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04-3442 (PLBG)Tdf 4 4 QUWCV I P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING PERMIT BUILDING & SAFETY DEPARTMENT (760)777-7012 FAX (760) 777-7011 INSPECTION REQUESTS (760) 777-7153 Application Number . . . 04-00003442 Date 4/13/04 Property Address . . . . . . 54645 AVENIDA CARRANZA APIA: 774-274-018-7 -000000- Application description PLUMBING Property Zoning . . . . . . . COVE RESIDENTIAL Application valuation 2295 Owner Contractor ------------------------ RECORD RONALD K ------------------------ DESERT EMPIRE PLUMBING & DRAIN 54-645 AVENIDA CARRANZA P.O. BOX 1836 LA QUINTA CA 92253 CATHEDRAL CITY CA 92235 (760) 328-6417 WCC: STATE FUND WC: 170522182003 10/01/04 CSLB: 803145 .01/31/06 CCC: C36 = ---------------------------------------------------------- Permit . . . . . . PLUMBING ----------------- SEWER Additional desc Permit Fee . . . . 30.00 Plan Check Fee .00 Issue Date Valuation 2295 Qty Unit'Charge Per Extension BASE FEE 30.Q0 ---------------------------------------------------------------------------- Special Notes and Comments SEWER CONNECT/SEPTIC ABANDONEMENT. 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 I i P.O. BOX 1504ICE VOICE (760) 777-7012 r 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: Date: Applicant: Applicant's Mailing Address: Architect or Engineer: Architect or Engineer's Address: Lic. No.: BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION 1 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 Uc�se full force and effect �C�cense Classss /" ,-�YO ---U'cense No. /N I < n ,4 If OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am ex pt from the Contractors' State License Law for the following reason (Sea 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 penally of not more than rive 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.). (--) I am exempt under Sec. . BA P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: _ I have and will maintain a certificate of consent to selt4nsure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the perlormance 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 iss rke mpensation umsu nce carrier a�licy mbar a r� ier . �irtify / �w Number �� I cethat, in the performance of the work for which this permit is i 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 1 should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. WARNING: FAILURE TO SECURE WORKERS'qOYAPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAN OLLARS ($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 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.). Lendefs Name Lender's Address 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 Ouinta, 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 160 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 nter upo the above-nwntioned roperty for inspection purposes. gnature (Applicant or Agent): �}5�,-_''c.fey4rf.3?S:,:R''.K�: COACFL I EY WATER DISTRICT Received From: l \/Ci k• ? Lt. Address: ) • r i 4-r X i 1 �.�'�..., 0 t-'l/�. Account No. 'V (: - _5f t r }' r�� Lots) ' t - k ' Service Address - �• .' ' > r ❑ Meter(s) ❑ Service(s) ❑ Backflow(s) ❑ House Lateral (s) ❑ Detector Check(s) ❑ Meter Surcharge 6 --Sanitation Capacity Charge IZ�5 ❑ W.S.B.F.C. ❑ Temporary Construction Meter ❑ Turn on Charge ❑ Uncollected Account - Name Q ❑ Inspection Fee -Tract - Fee - ❑ Plan Check Fees Water / Sewer - Tract - ❑ Bond Payment - A.D. - Bond Assmt. . ❑ Customer Deposit ❑ Other ! Remarks: i, C4 Copy to: G.A. Code 9813 M TOTAL $ —�C�/ r: Cash. Water Service Check Money moi" 7 r �.,. v ed,:: .. Cashier Order CVWD 438 (11189) wing record. These deviations from the drawingsof record are beyond the Y control of CVWD; therefore, the district will not be responsible for any charges incurred by the homeowner as a result of these inaccuracies. MY 1, 2002 HAMMER PUMPING INC. JOU INVOICE P.O. Box 2448 CATHEDRAL CITY, CALIFORNIA 92235-2448 171aA1 =n-WAID (760) 321- 7448 L;OFiYpMFR'S. ORDER Ny -ATE ORDERED — OROER 7AKEP1 BY DATE PROMISED ❑ A.M ❑ P_ M BILL TO PHONE ADDRESS - hSECHAIdkC, / CITY !HELPER JOB,I E N9LO TION L--�� i _ ❑DAY WORK D.E`.[.RiPTION OF WORK .:+�- • LJ F �',• { ,r -._ �. ❑ CONTRACT ❑ EXTRA I QESCfi IFTlQN OF M,)TTRI,IL. USED Pri1CL AMOUNT Gallons G i Pumping Fee per 1000 gal. ., . Dumping Fee per 1000 gal. Out of Area Fee Locating / Opening Fee (per hour) Size System: C 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. 1-IOUR5 LABOR AMOUNT TOTAL MATERIALS MECHANICS (9 HELPERS 0 TOTAL LABOR I hereby acknowledge the satisfactory completion of the above deserlbed work: I TOTAL LABOR TAX SIGNATURE DATF COMI'LETE❑ TOTAL - —