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06-1582 (PLBG)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 T-iht 4 4 Q.-" BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Application Number: 06-0000158',2 Property Address: 53640 AVENIDA OBREGON APN: 774-115-006-6 -000000- Application description: PLUMBING Property Zoning: COVE RESIDENTIAL Application valuation: 4300 D 4 Applicant: Architect or Engineer: APR 19.1006 CITYl OF Owner: KATHLEEN RUST 53640 AVENIDA OBREGON LA QUINTA, CA 92253 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 4/19/06 ---------------- LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter (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 Licerise 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: _ License No.: - for by Section 3700 of the Labor Code; for the performance.of the work for which this permit is - issued. Date: Contractor: 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-DECLARATIONinsurance carrier and policy number are: I hereby affirm under penalty of perjury that I am exenipt,frorn the Contractor's State License Law for the Drier / .Policy Number • ' 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 thii.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 oto become subject to the workers' compensation laws of California,' permit to file asigned statement that he or she is licensed pursuant 'to the provisions of the Contractor's State and agree that, if Ishould becoto-the workers' compensation provisions of Section License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and:Professions Code) or r ( r 3700 of the Labor Code, I shall rtliwi complyAith those provisions. that he or sheds exempt therefrom and.the basisfor the alleged exemption. Any violationof Section 7031-.5 by an .) pplicant for permit subjects the applicant to a civil penalty of not more than five.hundred dollars ($500).: ( I, as owner of theproperty, or my employees with wages as their.sole compensation, will do the work, and the structure is not intended oroffere&for sale.(Sec. 7044, Business and'Professions'Code: The. Contractors' State License Law does not apply to an owner of property wno builds or improves thereon, and who does the work himself or herself through his or her ;own employees, provided that the improvements are not intended or. offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder willhave the burden of proving that he or she did not build or improve for the purpose of sale.). - 1 1.4, as owner of.the propertyf=am exclusively contracting with licensed contractors'to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property. who'builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). ' (_ I I am exempt under Sec. B.&P,:C-fpm reason W. CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name: Lender's Address: LQPERMIT WARNING: FAILURE TO,SECURE WORERS NSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINALIPENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($.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 tc 'he' Director of duilding 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 issuan 'tra6G ssation of work for 180 days will subject permit to cancellation. I certify that 1 have read this application and state that the rr t. I agree to comply with all city and county ordinances and state laws relating to bui ing co ructio ,and hereb out ori -representatives of this cou/ity tb enter upon thelabove-mentioned pro e y for pectio purposes. Date: or Application Number . . . . . 06-00001582 Permit . . . PLUMBING SEWER Additional desc . Permit Fee . . . . 30.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 4300 Expiration Date 10/16/06 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 Quinta Building rel: Safety.Division P.O. Box 1504-78-495 Calle Tampico U Quinta;, CA 92253 - (7.60) 777-7012 Building Permt-Application .and Tracking Sheet Permit # Project Address: �j3 (Ql� �i/e D I . ` Owner's Name: A. P. Number: Address: 27• '. O Va-t O . Legal Description:City, Contractor: ST„ Zip: LQ Telephone:;.(p, oTo Project Description: Yl h Address: City, ST, Zip: Telephone: State Lie. # : City Lie. #: Arch., Engr., Designer: Address: City, ST, Zip: Telephone:'.Construction Type: Occupancy: U(I G. CL U Project type (circle one): New Add'n Alter Repair Demo Sq. FL: #Stories: # Units: State Lie. #: Name of Contact Person: %��1e ��S �- Telephone # of Contact Person:.7600—L409 -1 S3 a . Estimated Value of Project: as . 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 Cates. Plans picked up Construction Flood plain plan. Plans resubmitted Mechanical Grading. plan 2" Review, ready for 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 corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees 91 TELE PIC O —;LA QUINTA, CALIFORNIA 92253 1HONE (7fi0) 777-7012' FAX (760) 777-7011 OWNER%BUILDER INFORMATION Dear Property Owner: An application fora 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/Builder" you are the responsible party of record on such a permit. Building permits ar& not required to, be signed by property owners unless they are personally performing'their own work. If your work is'being';performed'$y' someone other than yourself, you may protect yourself from possible liability if that person applies for ihe.proper,permit,in his or her name. Contractors are. required.by law. to. 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 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 followtnformation:for your,'benefitand ing 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. the4entire project; and such• persons are not;licensed as contractors or subcontractors, then you may aq employer If you are an employer, you must register wit h�the,Staie and Federal. Government as aq.employer and you are subject to several obligations ,include'"S.tate. and Eederai income tax withholding, .federal social security'.taxes, worker's compensation insurance,, :disability' ,insurance costs, and unemployment compensation. contributions. -- p .�. - ,.•; There maybe 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.Fed'eral Law, contact :the Internal Revenue Service (and, if you wish, the U.S. Small Business Administration); For'nore specific, information_ about your obligations under State Law, contact°the Department,of=Benefit Payments,'and the Division of. Industrial Accidents. t�, t r If the structure is intended. for •sale; propertyowners who_,are not licensed contracts are allowed to perform their work personally or through their own, employees' without'x,licensed°contractor' r 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 pis providing his` or tiher• own. labor and material personally. Building permits are ,not required to -be signed,. by property .owners unless; 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 thesematters. The building p'ermitwill 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) 777-70U.1Lz211_1N1___) FAX: (7 0) -701 G ATURE/DATE OL �` p �_ 922 PROPERTY ADDRESS 0&- 1592 PERMIT NUMBER(S)