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05-3708 (PLBG)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: -Property Address: APN: Application description: Property Zoning: Application, valuation: Applicant: 0:5=:0.0.0 0-3-7 _0 8 51940 AVENIDA OBREGON 773-164-010-10 -000000- PLUMB'ING COVE RESIDENTIAL 2500 T4ht 4 4 Q,, " Architect or Engineer: BUILDING &,SA'FETY DEPARTMENT BUILDING PERMIT r• Owner: (n JERRY HYATT 51940 AVENIDA.OBREGON LA QUINTA, CA 9225.3 co, ntractor: , SO CAL PLUMBING &,REPIPE CO P.O. BOX 955 YUCCA VALLEY, CA.92286 (760)369-4104 Lic. No.: 793482 VOICE (760) 777-7012 FAX (760) 777-7011. INSPECTIONS (760) 777-7153 Date: -8/22/05 ' LICENSED CONTRACTOR'S DECLARATION ---------------------------— -. WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of, perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty.of perjury oneof the following declarations: - • Section 7000) of Division 3 of the Business and Professionals Code, and my. License is,in full force and.effect. I have and will'niaintain a certificate of consent to self4i ure,for'workers' compensation, as -provided License Class I C36- 2-B nse o.: 2 forby.Section 3700 of the Labor Code, for the performance of the.work for which this permit is ate ontr r. 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 - .OWNER -BUILDER DECLARATION insurancecarrier. and policy number are; I hereby affirm under penalty ofperjury that I am exempt from the.Contractor's State License Law for the _ •'-Carrier: EXEMPT Policy Number EXEMPT _ following reason.ISecv'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, I shall not employ any construct, alter, improve; demolish, 6r repair any structure, prior to its issuance, also requires the applicant for the _ person:in any manner so as to become subject to the workers' compensation laws of California, . permit to file.a signed'statement that.he'or she is licensed pursuant to the.provisions of:the Contractor's State • and agree that, if 1 should become subject to the workers'. compensation provisions of,Section License Law (Chapter, 9.(commencing:with Section J000) of Division 3,of the Business and Profession's Code) or 3700 of the Labor C�11'forthwi revisions.. that he or she is exempt therefrom and the basis fonlhe alleged exeniption..Any violationbf Si?ctipn 7031,.5 by any applicant for a`peimrt subjects the applicant to a civilpenalty of more than five hundred dollars (55001.: D Appl' -not (_ 1 l,.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 WARNING: FAILU O SECURE WOCOVERAGE IS UNLAWFUL, AND SHALL Contractors' State License Law,does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TorCRIMINAL PENALTIES AND CIVICFINES UP TO ONE HUNDRED THOUSAND - and who does.the-vwork.himself:or herself.through his or, her: own employees; provided that the DOLLARS ($ 100,000). ' IN ADDITIONTO THE:COST�OF COMPENSATION, DAMAGES `AS PROVIDED FOR IN - improvements4re 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'thq purpose of sale.): (_ 1 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—) 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 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 comply with all city and county ordinances and stat aws relating to building construction, and hereb authorize representatives of this county to enter upon the eve- mentioned property for Dati;: Signre (Applican gent): .. ` Application Number . . . . . 05-00003708 Permit . . PLUMBING SEWER Additional desc . Permit Fee . . . . 30.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 2500 Expiration Date . . 2/18/06 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 LQPERMIT Bin # .' City of La Quetta Building ;8t;Safety Division . P.O. Box 1504; 78-495 Calle Tampico La Quinia, CA 92253 - (;W) 777-7012 Building ..PermitApplication and Tracking Sheet Permit # Project Address: u ' (J0 Owner's Name: x A. P. Number. Address: jc ( �, Legal Description: f City. ST, Zip: K Telephoner Contractor. K ` Address: Project Description: X City. ST, Zip: V1 Telephone: hon e. K State Lic. # : X. �- City Lic. #:: Arch.. Engr... Designer: Address: City, ST. Zip: Telephone: hone: :: Co.n struc' on Type: Occup P n y.. .>' tat S e # Pr J ec t one): New type(circle o Add' n Alter Re air Demo Name of Contact Person:.{ �� Sq. Ft.: .# Stories: # Units: Telephone # of Contact Person: Estimated •Value of Project: X� APPLICANT: DO NOT. WRITE BELOW. THIS "LINE # Submittal Req 'd Recd TRACKING PERMIT FEES Plan Sets -Plan Check submitted Item Amount Structural Calcs. Reviewed, ready -for corrections Plan Check Deposit Truss Calcs. 'Call,ed`Contaci Person Plan Check Balance Title 24 Calcs. Plans picked up Construction Flood plain•plan Plans resubmitted Mechanical Grading plan 2nd. Review, readv for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans,picked up S.M.I. �1 H.O.A. Approval Plans resubmitted Grading IN HOUSE:- ''d Review, ready for corrections/issue Developer Impact Fee A.I.P.P Planning Approval Called Contact Person Pub. Wks. Appr Date of permit issue School Fees • Total Permit Fees COACHELLA IVtALLLEY WATER DISTRICT CASH RECEIPT DETAIL {�� Q 109051'� Received From: /1110'�'�-'/`��',t T�K4&A . IHLZE81�1V6 �/ ,o ^ ' ! Date:6-30—CS. Add s '/76 - L ��s'1 ,. k, Y ALCA', 1 . .'e, , ' 2-7-P(e ress. Account No. tQ'(3 t + Tract Service Address S�`'� µ �V - nWL/o�t(s)�fi' V,JQC �� 'V G.A. Code ❑ Meter(s) $ O Service(s) >. ❑ Backflow(s) ❑ House Lateral(s) ❑ Detector Check(s) ❑' Meter Surcharge Sanitation Capacity Chargee ❑ W.S.B.F.C. r ❑ S.I.W.S.C., ❑ Temporary Construction Mefer^ ❑ Turn on Charge ❑ Uncollected Account - Name ❑ Inspection Fee - Tract - Fee - ❑ Plan Check Fees Water / Sewer - Tract 0, Bon Bond Payment - A.O. =• Bond ` �' Assmt :.; .., ❑ Custorher"Deposit ❑ Other _ - - - _ _. ___-. - _ Sew'• _. ._ _ . `? 59 TOTAL $ Remarks Copy to: &V A�J/L Cash Water Service Check i /^ Money .� Cashier ' Order CVWD-438 (1/05) 7-777 90-427a/1222 36 40 MICHAEL & TAMARA H'ILDEBRAND 0210013168 5800 CAkMELITA CIRCLE, YUCCA VALLEY; CA 43756 YOSEMITE DR., BIG BEAR LAKE, CA ppTE PAY To COACHELLA VALLEY W �T�&flG7 $l .T E ORDE OF i LLARS-A MZ At� CANYON 5 ' ... national -ba lk . LOCALLY OWNED AND, MANAGED 1x+50CWNfRY CWD DHj.: PAW OESER( G/ DQT]6D��, NP 12'2 2-42 ?,813 :0 2 00 3 i68�i' 3'6 0lei Lic #C42 855 851 OU .290- / oo / •- I'moV V -.i34- / ADD CUSTOMER'S ORDER NO. DATE ORD FAX 760-3218-66'07"," Gallons P.O. Box 231 ath6deal'City,;CA 92235 ORDER TAKEN BY DATE PROMISED ❑Ann % Purnping'Fee per 1000 gal. ❑ P.M. BILL TO PHONE ADDRESS MEC C CITY' rqumpingFee per 1000 gal. H i`E JOB NAME AND LOCATION IR ❑ DAY WORK Out.of Area Fee DESCRIPTION OF WORK ❑ CONTRACT ❑ EXTRA vwo Locating / Opening Fee (per hour QUANT. DESCRIPTION OF MATERIAL USED PRICE AMOUNT Gallons Purnping'Fee per 1000 gal. rqumpingFee per 1000 gal. IR 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 LABOR WAIVER: Not responsible for secondary damage such as water damage, chipped -concrete, mark on streeo riveways--or-tress.�'� SIGNATUR� DASE_OONIPLRD l TAX TOTAL