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09-0602 (PLBG)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA,. CALIFORNIA 92253 Application Number: 090000060%2� �5 Property Address: e84 A� OBREGON APN: 7.73-164-025-8 -000000- Application description: PLUMBING Property,Zoning: COVE' RESIDENTIAL Application valuation:. 6000 T iht 4 4 Q, ",* r6i BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: STEVE.SAFT 51884 AVENIDA OBREGON LA QUINTA, CA 92253 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS. (760) 777-7153 Date: 6/09/09 Contractor: u JON OO 2009 lJ Applicant: Architect or Engineer: A 1 POOL CONCEPT P.O: BOX 623 L LA QUINTA, 'CA 92253 P. FLA QUINTA (760) 771-9822 FINANCE DEPT Lic. No,.,: 746662 ` - LICENSED CONTRACTOR'S DECLARATION- WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that 1 am licensed under provisions of Chapter'? Icommencing, with I hereby affirm under penalty of perjury one of.the following declarationsr Sectio -n-7000) . of Division 3 of the Business and. Professionals Code, and my Liggnse,_isrin'full force and effect:_ Phave and will maintain a certificate of consenrto-self-insure for workers' compensation, as provided License'Class:" C12 C53 - License No.: 38!,662 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is i issued. - Date:ntractor, -/ 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 OWNER -BUILDER DECLARATION insurance carrier and policy number are: hereby -affirm. under penalty of perjury that I am,exempt from the Contractor's State License Law for the, Carrier STATE FUND '-Policy Number 1576693-2008 ' following reason ,(Sec. 7031 .5, Business and Professions Code: Any city or county that requires_ a permit to - _ I certify that, in the performance of the work for which this'permit;is issued; 1 shall not employ any construct, alter,. improve, demolish or repair?any structure, prior to its issuance, also. requires the applicant for the person imany-manner so a''s to becom" bject to the workers' compensation laws of California, permit io file a•signed statement that. he or-s.he.is licensed pursuant to the provisions oftheContractors State a ndiilree•ihat;�if I should.beco a subje to the worker co 'n" tion provisions of Section . License Law•IChapter 9 (commencing.withSection 7000) of Division.3 of the Business and Professions' Code) or 3700 of -the L bor Code, al f ' hw comply with ose provisions. that he or.she is exempt therefrom and the basis forthe alleged exem Any violation of Section 7631.5 by -� li. any applicant fora permit subjects the applicant to a -civil penalty of not more than five hundred dollars (5500).: ate.(J 7� Aicant: ... ( 1 I, as'owniavof the property, or'my employees with wages. as their sole compensation, will do the work, and " the structure isnot intended or. offered for sale (Sec. 7044, Business and Professions Code: The WARNING: FAILU E TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL; AND SHALL Contractors' State License Law does not apply.to an -owner of property whd7builds 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 or offered 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.). (_ I 1, as ownerof 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.). 1 1 I am exempt under Sec. ,.B.&P.C. for this reason Date: Owner: CONSTRUCTION LENDING AGENCY. I hereby affirm underpenalty 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 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. I agree to rt)]'ply with all city and county ordinances and state laws relating to building construction, and hereby authorizer pr sentatives of this unt to a er upon t above-mentione I y p d. pr/o/ipeD�ty for in ecfion pu oses. ate: .ature (Applicant or Age. M:LI"/Ji Application Number . . . . . 09-00000602 Permit . . . . . . PLUMBING SEWER Additional desc . . Permit Fee . . . . '30.00 Plan Check Fee .00 Issue Date . . . . Valuation 0 Expiration Date 12/06/09 Qty Unit Charge Per Extension BASE FEE 30.00 ---------------------------------------------------------------------------- Special Notes and Comments SEPTIC ABANDON, SEWER CONNECT ---------------------------------------------------------------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged Paid -------------------- Credited --------------------- Due ----------=------ Permit Fee Total 30.00 .00 .00 30.00 Plan Check Total. .00 .00 .00 .00 Other Fee Total 1.00 .00 .00 1.00 Grand Total 31.00 .00 .00 31.00 LQPERMIT Bin # ' C� 0� !:d, Quinta "/ l -Building 8r Safety Division P.O. Box 1504, 78=495 Calle Tampico La Quinta, CA 92253 —(760) 777-7012 Building Permit-AOplication and Tracking. Sheet Permit # D Project Address:' A. P. Number: -. Address: ,S/Se�G4- evt /A Legal Description: Contractor' � / . � C7// �,• _4161 City, ST, Zip. ZA-.1: .�' 3 Telephone: :., , .,, J,.: ••.><:��:.: Address: �� Project D escr iption: City, ST, Zip: ��?P Telephone? j: c> • r^:as<>::::..;:;:>,•.;::j:;:;::::`>:::<' •i"r }ti:{vii:/.•i:{?{S: J J Y: ['�•� ��' �/ State Lic. # :,/ City Lic..#; Arch., Engr., Designer:. Address: City., ST, Zip: Telephone: ? ::::: > `.;.,.»:,:`'>:': :r;. ..: is i:•i:• .J.7•:!iiiiY•{`i'i::,; ..:i:tri:^:: '�`\„�: State Lica#: /n. v Name of.Contact Person: : Consf _tr,•, uction Type: Occupancy: - -. project•type (circle one): New . Add'n Alter Repair Demo Sq. Ft.,: #Stories: #Units: Telephone # of Contact Person: `, �` Estimated Value of Project:, �� APPLICANT:'DO• NOT 1NRITE:BELOW THIS. LINE # Submittal Req'd Recd TRACKING . I PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewedi ready for corrections PIan.Check Deposit Truss Calcs. Called Contact.Person Plan Check Balance. Title 24 Calcs. Plans picked no Construction Flood plain plan Plans resubmitted Mechanical Grading plan .2'd Review, ready for corrections/issue'.: Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans,picked no. S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- 7rd Review,.ready for corrections/issue 'Developer Impact Fee Planning Approval Called Contact Person A.LP.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees A? COACHELLA VALLEY WATER DISTRICT e FRO P.O. BOX 1058, COACHELLA, CALIFORNIA 92236 (760) 398-2651 INVOICE Dat'e:.6/8/2009 SUBJECT: 51-884 AVENIDA OBREGON, LA QUINTA 606013,357.0.1 NEUBURGER EQUIPMENT RENTAL & Project: 9-1731 CONSTRUCTION CO INC. PO BOX 623 Project Date: 6/8/2009 Amount Due: $3,995.00 LA QUINTA, CA 92247 GEO: 06-06-01-3 Planner: REBECCA MILWARD TO INSURE PROPER CREDIT, PLEASE RETURN THIS PORTION WITH REMITTANCE AND INCLUDE THE PROJECT ON YOUR CHECK SUBJECT: 51-884 AVENIDA'OBREGON, LA QUINTA 606013,357.0.1 COACHELLA VALLEY WATER -DISTRICT. P.O.: BOX 1058, COACHELLA, CALIFORNi,4;922.36-(760) 398-2651 Pagel _:A: -5-A P . PUMP/NG, Inc. Lic #C42 855 851 7630 328-7887 •760 365-4125 Fax 760 365-4118.1-800-334-7255 P.O. Box 2318 • Cathedral City, CA 92235 ESCROW # PRICE 11 17 1�ir- ,� g ' BILL TO PHONE ADDRESS FAX CITY MECHANI JOB NAME AND LOGAZION DESCRIPTION OF ARK A Camera Labor QUANT. DESCRIPTION OF SERVICES PRICE AMOUNT Pumping Fee per 1000 gal. Rooter Service Camera Labor $75/HR- - Septic Inspection Locating / Opening Fee $-75/HR_, . Jetting Service Out of Area Fee Comments: SYSTEM FAILING' ❑YES ❑ NO A FAILING SYSTEM MAY FILL BACK UP WITHIN A FEW DAYS AND CONTINUE TO HAVE PROBLEMS IF NOT RECTIFIED. FUEL CHARGE .$_2-5--0.0-' TOTAL MATERIALS - TOTAL LABOR WAIVER: Not responsible for secondary damage such as water damage, chipped co�crete,.mark•on.street or•driveway or trees. f �j G'� SIGNATURE DATE (0 /a� COMPLETED/ &I TAX TOTAL Z v