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0401-034 (PLBG)LICENSED CONTRACTOR 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 # Lic. Class Exp. Date Date Signature of Contractor OWNER-BUILpER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason: ('>) 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 & Professionals Code). ( ) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals Code). ( ) I am exempt under Section B&P.C. for this reason 1„1Dafe Signature of Owner 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. ( ) 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 & policy no. are: Carrier Policy No. (This. section need not be completed if the permit valuation is for $100.00 or less). ( ) 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 3700 of the Labor Code, I shall forthwith comply with those provisions. Date: Applicant Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $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. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his 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 applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 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 State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. . J,,Signature (Owner/Agent) c '+� Date BUILDING PERMIT PERMIT# 0401,034 DATE 01A)7/20[ VALUATION LOT TRACT JOB SITE _ ADDRESS 52-885 AVY040A CARIZARVA - - r OWNER CONTRACTOR // DESIGNER /EN IINEER /AUIMER LA QU.[A3 .A CA Q275.3 ;} 03Lti USE OF PERMIT PLUMBOTO SEPTIC.ARA14DCJAQFWMr EWER IiC3i KU1� J FSMIA'. M) COST OF COMMIUCITON 0.00 x 3SeR'11&T FFY S>i'1&MARY NLlfA3BINO FEE — SEWER 101.000-419»000 S3Q.a0 r,+ 4, � J 07- C1_ F=I �TAR'Cg 0 y SUB -TOTAL L e'`kJ�CftTTc+"I'1 ATl7Ii iS $0,00 RECEIPT DATE BY / D2 FINAL�D v INSPECTOR INSPECTION RECORD OPERATION 1 DATE I INSPECTOR BUILDING APPROVALS Set Backs f Forms & Footings f Slab Grade Steel Roof Deck O.K. to Wrap Framing Insulation Fireplace P.L. Fireplace T.O. Party Wall Insulation Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Set Backs Footings Bond Beam Final BLOCKWALL APPROVALS PLUMBING APPROVALS Waste Lines Water Piping Plumbing Top Out Shower Pans Sewer Lateral Sewer Connection Gas Piping Gas Test Final Utility Notice ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fbdures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power OPERATION DATE INSPECTOR MECHANICAL APPROVALS Underground Ducts Ducts Return Air Combustion Air Exhaust Fans F.A.U. Compressor Vents Grills Fans & Controls Condensate Lines Final POOLS - SPAS Steel Electric Bond Main Drain Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Gas Piping Gas Test Electric Final Heater Final Plumbing Final Equipment Enclosure O.K. for Finish Piaster Pool Cover Final 1 COMMENTS: Final Utility Notice (Perm) EC Sewer Service, Inc. JOB TICKET dba ECONO SEINER SERVICE P.O. Box 581029, North Palm Springs, CA. 92258 (760) 346-2793 (760) 328-7760 Customer Order No. Date Ordered Fax (760) 251-3405 } BILL TO ADDRESS CITY .106 ADDRESS SERVICE ❑ PUMP SEPTIC TANK HAS SEPTIC TANK BEEN DUG UP7 V Yes ❑ No ❑ PMT. ON SITE REQUESTED ❑ PUMP SEEPAGE PIT AT ITS RISER Pty FFICE BULLING ❑ PUMP GREASE TRAP �' ❑Yellow Cust. ❑ OTHER ❑ Yellow Office QUANT, 0 CRIPTIO OF PRICE AMOUNT Pumping Fee per 1000 Gallons (or fraction) Waste Discharge Fee per 1000 Gallons _. Locating and Opening Fee (I hr. Min.) Out of Area Fee GREASETRAPS RECOMMEND INLFT/OUTLETBAFFLE REPAIR. EXCESSIVE GREASE/FOOD/DEBRIS. EXCESSIVE ODOR. RECOMMEND MORE FREQUENT PUMPING. ❑ RECOMMEND LINE CLEANING. SEPTIC SYSTEMS ❑ THE LEACHING SYSTEM HAS FAILED. ❑ THERE IS AN OBSTRUCTION "UPSTREAM" OF THE SEPTIC TANK. It will be necessary to contact a line cleaning company. [I wE RECOMMEND MAINTENANCE PUMPING OF THf= SEPTiC TANK EVERY ❑ YEAR ❑ OTHER YEAR ❑ 2-3 YEARS To remove built up solids. This will increase the life of your leaching system. ❑ THIS PUMPING WILL PROVIDE ONLY TEMPORARY RELIEF AND NOT SOLVE CUSTOMERS SEPTIC PROBLEM BECAUSE OF THE ABOVE. ❑ CUSTOMER HAS BEEN GIVEN AN "EXPLAINATION" PACKET. A SERVICE CHARGE OF S22 WELL BE DUE ON ALL RETRUNED CHECKS. A FINANCE CHARGE OF 1 1/2% PER MONTH, 18% PER YEAR, WELL BE CHARGED ON PAST DUE ACCOUNTS OVER 30 DAYS. IF PAYMENT IS BY CHECK DRIVERS LIC, 0 STATE I hereby acknowledge satisfactory completion of the pbove described work: SIGNATURE %/ i Total p GG l r i l =i Due /G 01/07/2004 11:39 FAX 760 674 2019 ODYSSEY ADMIN ,an -07-04 10:42am From-WATER DISTRICT/COACHELLA VALLEY Received From: ��✓l /.Gl _ Address: _j Account No, f Service Address +T603913TII T-447 P.02/02 F-237 IN q., U 0 U V 0 Q Servtce(s) - D HauseLateral(s) O Detectorcheck(s) _ Q Meter Surcnarp _ UeSanitatlon Capacity Charge JQ�,r.J'1�Z:��� Q wB.b.F.C. _ Q Temporary Construction Meter _ Q Tum on Charge _ b Uncollected Account - Name- 0 ame O Inspection Fee - Tract - Fee - _ Q PI2n Check Fees water I Sewer - Treat - _ Q Bond payment - A,D, Aaatnt.- O Cuetnmerpopealt , p 41her _ TOTAL S Remarks: kf1^ dlrld �101>� r'rrxL .t7i'SGla:i►►�i- � ,"�� 26bt o2a4ZA �'EoaY ta: ash Tom? G� • "� C WatarCSaesrnvlie4re Cash MoneyOrder C1rWG-s39(11res1 ,rye r - aXNA VER0000 1 ' ' so MI4762 287 ` �V tssszotats o1�eA>R vrvAs ' MW AVPNIDA CAMRAN7A - tA QtJiNTA, CA 405"126 thvi ord6r alta':., W WashiniQ1 Mutual i � • CWrvgM�is NN� SSR.. , /jpr100� : • ice• � _ I --a l i c�Oi9ta 4322'. 4e7 . q 0L476118 0'87.... 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 your 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 yod are subject to several obligations including '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 Adminstration). 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 n FAX (760)/It7_7011 OWNER'S SIGNATURE / DATE U— ��S V,0 ,0 PROPERTY ADDRESS mDt_D34 PERMIT NUMBER(s)