05-0744 (PLBG)��. BUILDI-NG & SAFETY DEPARTMENT
P.0.. 504>= (760).777=7012
OFTt�9 7' ,.49'5 XI` LIE•7AMP1 0 FAX (760) 777-7011
pUI 1` CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
D 3Q®�J U - BUILDING PERMIT
Of
Ap;lica`t ;on��Nu er . . . . . 05` "OOOOOY744 Date 3/03/05
Proper-t'y Address .52410 AVENIDA_OBREGON---'j
APN:7x..7.3 255-'00T- -000000-
Application description . . 'PLUMBING
Property Zoning :,COVE` -RESIDENTIAL
Application-va-ludtion 7;00
Owner Contractor
ZAMORA DAVID A OWNER
52410 AVENI.DA OBREGON
LA ' QUI NTA =.CA . 9 2 2 5 3 7
Permit PLUMBING .SEWER
Additional'. de'sc
Permit Fee 3'0 ::0'0 Paan Check Fee .00
Issue Date Valuation . . 700
P.O. Box 1504 •
VOICE (760) 777-7012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: V S- 0"2'1 Y
Applicant: O l-/tv e/L_
Applicant's Mailing Address:
Date: 3 -3-
Architect or Engineer:
Architect or Engineer's Address:
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty 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 License No.
Date Contractor.
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' 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 Contractors' 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 or 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.).
U 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.).
L) I am exempt under Sec. , BA P.C. for this reason
WORKERS' COMPENSATION DECLARATION
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 Policy Number
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 Califomia, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
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.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance ofthe work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name
Lender's Address
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 state laws relating to building
construction, and hereby authorize representatives of this county to enter upon pe -above-mentioned property for inspection purposes.
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OWNER/BUILDER INFORMATION
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified.
For your protection you should be aware that as "Ow er/Builder" you are the responsible; party of record on such a
permit. Building permits are not.require'd to be signed by.property.owners: unless,'they are personally performing their
own work.' If your work is being performed by someone: other than yourself,. you may protect yourself from possible
liability if that person applies for the proper.permit,in his or her name.
Contractors are required by law.to be licensed and bonded by the State' of California and .to have a business license
from the City or County. They are also required by law to put their license num6er on all permits for which they
apply
If you plan to do your own work, with the -exception of various,. trades that you plan to subcontract, you should be
aware of the following information for yourbeneft,and-protection:
If you employ or otherwise engage: any persons other, than your immediate family, and the work (including materials
and other costs) is, $200.00 or more -for the entire project, and such persons- are not licensed as contractors or
subcontractors; then you may be an employer.
If you are an employer, you must.register.with the State. and: Federal Governmenras an employer and you are subject
to several obligations. include State and.. Federal income tax withholding, federal socialsecurity taxes, worker's
compensation insurance, disability insurance costs and unemployment compensation contributions.
There may be financial risks for you'if:you do not carry out.these obligations, and these risks�are especially serious with
respect to worker's compensation insurance.
For more specific information about..your obligations -under Federal Law contact the Internal Revenue Service (and, if
you wish; the U.S. Small Business Admmistrafionj. For mole specific information about .your obligations under State
Law, contact the Department of Benefit-paymen'ts and the'Division'of Industrial Accidents.
If the structure is intended for sale, property owners who are .not licensed contracts .are', allowed to perform their
work personally or through their own employees, without a licensed contractor or subcontractor, only under limited
conditions.
A frequent practice of unlicensed persons professing to be _contractors is to secure an :`Owner/Builder" building
permit, erroneously implying that the property owner is providing his ;or her.own labor and' -material personally.
Building permits.are not required to be signed by property owneru
s nless they are performing their own work
personally.
Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your
community or at 1020 N..Street, Sacramento, California 95814:
Please complete and return the enclosed owner -builder verification form so that we can confirm that you are aware of
these matters. The building permit will not be issued until the verification is returned.
Very truly yours,
CITY OF LA QUINTA
DEPT. OF BUILDING AND SAFETY
78-495. Calle Tampico
La Quinta, CA 92253
(760) 777-7012
FAX: (760) 777-7011
Gy s
ER'S SIGN RE/DATE
PROPERTY ADDRESS
PERMIT NUMBER(S)
EC`Sewer Service, Inc. JOB TICKET
dba ECONO SEWER SERVICE
P.O. Box 581029, North Palm Springs, CA. 92258
(760) 346-2793 (760) 328-7760 Customer Order No. Date Ordere
Fax (760) 251-3405 , .
—1-- o.. 0—:7
BILL
ADDRESS
JOB ADDRESS
'SERVICE ❑ PUMP SEPTIC TANK HAS SEPTIC TANK BEEN DUG UP? ❑ Yes ❑ No ❑ PMT. ON SITE
REQUESTED ❑ PUMP SEEPAGE PIT AT ITS RISER ❑ OFFICE BILLING
❑ PUMP GREASE TRAP Yellow Cust.
❑ OTHER ® Yellow Office
OUANT DESCRIPTION OF PRICE AMOUNT
Pumping Fee per 1000 Gallons (or fraction)
Waste Discharge Fee per 1000 Gallons
Locating and Opening Fee (lhr. Min.)
Out of Area Fee
,!/ A n n
GREASE TRAPS
❑ RECOMMEND INLETIOUTLETBAFFLE REPAIR.
❑ EXCESSIVE GREASE/FOOD/DEBRIS.
ODOR.
®EXCESSIVE
RECO-"ND MORE FREQUENT PUMPING.
❑ RECOMMEND LINE CLEANING.
SEPTIC SYSTEMS
❑ THE LEACHIN 'SYSTEM HAS FAILED.
❑ THERE 1S AN OBSTRUCTION "UPSTREAM" OF THE SEPTIC TANK.
It will be necessary to a line cleaning company.
�ntntacl
rEN ILWING OF THE SEPTIC TANK EVERY
❑ WE RECOMMEND MAINT
❑ YEAR ❑ OTHER YEAR ❑ 2-3 YEARS
To remove built up solids. This will in life of your leaching system.
`the
E3THIS PUMPING WILL PROVIDE ONLY 7MPORARY RELIEF AND NOT
SOLVE CUSTOMERS SEPTIC PROBLEM BEgAAUSE OF THE ABOVE.
❑ CUSTOMER HAS BEEN G[VEN AN "EXPLAINA [ON' PACKET.
A SERVICE CHARGE OF $22 WII L E DUE
ON ALL RETRUNED CHECKS.
A FINANCE CHARGE OF l 1/2% PER MONTH, 18% PER R, WILL BE
CHARGED ON PAST DUE ACCOUNTS OVER 30 DAYS.
IF PAYMENT LS BY CHECK
DRIVERS LIC. 8 STATE
I hereby acknowledge'the satisfactory completion of the above described work:
Total
SIGNATURE / % J A
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✓!✓ .sem
Due
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