06-1575 (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:
06-00001575
77777 CALLE ARROBA
774-171-001-24 -000000-
PLUMBING
COVE RESIDENTIAL
3400
Tiht 4 a(P Q"
Architect or Engineer
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
MADIGAN GERALD
P O BOX 501
LA QUINTA, CA
E
92253
Contractor:
NYPD
AP �Tn ii00 SO. SUNRISE WAY, #171
�°' �PALM SPRINGS, CA 92262
-- (760)485-3233
1C. No.. 610554
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 Class: B -//C36 L'c No.: 610554
Date: Q tl Contractor:
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).:
(_) 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 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:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/19/06
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.
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 EXEMPT Policy Number EXEMPT
_ 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 eco a subject tDAworkers' compensation provisions of Section
' 3700 of the Labor C e, I h orthwith co ply 't se provisions.
Date: ,19&16 Applicant:
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 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 orrect. I agree to comply with all
city and county ordinances and state laws relating to buiV�Pction, and ereb thorize representatives
of this co y t epter upon the above-mentioned prop ction pur ses
Date: Q Signature (Applicant or Agent)'
EC SEWER SERVICE, INC.
dba ECONO SEWER SERVICE JOB INVOICE
P.O. BOX 581029
NORTH PALM SPRINGS, CA 92258
(760) 346-2793 (760) 328-7760 Customer Order No. Date Ordered
'2
FAX (760) 251-3405
Order Taken By I Date Promised
ADDRESS
CITY
TECHNICIAN
SERVICE Mxumi, SEPrICTANK HAS SEPTIC TANK BEEN DUG UP? ❑ YES ❑ NO ;M NMT. ON SITE
REQUESTED ❑ PUMP SEEPAGE PIT AT ITS RISER ❑ OFFICE BILLING
QUANT DESCRIPTION OF PRICE AMOUNT
£�
Pumping Fee per 1000 Gallons (or fraction)
g S
Waste Discharge Fee Per 1000 Gallons
Locating and Opening Fee (/1 hr. Min)
If
n kA;ea Fee
w C
vl7 L J�-a Tlir.a/✓ � i�
b �J�, -�-� 41
(1
H as V-
❑ THE LEACHING SYSTE=M HAS FAILED
❑ THERE IS AN OBSTRUCTION "UPSTREAM- OF THE SEPTIC TANK
It will be necessary to contact a line cleaning company.
❑ WE RECOMMEND MAINTENANCE PUMPING OF THE SEPTIC TANK EVERY
❑ YEAR ❑ OrHER 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 OFTHE ABOVE.
❑ CUSTOMER HAS BEEN CIVEN AN "EXPLANATION' PACKET
A SERVICE CHARGE OF $22 WILL BE DUE
ON ALL RETURNED CHECKS.
A FINANCE CHARGE OF 1 1/2% PER h10NTH, 18% PER YEAR, WILL BE
CHARCED ON PAST DUE ACCOUNTS OVER 30 DAYS.
IF PAYMENT IS BY CHECK
DRIVERS LIC.# STATE
I hereby, acknowledge the satisfactory completion of We above described work:
SICNATUREq
Application Number . . . . . 06-00001575
Permit . .
. PLUMBING SEWER
Additional desc .
Permit Fee . . .
. 30.00
Plan Check
Fee
.00
Issue Date . . .
.
Valuation
. . .
. 3400
Expiration Date
10/16/06
Qty Unit Charge Per
Extension
BASE FEE
30.00
----------------------------------------------------------------------------
Special Notes and
Comments
SEWER HOOK-UP, 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
,-w
9
LQPERMIT
W7
R'• i t
COACHELLA VALLEY WATER DISTRICT CASH RECEIPT DETAIL ,2 114016
Received From: q ---A-- v��-�- S-/ F k-` a-r-/-1L-[N 1 /t�l['4 J![�Itlll _ Date: `r ^ ! t
Address:y Z o `: ko 44-A(� UI �r/ A . ('A
Account No. r-- � Lot-� s) �'� 4 Tract
Service Address 77 n !77 l� ALLL� At,�I aM G.A. Code
❑ Meter(s) $
❑ Service(s)
❑ Backflow(s)
❑ House Lateral(s)
❑ Detector Check(s)
❑ Meter Surcharge
/qr Sanitation Capacity Charge( -5S17
❑ 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
TOTAL $ IJ J7
Remarks:
❑ Copy to:
Cash , t
Check
F
Water Service
F
Money
��+
�;`
. Cashier
Order
`M *
CV WD -438 (1/05)
Bi" #
{
City of La 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 _#
o� y
Project Address:' — ?.72 C,q& da
Owner's Name:
A. P. Number:
Address: -22-272 / e
Legal Description:
City, ST, Zip: 7 C'' ,
Contractor: 241,y" n
del-
Telephone: 2da S d e- -Z A .Y
Address: /00 o , j10 jV j ye w0-121
Project Description:
City, ST, Zip: M S►^j n ldvz
IsJJ e ✓- !/ �1
Telephone:%)
CC 4 cy2
State Lic. # : ! d S City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: # Stories: # Units:
Telephone # of Contact Person:
Estimated Value of Project: j yUU
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
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
Energy Cales.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading, plan
2°" Review, ready for correctionsrssue
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