05-2091 (PLBG)i'
P.O. BOX 1504
11
D
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
05-00002091
Property Address:
License Class 793482 - License No EXEMPT - -. - -
APN:"
51:61:5 AVENIDA .OB'REGQN�
Application description:
773.- 3 0
Property Zoning:
PLUMBING
Application valuation:
COVE RESID
Applicant:
V1A�BlJILEM &
CW®FLA
Architect or Engineer:
44�w
MCF TY DEPARTMENT
IN_ ' PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
---------------------------------
CARMELO SALA
51615 AVENIDA OBREGON
LA QUINTA, CA 92253
Contractor:
SO CAL PLUMBING & REPIPE CO
P.O. BOX 955
YUCCA VALLEY, CA 92286
Lic. No.: EXEMPT
Date: 5/31/05
LICENSED;CONTRACTOR'SDECLARATION
- WORKER!S'COMPENSATION•DECLARATION
1 -hereby affirm under penaltyofperjury that I am licensed,un6rprovisions of Chapter 9; (commencing with - -
I hereby.affirm under penalty of,perjury g de
one ofthe followinclarations:
Section 7000) of Division 3 of the,Business and Professionals Codei'and rn �Licerise�is in full force and effect.
_ I have'and will maintain a certificate ;of consent to self -insure for workers' compensation, as provided
License Class 793482 - License No EXEMPT - -. - -
for by Section 3700of theoLabor Code, -for the performance of the work for which this permit is
-----,.- -. --"-;
issued ,�
' Date. tracto - _ � -
_ 1•have'and,will mamtain.workers'. compensation insurance, as required by Section 3700 of the Labor •
Code, for theperformance of the work for which this permit is issued. My workers' compensation
,OWNER -BUILDER DECLARATION
'insurance carrier and policy number are:.
I hereby. affirm under penalty of perjury that I am exempt from the. Contractor's State License Law for the
Carrier 4194 _ Poli4�Number EXEMPT
- following. reason .(Sec. 7031.5, Business and Professions. Code: Any city.orcounty.that requires'a permit to
4certify that, in the performance of the work for which'this permit is issued, I shall not employ. any
construct, alter, improve, demolish,.or repair any structure pnor to its issuance, also requires the applicant for the
person in any mannerso as to,become subject.to ihe'workers'_compensation laws of. California,
permit to file a signed statement that he or she is Iicensed;pursuant;to the provisions of the Contractor's State
' ' ' and agree that, if I should become subject to the workers'4ompensabon provision§ of Section'
License Law'IChapted9.'(commencing,with Section.7000),'-of Division 3 of .the Busir; ss and Professions Code) or
3700. of the Labor Code,'I shall forthwith comply .with those provisions.
that -he or she is exempt therefrom and the,tiasis 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 ($500).,.ate:.9.&�-
_ plicant:
(_ 1 I, as owner of the property, ormy employees with wages as their sole compensation, will do the work, and
the structure is notintended or offered for sale (Sec: 7044, Business-anA'.P,rofessions Code 'The ,:
WARNING`. FAILURE TO SECURE" WORKERS' COMPENSATION COVERAGE IS'UNL iWFUL, AND SHALL
'Contractors' State License Law doe`s€not apply to an owner of property who builds or improves thereon,
SUBJECT. AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL`•FINES;UP,TO:ONE HUNDRED THOUSAND -
and who does the work himself or herself through his or her own'employees, provided that. the
'DOLLARS -($.100,000):' IN ADDITION TO THE COST OF COMPENSATION; DAMAGES AS PROVIDED. FOR IN
improvements are not intended oroffered for sale. If, however, the building or improvement is sold within
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. '
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.)., : -
APPLICANT ACKNOWLEDGEMENT„ „
(_ 1 I, as owner.of the property, am exclusively contracting with, licensed contractors to"construct the'pwiect (Sec.
-,Q..,. ,.._,.
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044, Business and Professions Code: The Contractors' State License 'Law'does.not apply to an owner of
conditions and restrictions set forth on this application.
property who builds or.improves thereon, and who contracts for the projects with a contractor(s) licensed
1 . Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License Law.). _
whose.benefit work is performed under or pursuant to any permit issued as a result of this application,
(_) I am exempt under Sec. B.&P.C. for this reason
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.
Date: - Owner:
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
CONSTRUCTION LENDING AGENCY
permit to cancellation.
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
I certify that I have read this application and state that the above information is correct. I agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.).
city and county ordinances and tate laws relating to buildin c ' - re resentatives
of this county to enter up a above-ment y or inspection purposes.
Lender's Name:
-
3/
Lender's Address: %
ate: Signature (Applicant
LQPERMIT
j
Application Number .. . . . . 6S-00002091
Permit. PLUMBING SEWER
Additional desc .
Permit.Fee 30.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. . .
. 2500
Expiration Date 11/27/05
Qty Unit Charge Per
Extension
BASE
FEE
30.00
. Special Notes and Comments
SEPTIC ABANDON; SEWER „CONNECT.
Fee summary. Charged.'-
Paid"Credited
Due
Permit Fee:Total 30.00.
:00,'
.00.
30.00
'Plan Check.'Total 00
.00
.00
:00
Grand Total• 30.00.
.00
00.:.:;
30`.00
r
's`
LQPERMIT
�.-- COACHELLA VALLEY WATER DISTRICT CASH RECEIPT DETAIL 2„ -08090 // I
Received From: _. r' i_.' '�.Y 7 : i • 1�, l I/ I �,- K- _ r, {/ / i ,� I
- Address
Account
Service,
1.1
#!.z 4.
�_.W
.I ! / Date:
//c-
J
I
❑ Backflow(s)
i
I
o.!
Lot(s) '
,
) r -' Tract j
❑ Meter Surcharge
i�Sanitation Capacity Charge �/
.
dress
1
❑ S.I'.W.S.C.
G.A. Code I'
❑ Meter(s)
$ I
❑ Service(s)
J
I
❑ Backflow(s)
i
I
❑ House Lateral(s)
❑ Detector Check(s)
❑ Meter Surcharge
i�Sanitation Capacity Charge �/
c^/•; , ,,`j
❑ W. S. B. F. C,
1
❑ S.I'.W.S.C.
❑ Temporary Construction Meter
I
❑ Turn on Charge
7
❑ Uncollected Account - Name
❑ Inspection Fee - Tract -
,
Fee -
1
❑ Plan Check Fees Water /Sewer -
Tract -
❑ Bond Payment - A.D. - Bond Assmt'
❑ Customer Deposit
J
Remark
a
1 ( T.OTAL
'L Copy to:
Cash ,
L_j I �-� Water Service
Check tL 77
Money )
Cashier I
Order � I.
r. CVWD-438 (1/05) :I
4-0.01
AwSwAwPw
:PUMP/NG
Lic #C42 855.851
�wA AAA �AA� I AAw w
fou aAo- / Oo / 0 -1-011.1lu-334- / L00CUSTOMER'S
'.
ORDER NO,.:-
'DA3E ORDPED ' -
FAX 76032'8-6607
4/T�/•••
P.O. BOx�al 8 - Cathedral City, .CA 92235
ORDER TAKEN BY
DATE PROMISED ❑ A.M.
Pumping Fee per 1000 gal.
❑ P.M.
BILLTO
PHONE
ADDRESS
ME ' ANIC
CITY
HE PER "
JOB NAME AND LOCATION��
❑DAY WORK
DESCRIPTION OF WORK 7
CONTRACT
Out of Area Fee
[].EXTRA
QUANT
DESCRIPTION OF MATERIAL USEJ)
PRICE
AMQUNT""�?,r
Gallons;
Pumping Fee per 1000 gal.
Dumping Fee per 1000 gal.
Out of Area Fee
'
Locating /.Opening Fee (per hour)
Size System: .
A SERVICE'CHARGE OF $20 WILL BE DUE ON ALL RETURNED CHECKS.
18% PER YEAR WILL BE CHARGED ON PAST DUE
ACCOUNTS OVER 30 DAYS.
TOTAL
MATERIALS
TOTAL
WAIVER: Not responsible for secondary damg—such.es-water
damage, chipped concrete ",mar.-"n-stre'eMrdrIvewa gs or trees/
SIGNATURE DATE COMPLETED
TAX
TOTAL
�JJ;