PLBG (04-3723)77453 Calle Mazatlan
04-3723
4'.
UILDING" SAFETY' DEPARTMENT
4 NB
OX (760)-777-7012
0 , 1916kCAL E TAMPICO FAX (760) 777-7011
PT-
INTA, CALIFORNIA 92253 -INSPECTION REQUESTS (760)777-7153
BUILDING PERMIT
Application Number . . . .X04-00003.723--,
Appl
Date 4/28/04
Property Address . . .
774E JCALLE MAZATLAN.
APN:
658-.250-012-152 -14496
Application'description*.
-PLUMBING
Zoning Pro*erty Zo i
]p
LO'WDENSITY RESIDENTIAL
Application valuation
1000
Owner
Contra'dto'r'
---------
------------------------
M/M ANDERSON
- -------------
.,CLARKE PLUMBING -INC,
W.
7.7-453'.,CALLE MAZATLAN,
35450 PEGASUS:COURT
LA QUINTA CA 92253.
PALM DESERT
CA 92211
(75.0.). 34'5:=6166
WCC,: TALBOT INS'
WC:_...'., 1641967200
0_
10/01/04
CSLB': 65099'9.
:,07/.31/04
CCC: C36
-------------------------------------
Permit PLUMBING
---------------
Additional debc
Permit Fee 22.50
Plan CheckFee3.75'
Issue Date ... . . .
Valuation
0
Qty Unit -Charge Per
Extension
BASE - FEE
-15.0.0
7.5000 EA -PLB WATER-.-HEATER/VENT
------ -
7.50
--------------
Spec Comments
- - - - - - - - - - - - - -
- - - 7 - - - --- - - - -
RELOCATE WATER HEATER
Fee.summary. Charged
Paid Credited
-----------
Due
.ermit Fee T6ta --:`22,.-50
00 .00
------
22.50
Plan Check -Total' ;
-
00 00:..
3
Grand.Tot.al 26..25.
00 .00,
26-..25
P.O. BOX 1504 s t w
79-495 CALLS 'TAMPICO VOICE (760) 777-7012
LA QUINTA, CALIFORNIA 92253 FAX (760) 777.7011
INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: g2:2 - !7-7
Applicant:
Applicant's Mailing Address:
Date: defog
Architect r.
Archgect or Engineer's Address:
Lic. No.
ou1L. imm rtKmi I UEGLARATIONS
1 hereby aftinn under LICENSED CONTRACTORS DECLARATION
penin d perjury that 1 am licensed 9 ' *0 Sado 7000) a Division 3 a to Business and Pioiessionals
Ucenaaend Lio ss in tali roma and artea Clap 23
go
9,?
.-----
Data `i L Coner,aor
Icy affKrrr f>y a perjuryOWNER43ULDER DECLARATION
dty «cotnty ttat iegwas • pemdt lob ewub%CL dW iom t» Conlrsetors' StoleLbanse Law 1« Mre fobwip reason (Sec 7031.6. Business and Profssslons Cod4 My
irrrptova. OerrroisfStOWIM n, «repair any slnucWn , prior b Its issuarnoa, also 1e0uin'as the appirant f« M VMwdt b pa a sipna0
Profs::Wiot t Code) puumuw t b fn provisions a tM Ccr*scbrs' StMa l *, m Law (Chopler g (oanrwrdrq dom with So7000) a Division 3 alto Busi»ss
andthe appk I b a dvi penally a not more t ron iw hundred dolens (t500).xfor a sxmgion violation a Section 7031.6 by any applicant ler a pumil sub jects
U Las owner a ire property, «my e: The ears witln =Sut as their sob compansati n vA d0#10 work• and the stnxiurs Is not inlernded «alered for sorb (S.c. 7044,
Brtsiness and Prokssiornc Coda The CorMrsctors' Stale Law does net appy b an owner a property who bulls or improves wereon, and who does the work
OrAw
add whin one sold
his or her own mss. pw xW that the i Mmv menta are not iMerded or aft f« sale M. however. the bui6mp or n p ovement is
V Las owner Of the lIw a c the o wcfiw-buMw vA have the burden a proving that he or she did not build «improve ler the purpose of sale.).
Stab License t Law does not property. am excluisively cw ag with icansad cw*sabrt b oornstucl to project (Soc. 7044. Business and Pfolossions Code: The Cw*a*oW
the Coot adw Stale License
Stab owner of propaRy who builds «improves theismand who contracts for the projects wilt+ a oonaaaa(s) ticensad pursusrK b
U I am exempt under Sea _ . SA P.C. for this reason
Date Owner
1 hereby afkwm under penalty Of perjury ona thWORKERS
e e following declarations: • COMPENSATION DECLARATION
_ I have and wit nakdakn a Owfiicats Of consent b se"mure for wakes' campenubm as provided for by Sec don 3700 a the Labor Code. for the petomran,oe
a fhe work for whidn this pen. Is ksued
Carrier I have 6-4 vA maintain w*MW 4. Tao TDean . as required by Sedan 6700 a rie Labor Code. f« the pertomwrce a to welt for which fain penult is
ff _ Jn li _c tian iuraarnoe f am:
•
—I carNr that. lo tk l o(ColilogioninarM ia In g weak les issued I not employ any person in any roamer so as b became subject b i„e wwkar V
compen comply
laws of hose rov and subject b the workers' oongensation provisions a section 3700 aline Labs Code. I SW
. tatlm+iln comply wllhi inose provisions.
ti
Date Appkard .
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE S UNLAWFUL. AO SHALL SUBJECT AN EMPLOYER TO OWAINAL PENALTIE
CNN. FIVES UP TO ONE HUNDRED THOUSAND DOLLARS (St00A00), N ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN S MID
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. .
11weby afrwm wrier CONSTRUCTION LENDING AGENCY
penalty d p that there is a construcliorn brndimg sgenry for the perfonrwnoe a its welt ler which itis prem* k issues (SeC. 3007. Civ. C.).
lenders Nartie
Lenders Address
IMPORTANT AW"Gon is hereby mode b the Dirocbr of APPUCANT ACKNOWLEDGEMENT
1. Each person upon wtnose belalf this BWk&q end safety ler a Permit wbject b the conditions and restrictions set tarn on this appicaion.
Issued es o result a Ins abeW t n, application
Is Vie' each person at Whose MQued and ler whose benefd work is Penfomred and« «Pursuant b any pem*
apoNCant.each agrees b, and slaty. aarerd. indemnify and hold i,amr{ett the City of L, t3uYw, Its
afGars, agents and employees ler any ad or omission related b the work being perbnned under or following issuance of this peg,
2. Any permit Issued as a result Of fhk appfiabon becomes cam+enc null. void N is d within t w
cessation a work ler 160days wo wAjed Pam* bflys Nom dated issuance a such Pentyl «
1 certify that 1 have road lis application ed state that the above
construction. and hereby auarorin representatives a Iis county b le ordinancesta
to comply with ail city and county and state ws b b retssrg uk%V
/ boned property for inspection Purposes.
Oats v!/ Sgnalure (Applicant or Agenn(X