04-3611 (PLBG)i
` BUILDING &'SAFETY DEPARTMENT,
P.O. BOX 1504 '
OR.
(760) 777=7012
78-495 CALLE TAMPICO
. FAX (760) 777-7D11
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760)777-7153
BUILDING PERMIT '
Application Number
0.4-00003611 Date
Property Address . .
.4/21/04
. . 46755 HIGHLAND PALMS DR
APN:
6437191-013-13 -2117'-
Applica'tion description
•PLUMBING
property Zoning.. . . .
. . . LOW DENSITY_RESIDENTIAL
Application valuation..:,:
': 3730
Owner
Contractor
RICKETSON DONNA.
TRI STAR CONTRACTING, INC.
46755 HIGHLAND. PALMS DR
P.O. BOX 542 `
LA'QUINTA CA
92253 CATHEDRAL CITY CA 92234
(760') 321=0898...
WCC: STATE FUND
`WC: 197982*0.03 10/01/04 '
CSLB: 475515 01/31/05
CCC: A -B
------------
Permit PLUMBING SEWER
Additional desc
Permit Fee.
30.00 Plan Check Fee .00
Issue Date'.
Valuation 3730
Expiration Date
1,0/21/04
Qty Unit Charge
Per _ Extension
BASE FEE .. 30.00
Fee summary Charged. Paid Credited Due
Permit Fee Total
30.00 .00 .00 30.00 `
Plan Check Total
.00 .00 .00 .00
Grand Total
3.0:00 . .00 .00 30.00
P.O. BOX 1504 :����
LA QU
VOICE (160) 777-7012
495 CAi.LE TAM►ICO FAX (760) 777-7011
LA QuIN7A, CALIFORNIA 92253 Titf INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number:
Applicant:
Applicant's Mailing
Date: _ _Zi'a0- o
Architect or Engineer.
Architect or Engineer's Address:
Lic. No.
BUILDING PERMIT DECLARATIONS
JA
1 hereby atrrtn under LICENSED CONTRACTORS DECLARATION
Penally d perjury d e 1 am &cerued under rvvisioru d Chapter t (oommendrq with Seckm 7000) d Division 3 d the Business and Prolessionds
aC `�°e bye elm �° No.. '4-1 l 5
f hereby Gffk,.e peaky d p«jiry that 1 am OWNW-BUILDER DECLARATION
city or Douro teat s a permit b eauberet, eoeSlleegt from the Contractors, State Lbaese Law for the following room (Sec. 7031.5. Business and Professions Code: Any
city Of c t that he er she k licensed improve, d�sf L or� mY • p� b ks ksuanoe. d$D roquros the oppicw t ter t w pemmk b ties signed
Pursm t loon provisions of" Caebaefore Stab License Law (Dopler t (commencing with Section 7000) of Division 3 d the Badro s
and Professions Code) or that he or she Is exempt teerehhomn and the basis ter to alleged exemp&an. Any vbwm d Section 7031.5 by any applicant ter a permit subjects
the applicant b a old penalty d not mise than five hundred dollars (1500) x
U I. as owner of the properMess y.o s my employees:Twith wages as their sale oompamration, wi do the wok and the struckn is not I len rip or dtered forsale (Sec. 7044.
Business and Professions Code The Corniscbts Stab License Law does not appy to an owner of property who builds or improves thecae, and who does the work
himself or herself or trough his or her own employees, provided that the improvements aro not intended or offered for sale. It. however, to building or improvement is
sold within one year of completion, the ow w bolider will have the burden d
U 1. as owner d the property. am eatr+sively oontracfi,g with licensed cornoden construct #0 WwAng Italt he or she did no( build or improve for the purpose d safe.}
Stab License Low does not appy b an ow ner d proWly who builds err Protea 7044. Business and Prdessions Cab: The Contractors!
to Contractors' State License Law.). itproves twieon. and who contracts fpr the F!ojects with a contractor(s) kensed pursuant to
U 1 am exempt under Sec _ BA P.C. for this reason
Dale . . owner
11 ereby attrtm under peimaky d perjury one d ft following declarations.
WORKERS• COMPENSATION DECLARATION
_ I have and will maintain s oerti&csb Of Consent to sell -insure for wo*W
d the work for wtrdn this permit is issued as provided for by Scotian 3700 of the tabs Code, for the performance
I leave and will maintain workers' oom1pernsa6on insurance, as required by section 3700 of the Labor Code, for the performance of the wait ter whidm ria permit k.
efs� �o�emperesslien tl5rece carder &A
_ I y C ie the peA hmanos d the wait for which ttmis panrit is &raised, 161011 not employ any person in any manner to as b beoatme subject b the workers'
compensationly laws d Ca a pro , and epee that. I 1 stmould Deoome subject b the waken' compensation provisions d Section 3700 d the Labor Code, l shall
' fatmrkh oompiy w11ti those provisions,
��1 � '►_ � Com, -�wC "ne
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL. AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TOOK .IMNDREO T"OUBAND 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. .
1 hereby affirm under penalty of perjury that themk a oonsttuction CONSTRUCTION LENDING AGENCY
Wxkv agcy for the PeAamanoe of the work for which this permit is issued (Sec. 3087. Civ. C.).
Lender's Name
Lenders Address
IMPORTANT Application Is hereby made to the Director dAPPLICANT ACKNOWLEDGEMENT
1. Each person upon wfmose Oefealf this Bing
and Safety fpr a PertNt subject b the conditions nd itions arestrictions sel forthon tis application.
Issued Person
spot d trs er6on is made. each person at whose request and tews
r wte benerd work is performed under or pursuaN b any permit
oRroers, *p0c*6 . the own, and the app&csnl, each agrees b. and shall. defend. kedemnity and told him.. ss the City d LaOuir". its
agents and employees fpr any sd or omission related b the work being performed under or following issuance at this pem ft .
2 Any permit issued as a result Of this application beoommes null and void I work a not commenced within 160 days from dale of issuance d such perttdL er
cessation d work lex 160 days will subject pem . b cancellabon.
I read this application and state that the is carec L I. y with all city and county ordinances and state laws relating to bunting
constructim and forobt' auttmorize representatives d this b ermt the bove boned y lex inspection purposes.
,,�D,te O tore (Apprcamt
or Agermt).
'04 08:52a 'BOB EDWARDS CONSTRUTION 760-775 9.093
p.4
•
CASH F*L;rjiol Loclewu
I % I
Received F t j %J I I 1.
Addrem
% %J6
Account Na (s)
Service
C) meter(a)
0 Smice(s)
13 Bmkftw(s.
• O House lateralis)
13 Detect"ClIPCIC(s)
tots
O
M Surcharge
cmcapacity Chaw
0 W.S.B.F.C,
0 TwnpoM Construction Meter
0 Tum onCharge
0 Uncollected Account - Nam
13 inspection Fee -Tract -
Fee -
C, plan Check Fm Water I Sower
Tract -
O Bond Payment - A.11
C1 CustwW Deposit
0 Other
f 0 0
G
a
A-1 Cesspool Service, Inc.
P.O. Box 580188, North Palm Springs, CA 92258 JOB INVOICE
`Since 1959'
(760i =6875 Fag (760) 251-3405
State LIC #265214 Customer Order No. Date Ordered
R'WW.a1CeSSpOO1.COI11 Order Taken By Date Promised
s•T `Y t2
BILL TO I PHONF
JOB ADDRESS
SERVICE ❑ PUMP SEPTIC TANK HAS SEPTIC TANK BEEN DUG UP?-'QIYes ❑ No ❑ PMT. ON SITE
REQUESTED [3 PUMP SEEPAGE PIT AT ITS RISER - !❑,OFFICE BILLING
QUANT. DESCRIPTION OF PRICE AMOUNT
1
Pumping Fee per 1000 Gallons (or fraction) CNiOa
9�
aG
Waste Discharge Fee per 1000 Gallons
Locating and Opening Fee (I hr. Min.)
Out of Area Fee
cy— 9F—
❑ �TN��E LEACHING SYSTEM HAS FAILED.
❑ THERZ[kAN OBSTRUCTION •`UPSTREAM" OF THE SEPTIC TANK
Iiwill benecessary to contact aline cleaning company.
ElWE RECOMMEND MAINTENANCE PUMPING OF THE SEPTIC TANK EVERY
❑ YEAR ON H R YEAR ❑ 2-3 YEARS
To remove built up solids., will increase the life of your leaching system.
❑ THIS PUMPING WILL PROVIDEONLYTEMPORARY RELIEF AND NOT
SOLVE CUSTOMERS SEPTIC PROBLEM BECAUSE OF THE ABOVE.
❑ CUSTOMER HAS BEEN GIVEN AN "EXPbAINNAATION" PACKET.
A SERVICE CHARGE OF 522 WIhL BE DUE
ON ALL RETRUNED CHECIZ9,�
A FINANCE CHARGE OF 11/2% PER MONTH• 18% PER YEAR, WILL BE
CHARGED ON PAST DUE ACCOUNTS OVER 10 DAYS
IF PAYMENT iS BY CHECK
DRIVERS LIC. # STATE
hereby acSIGNATURE ovule/dge the milsfaddoory completion of the above described work: '
T0181
Due
C e
Y
-1