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04-7168 (PLBG)t �M BUILDING & SAFETY DEPARTMENT P O '-;BOX 15;04: t �< (760).777-7012 �,. 78-4975: CA'LLE TAMPICo ", FAX (760) 777-7011 LA.QUINTA, C'AL:iFokNI 9225:3 INSPECTION'REQUESTS (760) 777-7153 ! i BUILDING PERMIT _ 4 Application Number . . . 604 ,07AY68 -Date 11/10/04 Property.Address 53444 AVENhDAtiOBREGON APN: `" 3 x `774 075 009..10 000000- Application description.. PLUMBING.'-. Property.,Zoning COVE'RESIDENTIAL Application valuation =. 2500 Owner -,... Contractor. ------------------------ --------------------------- THOMAS ------------------ THOMAS PAMELA J "m SO CAL PLUMBING & REPIPE CO *NOT ON FILE _ - P.O. BOX..955 UNKNOWN CA 99999. YUCCA'VALLEY CA 92286 (7.:6:0) .3.6'9-410'4: -,WCC- EXEMPT EXEMPT 11/30/05 CSLB.';,. 7.9.:3482 04/30/05 °CCC.:. " ;C3:6 -C42-B Permit PLUMBING . SEWER Additional de.sc Permit Fee- 30.00' Ryan Check Fee 00 Issue Date Valuation . . . . 2500 ..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 10. 001 0'0 30;.00 Plan Check °To.'tal 00. '0000 00. Grand Total., 30.00 .00 .00 30.00 P.O. Box 1504 • �� VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 4INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: Applicant: Applicant's Mailing Address: Date: Architect or Engineer: Architect or Engineer's Address: Lic. No.: 0A . 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 Li s is in full f rce and effect. 2 icense Class t - 0C � icense No. .7Lf 19- '2— ❑arta � ��l%CX/ o �r..� �• 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).): U 1, 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.). (-.) 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 am exempt under Sec. , BA P.C. for this reason a Date v—nAA OX_ % r� 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 California, 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. ate p icant I 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 of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name Lender's Address A 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, indemnity and hold harmless the City of La Ouinta, 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 auth 'ze representatives of this county o— enter upon the above-mentioned property for inspection purposes. e �/ gnature (Applica n 7• ESTABLISHED IN 1915 AS A;PUBLIC AGENCY, �STWO " CO►aC.NELLA VALLEY4V AT DIST: ICT POST OFFICE 60X 1058'a:GOACHELLA, CAUfORNIA 92238 TELEPHONE (760) 398-2851 FAX -(760) 398-3711 DIRECTORS:. OFFICERS: Am* MCFADOI N PRESIDENT STEVEN B ,ROSBINS, . TELLIS CODEKAS CE'PRESIDENT September .11 2003 JU.GENERAL MANAGER -CHIEF LIA F RNANDEZ. SECRETARY RUSSELL KITAHAI A ,DAN PARKS: ASST: O GENERAL MANAGER PATRICK A: LARS )N REDWINE AND SHERRILL, ATTORNEYS File: 0032.31 . PAj Tii DUAS $3.444AVE'CaaEGON, 979 lei r4�• o� 47,71 Dolt ry An afternoon in -the sun BANKI RU. ST.i .,O.eA • � � =_ .• 1••rolnlW1►11f'll�,� G4A�MM Op101 _. �_ 12 2 2 3.2 10�9�409 79da� _ "i'•_•�.�.e •..._.. .........-.:.m.:,..:�s �,-, _ ear � �aoa �. SETNAME:Optimai SitcID: ProcDate:7/2/20 )3 CapturDate; . MflmSegNum:O A�■�.//��j■�/y� . 171 ' ' • o`:: ill`. �i �ia � _ -• • �• o :MY PK 9 �Tf$ll r x17+1_1 : ��r�ei:..i'�a'.�t.ii� t:�:' SII` i�l�•iJ lam. e :.Y Ivy �:i'r��'i °,F •r,� ��'' C;'• 1226004964 DISI MCT = CEN.ACCIP27A0013026 SETNAME:OP•ima3 Sit elDi t ProcDate:7/2/2003 ICaptprDate: 1,MfimSegNiim•1{ Z0' d 881 €zb!� 05Z > `.isna1. QtJd._;� NdH .d0 20 :2,0 b00Z-(3Z-100 i HAMMER PUMPING INC. JOB INVOICE P.O. Box 2448 CATHEDRAL CITY, CALIFORNIA 92235-2448 17An1 zAn-SAAR i7 -6-O-;3-2--1-7"4,4,8- 760 321-7448 CUSTOMER'S ORDER NO. D ORDI ED AMOUNT ORDER TAKEN BY DATE PROMISED O A.M. O P.M. BILL TO � PHONE ADDRESS MECHANIC CITY HELPER JOB NAME AND LOCATION - O DAY WORK O CONTRACT DESCRIPTION OF WORK O EXTRA Locating / Opening Fee (per hour) QUANT. DESCRIPTION OF MATERIAL USED PRICE AMOUNT Gallons Pumping Fee per 1000 gal. f o Dumping Fee per 1000 gal. Out of Area Fee Locating / Opening Fee (per hour) Size System: i 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. HOURS LABOR AMOUNT TOTAL MATERIALS MECHANICS Q HELPERS @ TOTAL LABOR I hereby acknowl d work: TAX GNA E DATE COMPLETE TOTAL