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07-1507 (PLBG)P.O. BOX 1504 78-495 CALLS TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 07-0000.1.507 Property Address: 52404 AVENIDA RUBIO APN: 773-253-026-16 7000000 - Application description: PLUMBING Property Zoning: " COVE" RESIDENTIAL Application valuation: 5500 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT r e Applicant: Architect. ofttA CCi 8e` 1f bI EdT& -------------------------------------------------- LICENSED CONTRACTORS DECLARATION hereby affirm under penalty of. perjury that I am licensed unde?, provisions of Chapter 9 (commencing with . Section 7000) of Division 3. of.IK6�Business and Pr ionalsCo J and my -License is in full force and'effect.' •, • r License.Class:—C3.6; ,��. 'Li' No: �.813326 en Dafe�S�23_G�Contractor: { _ "ta i. ; w�' OWNER-BUILDGR DECLARATION ''�•a '�w 1-hereb affirm:under penalty of perjury that am exempt from the Contract&'s State License Law -for the �•• Y P Y P. I Y P following reason (Sec. 7031.5, Busmessia�d;Professions Code: Any cify or county ift_at'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 ea-signed.statement�that he of she is licensed pursuant,to the provisions of-the.Contractor's State I`. License Law �ICliapter'9Icommencirig 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 thanfive hundred dollars'($ 500).; , ` I, "as own e�eoQh property, or my employees with wages'as�thair sole compensation, will do the work, and the.structure isnot 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 woik 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 :improvemeni is sold within, one yeai of completion, the owner -builder will have the burden of proving thai' he:orshe did not build or ` improve for the purpose of sale.). - ,.F . - - • (_) I, as ownerof the property, am exclusiveiy contracting with licensed contractors to construct the project (Sec. 7044; Business and Professions Code^ -The Contractors'State License Law does not apply to an-ownei 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. , 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 Owner: ESMERALDA NELDA 52 404 AVENI-DA'.RUBIO LA QUINTA, CA 92253 Contractor: ;FERNY!S PLUMBING, P.O. BOX 1015 INDIO, CA92201 (760)775-3171 Lic. No.: 813326 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 5/23/07 J .. 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 Sec 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.wof,the Labor ,' - `Code,:for the performance of the work for which this permit .is issued. My workers "compensation • ' ' msurarice carrier and policy numlier'arei • ' " Carrier ARCH INS 't ;Policy Number ' WKN0012Z0301: I certify that, in the performance of the work for whichthis'peimrt isiissued, I shall not employ any person in any manner so as'to becomeiub_jecvto•the- workerscompensation laws of California, - and agree that, if I should become subje o the workers compensation provisions of Section 3700 of the Labor Code, I shall fort rth m� pmly w' �seiprovisions: ???p 1 Date` r p dant: yrX ti WARNING: FAILURE TOSECURE WORKERS' C MPENSATION COVERAGEI,SAUNLAWFUL, AND SHAIh SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND'CIVIL FINES UP: TO ONE HUNDRED THOUSAND - DOLLARS (s100,000): IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST: AND ATTORNEY'S FEES. •Y 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 informatio rrect. I agree t mply with all city and county ordinances and state laws relating to building constructio , and ereby authori r 'esentatives ofthis county-to-enter.upon'the atiove=mentioned property for inspecti_ -purp ses: en t): Application Number . . 07-00001507 Permit . . . PLUMBING SEWER ' Additional desc . Permit Fee 30.00 Plan Check Fee ".00 Issue"' Date Valuation . . . . 5500. Expiration Date 11/18/07 Qty ", Unit Charge Per Extension BASE FEE 30.00 Special Notes "and. Comments --- ------------- ------------ ABANDON -SEPTIC TANK:AND HOOK UP TO SEWEk`LINE.May 22",-200.7 10:12:22 AM " ' Jjohnson Fee summary Charged Paid Credited Due J ----- Permit Fee -.Total- 30:0.0 ---------- .00 ---------- .00 30.00 " r' Plan Check Total .00 .00 00 00 " Grand Total`` 30.00 .00 .00 30.00 LQPERMIT Bin # l 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: 5-1o4- Avi rw0P, l0 ( -.Ownees_Name---),N6L4?A- K461yAA-Vg.. A. P. Number:Address: Z404- "i 0A- iZ4A,�7, J Legal Description: Contractor: _r PUA M61& ty,. ST,_Z1P �(�Pr QUI tJ>� CA • Telephone: Address: Project— t_D_escrption: City, ST, Zip: Nr.% LoPjo6ty ow Telephone: State Lic. # : City Lic. #: Arch., Engr., Designer: i S� Address: City, ST, Zip: Telephone: is 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=. APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Regld Recd TRACIQNG , 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 Construction Flood plain plan. Plans resubmitted Mechanical . Grading. plan:.. 2'" Review, readyTor 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 i Total Permit Fees .`+-�asrw✓s:W;J.yirr�pi�iea.�v+-- i� COACHELLA/VV LLLEY WATER DISTRICT CASH RECEIPT DETAIL 119696 Received From: `' ��'I `'r( Dater Address: _ /LI 1��7f �i�� t / Vk. Account No.I000vI1 /� l,Q.�% Lots)/ �! /5 �j/o Tract Service Address (� C� ` y t✓ G.A. Code ❑ Meter(s) $ ❑ Service(s) ❑ Backflow(s) ❑ House Lateral(s) ❑ Detector Check(s) ❑ Meter Surcharge ;<Saniitation Capacity Charge 7 ❑ 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 - Tract - ❑ Bond Payment - A.D. - Bond Assmt ❑ Customer Deposit ❑ Other /^ T Remarks: / n (L�. /Il l r 1 �.OTAL $ � G `� -r `� l �. `) U �-j..� !,} � {i-t� �. `�- (� ..` `F �'S:'tivl •••� i G� �G� l _b Copy to: Cash Water Service �t^R'` Check �o� tL J r.� Money } Cashier Order tai Yrs ssr CVWD-438(1/05)