07-1690 (PLBG)P.O. BOX 1504 .
78-495 CALLE TAMPICO
LA QUINTA,-CALIFORNIA 92253
Appljcation Number:
07'"00001690
Property Address:
151260 AVENIDA
APN:
773-045-020-15
Application description:
PLUMBING
Property Zoning:
MEDIUM DENSITY
Application valuation:
2900
r- j
c&t�/ 4 46 Q"
RUBIO
-000000-
RES
Architect or Engineer:
P.
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
--------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
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.2tass: B C36 C42 License No.: 793482
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 _ 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.).
( ) 1 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 ISec. 3097, Civ. C.).
Lender's Name:
Lender's Address: "
LQPERMTT
Owner:
GEORGE FARLELY
51260 AVENIDA RUBIO
LA QUINTA, CA 92253
Contractor:
SO CAL & ASSOCIATES P
P.O. BOX 955
YUCCA VALLEY, CA 9228
(760)464-3147
Lic. No.: 793482
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/11/07
D p
INC JUN 1.1 2007
CITY OF LA QU NTA
FINANCE DEFY.
------------------
WORKER'S COMPENSATION DECLARATION
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.
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 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 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' 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 correct. I agree to comply with all
city and county ordinances and state laws relating�tobu�ildingcons�truction,d hereby author'ze representatives
/city a, county to en er up the above-mentionedDate' ignature (Applicant o gen
Application Number 07-00001690
Permit ...
. PLUMBING SEWER
Additional dest .
Permit Fee . . .
. 30.00
Plan Check
Fee
.00
Issue Date
Valuation
. .
2900
Expiration Date
12/08/07
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
V COACHELLA VALLEY WATER DISTRICT CASH RECEIPT DETAIL Q 116 eo cc Fa9852
Received From: 2^l Date
Uyivlp
Account No. v v v v. Lot(s) 1 7/ J Tract
Service Addre ' �� — led d�d G.A. Code
❑ Meter(s) $
❑ Service(s)
❑ Backflow(s)
❑ House Lateral(s)
❑ Detector Check(s)
OM Surcharge
Sanitation Capacity, Charge J 5
❑ W.S.B.F.C.
❑ S.I.W.S.C.
❑ Temporary Construction Meter
❑ Tum on Charge
❑ Uncollected Account - Name
❑ Inspection Fee - Tract -
Fee -
❑ Plan Check Fees Water / Sewer -
t Tract -
❑ Bond Payment -A.D. - Bond Assmt
❑ Customer Deposit
❑ Other
had A1jei'4Z'j � TOTAL $ ► S 1 / • .
Remarks:
E r_ y to:
Cash
Check
Money ti
Order
Water Service
0F
1 Cashier
Gx
(1/06)
� - �-
Bin # . -.
'
City. of La Quints
Building a 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
Project Address:
Owner's Name: /L' edLCoG�
A. P. Number:
Address: ppf 1
Legal Description:
City, ST, Zip:
Contractor:Telephone:
"
�
Address:
Project Description:
City, ST; Zip:.
Telephone:
Room "_
[+hAz U/0* 4? V_Lll� .
State Lic. # :
City Lic. k
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
.&
Construction Type: Occupancy -
State Lic. #:
Project type (circle one): New Add'n 'Alter • Repair Demo
Name of Contact Person.:
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project: 21:1
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACIUNG .
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 Calcs.
Plans picked up r
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading. plan'
2" Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed -
Plans picked upS.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
''" Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person s'
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
AZff'NwAwPw
PUMP/NG
Lic #C42 855 851
IbU .Slit -105f • 7-?5UU-JJ4-fAb0
FAX 760 328-6607
P.O. Box 2318 • Cathedral City, CA 92235
CUSTOMER'S ORDER NO.
DA ORDER D
ti` 'Qg
ORDER TAKEN BY
DATE PROMISED ❑ A.M.
❑ P.M.
BILL TO
PHONE
ADDRES
MECH IC
CIN
HELPER
JOB NAME AND LOCATION
❑DAY WORK
❑ CONTRACT
❑ EXTRA
DESCRIPTION OF WORK
Dumping Fee per 1000 gal.
QUANT.
DESCRIPTION OF MATERIAL USED
PRICE
AMOUNT
Gallons
Pumping Fee per 1000 gal.
Dumping Fee per 1000 gal.
e
Out of Area Fee
Locating / Opening Fee (per hour)
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 e
damage, c oncr IF ees.
SIGNA DATE COMPLETED
�J�
TAX
TOTAL