Construction: Address: S ( i Ut�r Conditioned Space SF City, St, Zip ( _ I / Garage SF Telephone: O p $-� Patio/Porch SF Email: Clot Fire Sprinklers SF State Lic: V City Bus l.ic: G j c Do p Arch/Eng Name: Construction Type: Occupancy: Address: Grading: City, St, Zip Telephone: Bedrooms: Stories: # Units: Email: State Lic: City Bus Lic: Property Owner's Name:' New Commercial / Tenant Improvements: Address: Total Building SF City, ST, Zip �� Construction Type: Occupancy: Telephone: _ <- Email: 78495 CALLE TAMPICO LA QUINTA, CA 92253 (760)777-7125 WWW.LAQUINTACA.GOV OFFICE USE ONLY # Submittal Plan Sets Req'd Req'd Structural Calcs Truss Calcs Title 24 Calcs Soils Report Grading Plan (PM 10) Landscape Plan Subcontractor List Grant Deed HOA Approval School Fees Burrtec Debris Plan Planning approval Public Works approval Fire approval City Business License WG L) � Lo, ce A) Uq o h ` — a5 CITY OF LA Q U I NTA BUILDING & SAFETY DEPT APPROVED FOR CONSTRUCTION 4DATE 7f�/S Cf,.tR1A vC