07-1196 (PLBG)rt
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
07-00001196
Property Address:
53880 AVENIDA CARRANZA
APN:
774-161-008-17 -000000-
Application description:
PLUMBING
Property Zoning:
COVE RESIDENTIAL
Application valuation:
3000
Tiht 4 4 Q"
Applicant: Architect or Engineer:
LICENSED CONTRACIOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
I hereby affirm under penalt perjury th I am licens under pr visions of Chapter 9 (commencing with
Section 7 00) of Division of the Business d Profe io Code and my License is in full force and effect.
Licensef�C ss: C42 Lice o.: 661018
Date: '( ontracto
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.).
(_ 1 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.).
1 _ 1 I am exempt under Sec. B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
1 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:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/19/07
Owner:
BROM TERRI E
P O BOX 1008
LA QUINTA, CA 92253 rI D n
APRContractor: APR 1 9 ZOO[
HAMMER PUMPING INC
P O BOX 2448 CITY OF LLA QUI TA
CATHEDRAL CITY, CA 92 Ffr��NCE®SPi
(760)321-7448
Lic. No.: 661018
-------------------------------------------------
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.
1 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 1828655-2007
I certify that, in the p ance he work for which this permit is issued, I shall not employ any
person in any anner so as to bec me subject t the orkers' c pensation laws of California,
nd agree t at, if I should become ubject to th o ers' compe sation provisions of Section
�t n7.�00 of a labor Code, I she r with co y with a pr isions.
Date: p
cant:
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 ermit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application an state that the above info ation is cor ct. o comply with all
city and county o dinancas and state la relating to building construc i , and h eby au rize r resentatives
of this cou ty to enter upon the above- entioned property for irisp o purpo s.
Date: `Z Signature (Applic t or Agent):
Application Number . . . . . 07-00001196
Permit . . . . PLUMBING SEWER
Additional desc .
Permit Fee . . . . 45.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. .
. 3000
Expiration Date 10/16/07
Qty Unit Charge Per
Extension
BASE FEE
30.00
1.00 15.0000 EA PLB BUILDING SEWER
15.00
----------------------------------------------------------------------------
Special Notes and Comments
SEWER CONNECT SEPTICABANDONEMENT
Fee summary Charged Paid
----=------------
Credited
Due
--------------------
Permit Fee Total 45.00
----------
.00
----------
.00
45.00
Plan Check Total .00
.00
.00
.00
Grand Total 45.00
.00
.00
45.00
LQPERA11T
Bi" #
City of La Quinta
Building U Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address:" tS7� tbc)
Owner's Name:.'—
A. P. Number:
Address: v(j
Legal Description:
City, ST, Zip: (—N QU y CON- 2 2
Contractor:
Telephone:
Address:
Project Description: i vJ
City, ST, Zip:
Telephone:
State Lie. # :
City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lie. #:
Construction Type: Occupancy:
Project type (circle one): New Add'n . Alter Repair Demo
Name of Contact Person:��
c1t^.1 S
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: '3 (o o (p
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS UNE
Req'd
Recd
TRACKING.
PERMIT FEES
Plan Check submitted
Item
Amount
l Calcs.
EEnergy
Reviewed, ready for corrections
Plan Check Deposit
cs.
Called Contact Person
Plan Check Balance
ates.
Plans picked up
Construction
Floodplain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for correctionslssue
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
M
i
f
Received From: -7 I t
1 Address: ft' 1...
COACHELLA VALLEY WATER DISTRICT CASH RECEIPT DEFAtL22
�.
! . r
1� Y'] 4 !1 (�y(f !'y P " �4 "�,• f
gni
a� Ltd / j
Date: ! / 6/
�J ��
Account No.
s)
Tract
C' i l l d t C/"
i, Service Address
c
G.A. Code
❑ Meter(s)
$
❑ Service(s)
❑ Backflow(s)
❑ House Laterals)
4. ❑ Detector Checks)
!. ❑ Meter Surcharge
f Sanitation Capacity Charge
/J
/ w G
f
❑ W.S.B.F.C.
❑ S.I.W.S.C.
` ❑ Temporary Construction Meter
i
❑ Tum on Charge
❑ Uncollected Account - Name
i
❑ Inspection Fee - Tract -
Fee -
❑ Plan Check Fees Water / Sewer -
Tract -
i
❑ Bond Payment -A.D. - Bond Agrmt
`r
1 ❑ Customer Deposit
5 ❑ otnar
-TC
TOTAL $
it r
Remarks:
i
b, copy. to:
Cash / f r -j Water Service t{)
Check R "
Money Cashier
Order
'' CVWD-438 (1105)