05-5334 (PLBG).4
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
TW!t "
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number:
05-00 0 05.3.34
Property Address:
53511 AVENIDA OBREGON
APN:
774-114-011-1 -000000-
Application description:
PLUMBING
Property Zoning:
COVE RESIDENTIAL
Application valuation:
2500
Applicant: Architect or Engineer:_
Owner:
LA QUINTA REAL ESTATE
P.O. BOX '1511
LA QUINTA, CA 92247
Contractor:
SO CAL PLUMBING & REPI
P.O. BOX 955
YUCCA VALLEY, CA 92286
(760)3.69-410.4
Lic. No.: 793482'
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 12/06/05
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-_ 1 I, as owner of the property, am exclusively contracting with licensed'contractois to construct the project (Sec.
7044, Business and Professions Coder 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. , 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 applicatiori becomes null and void if work isnot 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 constru Adte wes
of thi ounty to entea/pon the above-mentione pro earl p pose'
aU taA ignature (Applica or A e
r
---------=-----------------------------------------------==--=--=-'----------------
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION .
hhereby affirm under penalty of perjury that I am licensed under. provisions of,Chapter 9 (commencing with "
I hereby affirm under penalty of perjury one of 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 maintain a certificate of consent to:self-insure for workers' compensation, as provided .
License Class - C36" -C42 -.B L'
for by Section 3700 of the Labor Code, for the.performance of the work for'which this permit is
. _.
.ntra
issued. -... ".. '
- _ -'-"'
_ I have:and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
"permit
Code,.fortheperformance of thework for which this is issued. My workers' compensation
OWNER-BUILDERDECLARATION
insurance carrier and policy number are:
:I;hereby affirm under penalty of perjury. that I am exempt from the:Contractor.'s State License Law for the
Carrier EXEMPT Policy. Number .EXEMPT
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, I shall not employ any
construct, -alter, improve, demolish, or 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 fo the provisions of the Contractor's State
and agree that, if I should become subject to the workers' compensation provisions of Section
License'Law (Chapter 9.(commencing,with Section 7000) of Division 3 of the. Business and Professions Code) or
370 a Labor Code, I shall forthwith comply with those provisions. '
that he or she is exempt therefrom and the basis for -the alleged exemption. Any violation of Section 7031.5 by
an_y applicant for-apermit subjects the applicant to a civil penalty of not more than -five hundred. dollars155001:
e// is _
1' 1 I, as owner of the property, or my employees with wages as, their sole compensation, will do the work, and
41
the structure is not intended or offered for sale (Sec. 7044; Business and Professions Code: -The
WARNING:- FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
_
Contractors' State License'Law does not apply to an owner of property who builds,or improves thereon,
. SUBJECT AN EMPLOYER TO CRIMINALPENALTIES 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 ($100,0001. IN ADDITION TO THE COST OF COMPENSATION, DAMAGES`AS PROVIDED FOR IN
improvements'arenot 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.)., -
1-_ 1 I, as owner of the property, am exclusively contracting with licensed'contractois to construct the project (Sec.
7044, Business and Professions Coder 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. , 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 applicatiori becomes null and void if work isnot 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 constru Adte wes
of thi ounty to entea/pon the above-mentione pro earl p pose'
aU taA ignature (Applica or A e
r
Application Number . . . . . 05-00005334
Permit . . PLUMBING SEWER
Additional desc .
Permit Fee 30.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. . .
. 2500
Expiration Date 6/04/06
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 30.0,0.
.0-0
.00
30.00
YPlan Checks Total :0.0
00
OQ:
r 00
Grand Total 30.,00
.00
—00
: 30.'00.
;L
- LQPERMIT .. .. .
Bin #
City of La-:Quints
Building & Safety Division
P.O. Box'1504,° 78=495 Calle Tampico
La Quints;. CA"92253 - (760) 77.7-7012
Building,Permit Application and Tracking Sheet
4
Permit #
Project.Address: 3 5
Owner--'s~Name: r �GX '.
A. P. Number:
Address:
Legal Description:
City, ST; Zip:
Contractor:
Telephone:
Address:
CJS t)g
Project Description:
City, ST, Zip:
Telephone:
IN9
State Lic. # : City Lic: #:
Arch., Engr., Designer:•
Address:
City, ST, Zip:
Telephone:
State Lic.
Name of Contact Person:J
:Construction Type: Occupancy:
�Trojecrtype (circle one): New Add'n Alter Repair Demo
Sq: Ft::
#Stories
# Units:
Telephone # of Contact Person:
Estimated Value.of Project:. 2-5ZZ
APPLICANT: DO NOT WRITE.,EIROW,THIS LINE
H
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submifted
Item
Amount
Structural Cates.
Reviewed, ready for corrections .
Plan Check Deposit
Truss Cates.
Called Contact Person
Plan Check Balance
Energy Cplcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading. plan
2°" Review, ready [or coi•rectioushssue
a
-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 corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person-
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
T-iTotal
Permit Fees
FROM : LA QUINTA REAL ESTATE PHONE NO. : 7610 5644326 Nov. 01 2005 12:21PM P2
-T rJ Al
L
v Y-
0
2 1-)
COACHELLA VAU.EY WA -(r -A DjSnjQj CASH REC;FiWr DETAIL
1
lil24
®1
Racsived Frommoo n ' n
—
Acoount No. St Lo
Tract
&tmoe Address-
GA. Code
0 Meter($)
0 asoldlow(s)
0 House Lalwai(s)
0 Detector Check(s)
0 Water Surcharge
cz)
charge
M slw-B.C.
0 lomwaty Co"Muction Meter -
0 7kim on Charge—
Inspection l;w - TrW -
Fee -
0 Plan Check Fees Water 1 Sewer -
Tract -
C3 gond Payment - A.V. - Bond —
0 Customer Dwo
Cl Other—
rOTAL
t72
Rarnaft:
Mof*y
water semfta/
Cashier
Onw
IOU 13ZO-fOOI
FAX 760 328-6607
Ro. Box Cathedral Cii ty, CA 92235
--CUSTOMER'S ORDER NO.
DATE 4R�DgD<
ORDER TAKEN BY
DATE PROMISED 0 A.M.
0 P.M.
BILL TO
PHONE
ADDRESS
ME NIC
CITY
HELPER'1
JOB NAME AND LOCATION
0 DAY WORK
0 CONTRACT
.0 EXTRA
DESCRIPTION OF WORK
Dumping Fee per 1000 gal.
QUANT
DESCRIPTION OF MATERIAL USED
PRICE
AMOUNT
Gallons
V
Pumping Fee,per 1000 gal.
Dumping Fee per 1000 gal.
Out of Area Fee
Locating / Opening Fee (per hour)
Size System:
6qvr-Q Fv
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
MATERIALS
TOTAL
LABOR
WAIVER: Not responsible for secondary damage such as water
damage, chipped concrete, mar o a s or trees.
SIGNATURE B*W-OOM TED
TAX
TOTAL