05-1040 (PLBG)(f
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BUILDING & SAFETY DEPARTMENT
P.O. BOX 1504 (760).777-7012
p' 78495 CALLS TAMPICO FAX (760) 777-7011
D L00� A QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
ication Number X05-00001040 Date 3/23/05
Property Address . . . .. . . 51865 AVENTDA MORALES
APN: 77.3-151-004-4 -000000-
Application description PLUMBING
Property Zoning . . . COVE RESIDENTIAL
Application valuation 2500
Owner Contractor
EDWIN CUTLER SO CAL PLUMBING & REPIPE CO
YUCCA VALLEY CA 92286
(760) 369-4104
WCC: EXEMPT
WC: EXEMPT 11/30/05
CSLB: 793482 04/30/05
CCC: C36 -C42 -B
Permit . . . . . . PLUMBING SEWER
Additional desc
Permit Fee . . . . 30.00 Plan Check Fee .00
Issue Date . . . . Valuation 2500
Qty Unit Charge Per Extension
BASE FEE 30.00
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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
P.O. Box 1504 •
VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: D S-/0.3 I Date: —AVr .23-0$—
Applicant:
Applicant's Mailing Address:
Architect or Engineer:
4
Architect or Engineer's Address: .
Lic. No.:
BUILDING PERMIT DECLARATIONS
A
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
Co and my Lic sem� ipe� II fAArce a e ect. �712r ! 9 Z_
cense Class L%'{L C. ense No. J`L
—OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that 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 pursuant to 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 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.).
U I am exempt under Sec. , BA P.C. for this reason
Date
WORKERS' 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.
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 insurance carrier and policy number are:
Carrier 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'
T 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.
to fL
WARNING: FAILURE TOS UREtitan WORKER NSATION 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.
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 J
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 employeesfor 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.
I 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 county to enter upon the above-mentioned property for inspection purposes.
ate 3- 2 ignature (A or Agent)
'-OACHELLA VALLEY WATER DISTRICT CASH RECEIPT DETAIL
Received Frd_M:.`�i N
Address: t
Account No. 4 Lot(s) t-4
c
Service Address- Tract
0 Meter(s) G.A. Code
0 Service(s)
0 Backflow(s)
0 House Lateral(s)
0 Detector Check(s)
0 Meter Surcharge
�<Sanitation Capacity Charge
0 W.S.B.F.C.
0 S.lw. ,C.
0 Temporary Construction Meter
0 Turn on Charge
0 Uncollected Account.- Name
0 inspection Fee - Tract -
Fee - --------
0 Plan Check Fees Water / Sewer -
Tract -
0 Bond Payment -A.D. - - Bond- Assmt
0 Customer Deposit
0 Other
Remarks:
CO3C , opy to:
TOTAL
Date:
A
"7k
Water Service
Cashier
CVWD-438 (1/05)
HAMMER PUMPING INC. JOB INVOICE
P.O. Box 2448
CATHEDRAL CITY, CALIFORNIA 92235-2448
(79n1 2An_ SAAR
i
(760) 321- 7448
DESCRIPTION OF MATERIAL USED PRICE
CUSTOMER'S ORDER NO.
DAT ED
ORDER TAKEN BY
DATE PROMISED ❑ A.M.
0 P.M.
BILL TO
Pumping Fee per t00 gal.
PHONE
ADORES
Avo
p
\T
CITY
Dumping Fee per 1000 gal.
HELPER
JOB NAME AND LOCATION
Je+
IJ DAY WORK
❑ CONTRACT
❑ EXTRA
DESCRIPTION OF WORK
Locating / Opening Fee (per hou
QUANT.
DESCRIPTION OF MATERIAL USED PRICE
AMOUNT
Gallons
% S
Pumping Fee per t00 gal.
Dumping Fee per 1000 gal.
Out of Area Fee
Locating / Opening Fee (per hou
Size System:
'A SERVICE CHARGE OF $20 WILL BE DUE
ON ALL RETURNED CHECKS. .
18% PER YEAR WILL BE.CHARGED ON'
PAST DUE ACCOUNTS OVER 30 DAYS.
HOURS
LABOR AMOUNT TOTAL
MECHANICS @ MATERIALS
TOTAL
HELPERS @ LABOR
I hereby ackno the -set' R
co o the above des cr' TAX
,SIGNATURE DATE COMPLETED
TOTAL