05-4296 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
05-00004296
53260 AVENIDA CARRANZA
774-081-025-24 -000000-
PLUMBING
COVE RESIDENTIAL
4150
Architect or Eng
P (a
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed underXN
'ommencing with
Section 7000) of Division 3 of the Business and Professionals Cull force and effect.
License
,'�fCI ss: A Lice
Date.4 rector:
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).:
(_ 1 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.).
(_) 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.).
( ) 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: JA
LQPERMIT
Owner:
FRANCO DIANNE MARIE
P O BOX 1031.
LA QUINTA, CA 92253
Contractor:
TRI STAR CONTRACTING, INC.
P.O. BOX 542
CATHEDRAL CITY, CA 92234
(760)321-0898
Lic. No.: 475515
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/26/05
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.
V 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 STATE FUND Policy Number 0440019798
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 ome subject tothew ers' compensation laws of California,
and agree that, if I should b o e subjec th work r co pensation provisions of Section
37.00 of the Labor e, I s forthwit c mpl i ose provisions.
J)ee: icant:
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.
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 per ' or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the abov i drmation is rre I rea to co ly with all
city and county ordinances and ate laws relating to building co ruction, an web ut or a rep entatives
of this cou to a er upon a above-mentioned property for i pection purp as.
D gnatura (Applicant or Agent):
Application.Number . . 05-00004296
Permit
PLUMBING SEWER
Additional desc .
Permit Fee . . .
. 30.00
Plan Check
Fee
.00
Issue Date . . .
.
Valuation
4150
Expiration Date
3/25/06
Qty Unit Charge Per
Extension
BASE FEE
30.00
---------------------------=------------------------------------------------
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
LQPERMIT
COACHELLA VALLEY WATER. DISTRICT CASH RECEIPT DETAIL
Received From: t' K"l=1. 1fINNo. �" t 4
Address: C
Account No. Z Z O'�avLot(s) Z3
Service Address , ^ Z60 a&NIDA
IDA GA2 MAN
❑ Meter(s)
❑ Service(s)
❑ Backflow(s)
❑ House Lateral(s)
❑ Detector Check(s)
❑ Meter Surcharge
anitation Capacity Charge
❑ W.S.B.F.C.
❑ S.I.W.S.C.
❑ Temporary Construction Meter
❑ Turn on Charge
❑ Uncollected Account - Name
❑ Inspection Fee - Tract -
Fee -
❑ Plan Check Fees Water / Sewer -
Tract -
❑ Bond Payment -A.D. - Bond Assmt
❑ Customer Deposit
❑ Other
Remarks:
o 1 noA1
Tract
G.A. Code
TOTAL $
P-60-py to: IAL,/ -C--, Y
Cash ! - Water Service
Check
Money Cashier
Order CVWD-438 (1/05)
DIANNE M FRANCO
PO BOX 1031
LA OUINTA, CA 92253-1031
PAY TO THE
1004
90-8123/3222
DATE ZL 05
OLLARS 8
_ ` Equity Select Line of Credit
, . Altura Formerly ftercide Countys Credit Union 7 a Not. Valid, for Less Than $100.00
CYEDrT U,rre,r,. 1.888.883.7228 -www.elturecucom ..
n
FOR
/
Bin #
City of LQ Quinta
Building & Safety Division '
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012 ;
Building Permit Application and Tracking Sheet
Permit #
roject Address: 5-�>'Z k4j AjQ CLV►/L4 {n wner's Name:q . vC `CD
A. P. Number: Address: _ D P
Legal Description: City, ST, Zip: C9
�n h n •
Vontract r: Telephone:
— � ..............:::............................
Address:
Project Description: � i
City, ST, Zip:
Tel e hone /�
P 7 �[J
� �^
..............................
State Lic. # :
City Lic.
ry
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone: ne: Constructi n Type: Occupancy:
X.
State is #•i ..... Pr 'ect type circle one):: New Add'n Alter Repair Demo
Name of Contact Person:�Sq. Ft.:#Stories: # Units:
Telephone #of Contact Person:' Lto stimated Value of Project: ®-
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
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"d Review, ready for corrections/issue
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 corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
AwSmAmPa
PUMP/NG
Lic #C42 855 851
Ibu IjAn-/ion f • '1-ifUU-S34-/zoo
FAX 760 328-6607
-P.O. Box 2318 • Cathedral City, CA 92235
CUSTOMER'S ORDER NO.
DATE ORDERED
- �_G -o S`
ORDER TAKEN BY
DATE PROMISED ❑ A.M.
❑ P.M.
BILLT, V �w
PHONE
ADDRESS
MECHANIC
ClG1
CITY
HELPER
JOB NAME AND LOCATION
s, DAY WORK
C3 CONTRACT
❑EXTRA
DESCRIPTION OF WORK �-
QUANT.
DESCRIPTION OF MATERIAL USED
PRICE
AMOUNT
�tbv
Gallons
�dd
Pumping Fee per 1000 gal.
Dumping Fee per 1000 gal.
Out of Area Fee
I
Locating /tOpening Fee (per hour)
t 3j((.^ -
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.
TOTAL
MATERIALS
TOTAL
LABOR
WAIVER: Not responsible for secondary damage such as water
damage, chipped concrete, mark on street or driveways or trees.
'SIGNATURE /} DATE COMPLETED
�f ), 0( ), W" Il11 (,_flA 2/yT\ ' oZG /6V
TAX
TOTAL