PLBG (07-0404)52160 Avenida Martinez
07-0404
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:
Applicant:
`07-00000404
52160 AVENIDA MARTINEZ
773-232-008-15 -000000-
PLUMBING
COVE RESIDENTIAL
5000
T-ity 4 4 Q"
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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 License is in full force and effect.
License Class: License No.:
Date: Contractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor'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 (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).:
(_) 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
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
/ 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.).
as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
y 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. , 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
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 2/05/07
Owner:
FLEMING PATRICK J /
18 TAYLOR AVE
PALM DESERT, CA 92260
--------------------- ---
V
Contractor: 06 oo/
Owner
OF
.4A jV TA
WORKER'S 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.
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
nswance carrier and policy number are:
Carrie_ r 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
37YO of the Labor Code 'S biI rthwi h comp) ith hose provisiohs.
Date: `G pplicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERA 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 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 issuance of such permit, or cessation of work for 180 days will subject
permit to cancellation.
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 authorize representatives
of this c o77unty to ter upon the above-mentioned propertypr i p tion purposes. _
Date:; ignature (Applicant or Agentl:, •' -' :•L' ' Lim
Application Number . . . . . 07-00000404
Permit . . . PLUMBING SEWER
Additional desc .
Permit Fee . . . . 30.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. . .
. 5000
Expiration Date . . 8/04/07
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
I
LQPERMIT
Bin #
Cit/ Of La Quints
Building &' Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Qulnta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
O
Project Address:"-, 42�
Owner's Name:
A. P. Number: -7 73 —�,2 3o2 — 00,Y
Address:
Legal Description: L07 s &OCef°
Contractor.Te
City, ST, Zip:
le hone
P 7
:;)i>f is+iYyf`y\}i:d}Z/'.w:iv h•F
��
Address:
Project Description:
City, ST, Zip:
Telephone:
State Lic. # :
City Lic. #•:
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
State Lic. #:
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h:; r;; ":,:s<.,.o.;^,:.::;;;;<;:
?. fi ::•»::•<S):l m+:.viJ�:li:4:iivY::Li:•n':
Construction Type: Occupancy:
project type (circle one): New Add'n to Repair Demo
Name of Contact Person:
Sq. Ft: 1.2 W7#
Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project: Ste, fJd
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
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2°" Review, ready for correctionsfissue
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.I.P.P.
Pub. Wks. Appr
Date of permit issue
SchodrFees
Total Permit Fees
^lv
Lo-
Received From:`
OJAjCHELLA VALLEY WATER DISTRICT CASH RECEIPT DETAIL
, I'
8 3 3
2 Date`Y.
( (
✓' V §' ; LJ ^ ' Z, ci
Address:
/ r
Tract
'
Lot(s)
-P' rp if l/ -7
y
Service Address %
V / G.A. Code
❑ Meter(s)
$
❑ Service(s)
❑ Backflow(s)
❑ House Lateral(s) .
❑ Detector Check(s)
❑ Meter Surcharge
(Sanitation Capacity Charge
❑ W.S.B.F.C.
❑ S.I.W.S.C.
i
❑ Temporary Construction Meter
,
❑ Tum on Charge
❑ Uncollected Account - Name
x
❑ Inspection Fee - Tract -
Fee -
❑ Plan Check Fees Water / Sewer -
Tract -
❑ Bond Payment -A.D. - Bond
Assmt
❑ Customer Deposit
❑ Other
TOTAL $!
1
)
' Remarks:
" Copy to:
Cash ,.r^ Water Service
s.,`
f Check
Money r ' ;. Cashier
Order ';r r . CVVJD-438 (1/05) '
TELEPHONE (760) 777-7012 FAX (760) 777-7011
OWNER/BUILDER 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/Builder" you are the responsible party of record on such a
permit. Building permits are not required to be signed by property owners unless they are personally performing their
own work. If your work is being performed by someone other than yourself, you may protect yourself from possible
liability if that person applies for the proper permit in 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 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 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 persons are not licensed as contractors or
subcontractors, then you may be an employer.
If you are an employer, you must register 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 out 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, contact the 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 Benefit Payments and the Division of Industrial Accidents.
If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their
work personally or through their own employees, without a licensed contractor or 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 is providing his or her 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
these matters. The building permit will 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) 777-7012
FAX: (7607-7011
z 6 iZ 1;;
OWNER'S SIGNATU /DATE
PROPERTY ADDRESS
PERMIT NUMBER(S)
WRIGHT SEPTIC TANK PUMPING INC.
P.O. Box 196 • San Jacinto, CA 92681
(951) 654-4840
Name & _-5 > Owner
Job at Z U IQIU a h; ( ,a Y cx1t{ i -Tenant
Cityjal'-i11L1AG` Zip
1112
JOB NO. 64644
DATE 7 —_7 07
WORKMAN ', %
At ❑ Old Customer ❑ New Customer
City
Zip
Telephone
WORK AUTHORIZATION: VWe hereby authorize the work described along
knowing the price is of one septic lank, 0 to 1500 gallons.
WORK ORDERED:
Tax
COMMENTS
'-YES:
'NO
:NA
: ':.:: :-:: :' DESCRIPTION
AMOUNT
Solid sided septWgrease tank open?
1
Truck - Equipment
r
Liquid side of septidgrease lank open?
TOTAL
r
f
Customer aware there are two sides of septidgrease tank?
r
Solid side sanitary T intact?
r
Liquid side sanitary T intact?
f
r
Water level standing in or above sanilary T prior to pumping?
1
Did affluent lfmv back into tank from leach area while pumping?
f
r
Were lids put back on tank?
i
Are the leach lines failing?
Was customer told about additives & riser lids?
r
r
All tools picked up and put away?
r
The tank is gallons
r
How many gallons pumped?
I
TO OUR CUSTOMERS: Serviceman are required to have work slip signed. This is done in order lo protect you. the workmen and ourselves. and to enable us to
give you absolute satisfactory service. You are respectfully requested to examine materials and labor statement before workmen leave the job. and if you find
everything salislaclory. okay this licket If service is unsatisfactory. in any way. please phone our office immediately.
I find the lime and maleriats charged above satisfactory and agree to pay for same on presentation of invoice. and further agree to pay reasonable charges for
coftection. including atlornsys leas in the eventol my default. A delinquent penallywili be charged if account is past due.
CUSTOMER WAIVER. Eky authorizing WRIGHT SEPTIC TANK
PUMPING SERVICE to drive on my property and to work on
my property; I acknowledge that they are not responsible for any
damage done 0o the r➢riveway. Inlet or outlet lees, baffle walls and
any damage to the lids (or any other improvement) thal may occur
as a result of the service provided.
Signed
By
Material
'
Tax
Service
r
1
Permits - Insurance
r
1
Truck - Equipment
TOTAL
777z. ar,
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