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PLBG (05-0151)P.O..Box 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 �A 1 JANE g 2005 Application -Nu BUILDING PERMIT a�rw BUILDING & SAFETY DEPARTMENT (760).77777012 FAX (760) 777-7011 INSPECTION REQUESTS (760) 777-7153 tuber .�0:5 0-00-0-0151-- Date. 1/18/05 A . . . . . . .51864 AVENIDA MENDOZA . 773-182-005-20 -000000- Application description PLUMBING Property Zoning COVE RESIDENTIAL Application valuation 1200 Owner Contractor. --------------- INGRAM MELANIE/RICHARD SPEEDY AIR CONDITIONING 51864 AVENIDA MENDOZA 51655 AVENIDA DIAZ LA QUINTA' CA 92253 LA QUINTA CA 92253 (760) 567-0133 WCC: EXEMPT WC: EXEMPT 01/31/06 CSLB:- 834471 03/31/06 CCC: C20 Permit. PLUMBING Additional'desc Permit Fee . . . . 18.00 Plan -Check Fee .00 Issue Date Valuation . . . . 0 Qty. Unit Charge Per Extension BASE FEE 15.00 1.00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS 3.00 Special Notes and Comments CHANGE APPLIANCES FROM ELECTRIC TO NATURAL GAS PER APPROVED PIPE PLAN Fee summary Charged.. ----------------- Permit Fee Total 18.00 Plan Check.Total .00 Grand Total 18:00 Paid Credited Due .00 ..00 18.00 .00 .00 .00 .'00 .00 18.00 P.O. BOX 1504 78-495 CALLE TAMPICO�� VOICE (760) 777-7012 LA QUINTA, CALIFORNIA 92253 4 4 aINSPECTIONS (760) 777-7011 BUILDING & SAFETY DEPARTMENT Application Number:. U i) - •d J / . .App It I• Date: /- / Q v--\ can. Applicant's Mailing Address: Architect or Engineer: Architect or Engineer's Address: Lic. No.: BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (cornacing with Code, and my License Section 7000) of Division 3 of the Business and Professionals is i fu force and effect. p "��J' ` License Glass i t� license No. 15 ✓ % `f 7 `Contractor OWNER -BUILDER DECLARATION hereby affirm under penalty of perjuryhat I am exempt from the Contractors' 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 pursuantto the provisions of the Contractors' 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).): U 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 or 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.). U I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Cont State License Law does not apply ractors' an owner of property who builds or improves thereon, and who contracts for the projects with a contractors) licensed pursuant to the Contractors' State License Law.).) . U I am exempt under Sec. , BA P.C. for this reason Date Owner hereby affirm under penalty of perjury one of the following decWORKERS' COMPENSATION DECLARATION larations: _ I have and will maintain a certificate of consent to self -insure for workers' compensation of the work for which this permit is issued. , as provided for by Section 3700 of the Labor Code, for the performance . _ I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for he performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Cartier - Policy Number 40 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 3700 of the Labor Code, I shall forthwith comply with those provisions. Date�X r -App `-- plical _�� ce WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE 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. 1 hereby arm under penalty of perjury that there is a construction 1 nd ng agency for rJthe performance oC affirm he work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name Lender's Address IMPORTANT Application is hereby made to the Director of Building and Safety or aCKNOWLEDGEMENT 9 y 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 u scantLa'Quo a its officers, agents and employees for any act or omission related to the work being performed under d, indemnify issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within following days from date is 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. 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter pon the above entioned . roperty for inspection purposes. -Date" \ Vim, � �� Signature (Applicant or Agent): 77 en C\ K 03; J7 Lal � 0� �� p �a a m -L U- A op t �N 4 /0 CITY OF LA QUINTA B1 ILDING & SAFEW DEPT. APPROVED FOR CONS Rl ICTION �j n/