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06-1965 (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: r. 06-00001965 53178 AVENIDA OBREGON .774-045-009-9 -000000- PLUMBING COVE.RESIDENTIAL 500 Architect or Engineer: BUILDING & SAFETY DEPARTMENT BUILDING PERMIT LICENSED, CONTRACTOR'S DECLARATION - - �I herebyaffirm under penalty of perjury that I am licensed under provisions.of Chapter 9 (commencing with ' Section 7000) of Divisicn-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 - Lhereby affirm under penalty of, perjury. that.) am exempt from the Contractoi's 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 Contractor's State License Law (Chapter 9'(comrnencing with Section 7000) of Division.3 of the Business and Professions Code) or that heor,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).: ( 1 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.oi offered forsale,ISec. 7044, Business and Piofessions,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 through his or her own employees, provided that the ' improyements are not intended 'orofferedfor 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.). (_) .1, 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 LicenseLaw.). . (_) I am exempt under Sec. ., B.&P.C. for this reason e Date: QS - � �•• 6 Owner: CONSTRUCTION LENDING AGENCY 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 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 5/11/06 Owner: CHILPA ADRIAN 53178 AVENIDA OBREGON LA QUINTA, CA 92253 --------------------------------- Contractor: Owner %A\ ------------------ - - - - - - WORKER'S COMPENSATION'DECLARATION I hereby affirm under penalty of perjury one_of the following declarations:I . I have and will maintain -a certificate of consent to self -insure for workers' compensation, as provided _for 6y 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 ),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 the wo .s' compensation provisions of Section 3700 of the Labor Code, I she I forthwith comply ith t se provisions. ' A � Date: ' //�•:&bicannt:�^�rC�. 1 cGt rl.' C �.t L� o 7. `a 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 ' IMPORTANT Application is hereby made to the Director of. Building and Safety for a permit subject to the conditions and restrictions ser 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 isnot commenced within .180 days from date of issuance of such permit, or.cessation of work for 186 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 he authorize representatives of this county to enter upon the above-mentioned property for i�n>spection purpos s. 1` .Date:­W- 1-i •-.6®onature IAoolicant or Aoentl: ��f —, l n /LC1 Application Number . . . . . 06-00001965 Permit PLUMBING SEWER Additional desc . Permit Fee . . . . 30.00 Plan Check Fee .00 Issue Date Valuation . . . . 500. Expiration Date 11/07/06 Qty Unit Charge Per Extension BASE FEE 30.00 ---------------------------------------------------------------------------- Special Notes and Comments SEWER CONNECT/SEPTIC ABANDONEMENT 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 U• 1 Received From: Address: COACHELLA VALLEY WATER DISTRICT CASH RECEIPT DETAIL y� L ~f 114387 Date•- r 1 t " Account No. -� C C Lot(s) - f " / i ^Y` Tract 4 - Service Address�. , : i a -L l ;�.j { ... a GA: Code ' ❑ Meter(s) $ " ❑ Service(s) j '! ❑ Backflow(s) ❑ .House Lateral(s) ❑ Detector Check(s) ❑ . Meter Surcharge O'Sanitation Capacity Charge y,. -t~� i J �.., i ,/ l O W:S.B.F.C. ❑ S.I.W.S.C. ❑ . Temporary Construction Meter i ❑ Tum on Charge ❑ Uncollected Account - Name ❑ Inspection Fee - Tract - { ' Fee - ❑ Plan Check Fees Water / Sewer - Tract - i ❑ . Bond Payment - A.D. - Bond Assmt ; ❑ Customer Deposit 1 i ❑ Other TOTAL Remarks: - 1 ❑'' Copy to: "' Cash f 1 I Water. Service Check Money it. ":. Cashier Order :g .; CVWD (1 -438 %OS) _.�. 1 Bin# • Ci of -�.aQuinta.tY A•ox,,4,u cA cPa Building at. SafetyDivision P.G. Box 15,04; 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building PermitApplication and Tracking Sheet Permit .# (_ Project Address:' Owner's Name:.. A. P. Number: Address: O t Legal Description: Contractor: City, ST,.Zip: b C Telephone Address: Project Description: City, ST, Zip: S L) iv P_ m r ti/ Telephone: State Lic. # : City Lic. #: Arch., Engr., Designer: Address: City, ST, Zip: Telephone: 'Construction Type: Occupancy: State Lic. #: Project type (circle one): New _ Add'n Alter Repair Demo Name of Contact Person: Sq. Ft.: #Stoties: #Units: Telephone # of Contact Person: 'tstimated Value of Project: ` ±D,) 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. Called Contact Person Plan Check Balance Energy Calcs. Plans picked up Construction. Flood plain plan'. ..Plans resubmitted Mechanical Grading, plan 2°" Review, ready Cor corrections/issue Electrical Subcontactor. List Called Contact.Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval: Plans resubmitted Grading, IN HOUSE:- ''" Review; ready for. correctionsfissue Developer Impact Fee Planning Approval Called Contact Person A:LP.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees Post Office.s6x.955 Yucca Valley, CA.,92286 " 76-0/369.41104 LUMPING Special/:Ing In'- Fax.. 760 328=6607. Sewer Hookups & Systems Lic #793482 B/G42/C96 " Customer Name PARTS PRICE '.Dat '. ten�' lJ j Address ome Phone Date Schedrui d City Business Phone Date Completed I^ V � Tax Location Name Labor Total Type & Make Address Home Phone Model Number'. City Business Phone ., Serial Number' 'JOB DESCRIPTIO LABOR PRICE ' Y 4 PARTS USED: PARTS PRICE WAIVER: Not responsible forsecon ary damage such as water damage, chipped concrete, mark on street or dr= sNr trees. I Customer's Signature /' Parts T I Tax "Invoice Number 5692 ::1 Labor Total Irtvo �e Tota. 1- A-w5wA P. PLIMPJIIVG-- Lic #C42 855 851 tau SLif-fisof • 7-ifUU-334-/LJJ FAX 760 328-6607 P.O. Box 2318 • Cathedral City, CA 92235 CUSTOMER'S ORDER NO. DATE ORDERED ORDER TAKEN BY DATE PROMISED ❑ A.M. ❑ P.M. BILL TO PHONE ADDRESS MECHANIC L CITY HELPER JOBj AMA�D L A ON '';�jj DAY WORK ❑ CONTRACT DESCRIPTION OF WORK Ile.S'❑EXTRA QUANT. " DESCRIPTION OF MATERIAL USED PRICE AMOUNT l©6p Gallons //K,�,� Pumping Fee per 1000 gal. !S o ` •-- Dumping Fee per 1000 gal. Out of AFea Fee " . Locating /Opening Fee (per hour) Size System: j 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 MATERIMA TOTAL LABOR WAIVER: Not responsible for secondary damage such as water damage, chipped concrete, mark on street or driveways � trees. SIGNATURE OA�/c7 TAX TOTAL 5� OWNER/BOLDER 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 °°Owner/Buil'der" you are theiresponsible party of record on such a permit.. Building permits are not:required'to_be signed by property owner§: unless'they"are personally performing their own work. If your.work is beingperforined,by someoneoiher'ahan yourself, you may p`ro'tect yourself from possible liability if that. person applies for the proper permit m` -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.Cityor.County. They are, also.required by law-,to..putq their- license,number .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 your- benefit 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 .persoris are not.licensed as contractors or subcontractors, then you .may -be an `employer. If you are an employer, you must•regster with the -State .and Federal Government. as an.employer and you are subject to several< obligations include State" and. Federal :income tax ,withholding, federal social security taxes, worker's compensation insurance, disability" insurance costs and unemployment `compensation 'contributions. There may be financial risks for,you if you do not carry but -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,, contactwthe.:Internal.. Revenue Service (and, if you wish the U:S. Small Business Administration)::'For,more,specific information: about,your obligations under State Law, contact the Department of Benef t 'Paymenis :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, 'wrthout a'.licensed contractorlor'subtonfractbr, only under limited conditions. - A frequent practice` of unlicensed persons professing to be 'contractors, is to secure an "Owner/BuildeC building permit, erroneously implying that- the .property owner' is providing liis or her.:gwn.labor, and material personally. Building permits are not required to" be 'signed by'property ownersunless:,they' are `performing their own work personally. Information about licensed contractors may be obtained by cpntacting..the Contractors''State License Board in your communityor at 1020 N. Street; Sacramento, California 95814. Please complete and return the enclosed owner -builder verification form so thatwe can confirm that you are aware of these matters. The building permit will not be issued until the verification is i