12-1048 (PLBG) +6897
48901 Avenida Anselmo
• 11 4 e R I IIIIIII VIII III VIII (III 80
P.O. BOX 1504 IE 4
a 78495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 12--0-00010,18 Owner:
Property Address: 48901 AVENIDA ANSELMO FOX DAVID
APN: 658-300-014- - - 48901 AVENIDA ANSELMO
Application description: PLUMBING LA QUINTA, CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL (760) 902-2465
Application valuation: 900
Applicant: Architect or Engineer:
AA"
------------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm underpenalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
License Class: C36 Li No.: 831798
—__ Date`_Contractor:
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.).
(_ 1 1, 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:
LQPERMIT
Contractor:
KCrS 23 1/2 HOUR PLUMBING
702 EUGENE ROAD
PALM SPRINGS, CA 92264
(760)327-8718
Lic. No.: 831798
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/13/12
D ;OF
2012
CIYY t A,, - - -)
WORKER'S COMPENSATION DECLARA1iON - `_,-, T
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 SECURITY NATL Policy Number WC040001A
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 e,s' compensation provisions of Section
37700(0 of the Labor Code I all forthwith com th those provisions.
Date: Applicant:
Applicant:
WARNING: FAILURE TO SECUR ORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,0001. 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 Director of Building and Safety 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 all
city and county ordinances and state laws relating to building construction, and her authorize representatives
of this county to enter upon the above-mentioned prapert inspection purpo
12.
. Date: , -Signature (Applicant or Agent): 14
Application Number . . . . . 12-00001048
Permit PLUMBING
Additional desc . .
Permit Fee . . . . 18.00
Plan Check Fee
4.50
Issue Date . . . .
Valuation
0
Expiration Date 3/12/13
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 3.0000 EA PLB GAS
PIPE 1-4 OUTLETS
3.00
----------------------------------------------------------------------------
Special Notes and Comments
RUN NEW GAS LINE FROM METER TO FIREPIT.
70K BTU Q REAR 90 LN FT POLY PIPING.
2010 CODES APPROVED BY B.H.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG
STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid
-----------------
Credited
Due
--------------------
Permit Fee Total 18.00
--------------------
.00 .00
18.00
Plan Check Total 4.50
.00 .00
4.50
Other Fee Total 1.00
.00 .00
1.00
Grand Total 23.50
.00 .00
23.50
LQPERMIT
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4891 01 Agien '►dG 41sd v'A v
C LA , G14 5 2253
7 (4 _ 9 o Z- Z ,-f ��-
L
CITY OF LA QUINTA
BUILDING & SAFETY DEPT. ;
APPROVED
FOR CONSTRUCTION 1
DA ! l�,4'7- gY
70"0" 3710
stn.#
Of La QUIf1td
Building 8t Safety Division
P.O. Box 1504,78-495 Calle Tampico
La.Quinta, CA 92253.:(760) 777-7012
Building Permit Application'and Tracking Sheet
Permit #
Project Address: q o / p A %� �L �-
Owner's Name:.
A. P. Number.
Address: g`(d. V eo dc, 11 S el Wl p
Legal Description:
Contractor. 60 Mr3,
City, ST, Zip: CA T,995-3
Telephone: '70-10Z-
Address: 700 1 cu( 0—c .-12J
Project Description:
City, ST, Zip: ?OC.h
Telephone: 7(00-'3
State Lie. #: g-�> (-7 City Lie.. #,
Arch., Engr., Designer.
(/�:krr tcZt 'TZ? . �C(l2ls tQ t i �i
% k
Address:
City., ST, Zip:
Telephone:
Construction Type:. Occupancy:
Project type (circle one): Now Add'n Alter Repair Demo
Sq. Ft.: #Stories: # Unity:
State Lic. #:
Name of Contact Person:
Telephone # of Contact Person:
Estimated Value of Project: 1 60 !
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Reed
TRACMG
PERMIT FEES
Plan Sets
Plan Cheek submitted
Item Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Cates.
Called Contact Person
Plan Check Balance
Mile 24 Calcs.
Pians picked up
Construction
Flood plain plan
Pians resubmitted..
Mechatilcal
Grading plan
2'! Review, ready for correctioustiissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE--
ReHew,' ready for correctionslissue
Developer Impact Fee
Planning Approval
Called Contact Person
AXP.P.
Pub. Wits. Appr
Date of permit issue
School Fee:
Total Permit Fees
Veave
IIIIIIIIIIIIIIIIIIIIIIIII
01
IE
Building qlp-
Owner
maning
Address Sa,r,,,r q11
City Zip
La Q#Anta 192253
Contractor
D. W. C. 6 Assoc.
Address
T444f
"
P.O. BOX 1504 N o , 06897
713105 CALLE ESTADO
[M LA QUINTA, CALIFORNIA 92253
77-170 Indimm Ave.
City lZip Tela
BUILDING: TYPE CONST. OCC. GRP.
A:P. Number Let Qninta Country Club
345-2055 Legal Description L % k 7
Project Description Front doors md dart»
State Lic. I City
1£ Classif. 560745 Lic. #
Arch., Engr.,
Designer
Address Tel.
CityI Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter Q'(commencing with Section
70pp) of Division 3 of the Business and Professions Code, andrmy license is in full force and
SIGNATURE ,+"'. v' vii.- DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, atter, improve, demolish, or repair any structure, prior to its issuance also
requires the appfir-W for such permit to file a signed statement that he is licensed pursuant to
the provivons of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. he 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).
O 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, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon and who does such work himself or through his own employees,
provided that such 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 did not build or irprove for the purpose of sale.)
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project (Sec. 7044, Business and Professions Code: The Contractors License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
O 1 am exempt under Sec B. & P.C. for this reason
Date owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No Company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of the work for which this permit is issued, I shall not
employ any parson in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT., N, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I car tity 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 to enter the above-
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
mated
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Driveway Enc.
Infrastructure
TOTAL
C, c/ LW
AMOUNT
r.. Z
REMARKS f](rat tl ,sri.iSt.2 Crj_.?'%-vf)._ '.SU
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Datel/23/90 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
PLUMBING FEES
1ST FL. SO. FT. a $
UNITS
m
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL SO. FT. a
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING,
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. a
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. a
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SO. FT. a
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN.
WALL SO. FT. a
=$
LUMBER GR.
FINAL INSP.
URINAL
SO. FT. a
ROOFING
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
VENTILATION
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FIREPLACE
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. a c
BATH TUB
SO. FT. a c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID a 1 Vi c
SEWAGE DISPOSAL
SO.FT.GAR a V4c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING,
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
g plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
to
REMARKS:-
EMARKS:VENTILATION
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING Zi t' ,
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
'
GARDEN WALL FINAL
I