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06-3440 (PLBG) IIIIIIIIVIIIIIIVIIIIIII 57 IE QX14M P.O. BOX 1504 l - _- VOICE(760)777-7012 , 78-495 CALLE TAMPICO FAX (760).777-7011 LA QUINTA, CALIFORNIA 92253 BUILDING&SAFETY DEPARTMENT INSPECTIONS (760)777-7153 BUILDING PERMIT Date: 9/25/06 Application Number: 06-00003440 Owner: -- Property Address: 80600 AVENUE 58 BAKER RICHARD M D APN: 762-240-012- -000000- 5820 VALLEY OAK DR Application description: PLUMBING LOS ANGELES, CA 900 Property Zoning: LOW DENSITY RESIDENTIAL SEP 2 6 2006 Application valuation: 4500 CITY OF LA QUINTA �. Contractor: FINANCE DEPT. Applicant: Architect or Engineer: VALLEY PLUMBING COMPANY 46780 CLINTON STREET INDIO, CA 92201 (760)347-3629 Lic. No. : 273088 -- --- - - ----- ----- ------- ------- ---------- - ---- - - - ----------- --------- --------------- -- -------- --- LICENSED CONTR CTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that I am licensed u er 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 a !\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 License Na.: 273088 for by Section 3700 of the Labor Code,for the performance of the work for which this permit is #�y issued. Dateontractor: _ 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 OVA/ER-BUILDER DECLARATION 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 HAM INS Policy Number FN33090901 following reason ISec.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 beco subject to the workers'compensation laws of California, permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that,if I should be:0 biect to the wor rs'com ensatio vision f Section License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or 3 00 of the Labor Code, h comply [h t ovisio . that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by 7 any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).: Date:ZZ,rJ.S 'Applicant: 1_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 or offered for sale(Sec.7044,Business and Professions Code: The v WA ING: FAILURE TO SECURE WORKER COMPENSATION COVER• GE IS UNLAWFUL, D SHALL ' Contractors'State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES 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($100,000). IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN improvements are not 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.). APPLICANT ACKNOWLEDGEMENT 1_I I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the 7044,Business and Professions Code: The Contractors'State License Law does not apply to an owner of conditions and restrictions set forth on this application. property who builds or improves thereon,and who contracts for the projects with-a contractors)licensed 1. Each person upon whose behalf this application is made,each person at whose request and for pursuant to the Contractors'State License Law.). whose benefit work is performed under or pursuant to any permit issued as a result of this application, (_) I am exempt under Sec. ,B.&P.C.for this reason 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. Date: Owner: 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 wilt subject CONSTRUCTION LENDING AGENCY permit to cancellation. I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify that I have read this application and state that the above inform ion is correct. 1 a r to c mply with all work for which this permit is issued(Sec.3097,Civ.C.). city and county ordinances and state laws relating to build' stru ,and hereby a or esentativ Lender's Name: of this cou y to nter upon the above-mentioned proper r' sp - purposes Date: Signature(Applicant or Agent): Lender's Address: LQPERMIT Application.Number . . . . . 06-00003440 Permit . . . PLUMBING SEWER Additional desc Permit Fee . . . . 30.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 4500 ' Expiration Date 3/24/07 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 Bin # City of LaQ uinO Building U Safety Division Permit# P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Project Address: 4 C7 pp (� /d ✓-2 Owner's Name: A.P.Number: Address: �L2 Legal Description: City,ST,Zip: Contractor: Telephone: Address: -/6 700 �� C t•o �.� Project Description: City,ST,Zip:Wiz. d" Q &92- Jco?a`7�7 / !/ Telephone: p"q-��®-+ -y6 yS State Lie.# : a'7.3© sr$" City Lie.#: Arch.,Engr.,Designer: Address: City,,ST,Zip: Telephone: h Construction Type: Occupancy: State Lie.#: � Project type(circle one): New Add'n Alter Repair Demo Name of Contact Person: �,�L e �Ia,,,, 6,11- 0)&T Sq.Ft.: #Stories: #Units: Telephone#of Contact Person: 6 a"7oa- y�5--J Estimated Value of Project: O c7 APPLICANT: DO NOT WRITE BELOW THIS LINE # I Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cafes. 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 for correctionslssue 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 i 1 pF COACHELLA VALLEY WATER DISTRICT CASH RECEIPT DETAIL �.,� ' ��®9. Received From: 4',•'�{( � 11�r t G-� ,,`�_ ' •..C? t"` Date: Address: Account No.. Lo(s) Trate Service Address GA. 'C ode i ❑ Meter(s) $ I ❑ Service(s) II ❑ Backflow(s) ❑ House Lateral(s) ❑ Detector Check(s) ❑ Meter Surcharge Sanitation Capacity Charge -5 ❑ .W.S.B.F.C. . r ❑ S.I.W.S.C: A ❑ Temporary Construction Meter i ❑ Tum on Charge , •,J ❑ Uncollected Account-Name v ❑ Inspection Fee-Tract- Fee- .0 Plan Check Fees Water/Sewer- Tract- i ❑ Bond Payment-A.D.- Bond Assmt ❑ Customer Deposit ❑ Other j i jt Y 1 i TOTAL $ -7) i Remarks: 1? d%ii ! / =''i-�/6A (" .PP4, 7 Nt. ?f� t%�L� 1=.A �f''t! ( f .✓S Copy to: Cash Water Service Check y ? a i Money Cashier 4. a CVWD-438(1/05)