05-5600 (PLBG).%r" .
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:0-5-00005600
Property Address:
54205 OAK HILL
APN:
775 -061 -016 -
Application description:
PLUMBING
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:.
500
Applicant: Architect or Engineer
l H
4 4Qulft&
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
MAT,ONEY .
205 OAK
QUINTA,
LICENSED CONTRACTOR'&DECLARATION.
-- -- -- - -–hherebymaffirundeCpenalty of.."perjuy that
rImalicensed��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.
t License.Class: C36 cense No:: 828264 .
C ctor.
W ER- BUILDER DECLARATION
I herebyaffirm 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 apermit 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 sheds licensed pursuant to the provisions'of theContractor'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 acivil penalty of not more than five hundred dollars ($500).:
1 _ 1 1, 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: They
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 w 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 I, as owner of the property, am exclusivelycontractingwith licensed contractors to construct the project (Sec.
70.44, Business. and ProfessionsCode: The-Contractors''State License Law does novapply 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 Law3.
(_ 1 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: 1P k
LQPERMIT
HILL
CA 92253
:ractor:
SCOTT A.
79 MAIN STREET
IO, CA 92201
0)775-9405
. No.: 828264
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/04/06
WORKER'S -COMPENSATION DECLARATION–_ -- - = - -- - – - - -- "-- -'
hereby affirm under penalty of perjury of the following declarations:
_ I have and will` maintaina certificate of consent to se If-: workers' compensation, is provided
;.'for by Section 3700'of-the . Labor Code, for the performance of the work for which this permit is
issued. _
_)�lhave andwill maintain workers' compensation insurance,, as required by Section 3700 of the Labor
Code; for the performance of the work fdi'which this permit is issued. My workers' compensation
'insurance carrier and policy number are:
Carrier STATE FUND Policy Number '.1576840
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 a workers' compensation provisions of Se-ction
- 3700 of the Labor Code, I steal forthA. mply with those. provisions.
I r
te: `. ,cant:
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'S -
IMPORTANT. Application is hereby made to the Director,of Building and Safety for a permit subject to the
conditions and.restriotions 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 uthorize representatives
of this c untiy to enter upon the above-mentioned property for inspe ion purpose.
elmc j/ -� Si re (Applicant or Age 0:
LQPERMIT
Application Number . . . . . 05-00005600
Permit PLUMBING
Additional desc .
Permit Fee 22.50
Plan Check
Fee
.00
Issue Date . . . .
Valuation
0
Expiration Date 7/03/06.
Qty Unit Charge Per
Extension
BASE
FEE
15.00
1.00 7.5000 EA PLB WATER HEATER/VENT
7.50
Special Notes. and Comments
WATER HEATER.CHANGE-OUT.
Fee summary. Charged
Paid Credited
Due
Permit Fee Total 22.50
.00
.00..
22.50
Plan, Cheek Total 00
00
.00
.00 .
Grand Total 22.50
.00
.00
22.50
Y.
..
LQPERMIT