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07-0635 (PLBG)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 T4ht4-4Q" BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Applicant: ],hereby affirm under penal o pert that I am Section 7000) of.Divisio 3 of the Bus ass and License Class:_ C42 Architect or Engineer: TOR'S DECLARATION provisions of Chapter 9 (commencing with tode,,an,d myLicense is in full force and effect. : 661018 v 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—) 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: LQPERA11T Owner: MERIDIAN MOULDING INC 330 CESNA CIRCLE CORONA*, CA 92880 Contractor: HAMMER PUMPING INC P O BOX 2448 CATHEDRAL CITY,_ CA 92235 (760)32.1-7448 Lic. No.: 661018 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 2/28/07 0 WORKER'S COMPENSATION DECLAR TION�,ti.�. 1^ 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 r ars'mpensation co,•as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is D4 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 STATE FUND Policy Number 1828655-2007 _. 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 to become je the workers' compensation laws of California, and agree hat, if I should b come sub' to the workers' compensation provisions of Section 700 o the Labgr C _, I , hall for ith co with those provisions. WARNING: FAILURE T10_5 CJAE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS 1$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 'qJmp'Y commenced within 180 days from date of issuance of such permit, or cessation of work s will subject permit to cancellation. - I certify that I have read this application and. to that the abov 'nformation is correct. I awith all cit and c nt ordinances and stat aws )alio to build,n con truction, d hereb autesentatives Y g. 9 V of thi o ntyrto enter upon the ova- .6tioned propg1 y for in action rposes. or Application Number: t _07=00000635r Property Address: 53380 AVENIDA RUBIO APN: 774-0737007-18 -000000- Application description: PLUMBING Property Zoning: COVERESIDENTIAL Application valuation: 3500 Applicant: ],hereby affirm under penal o pert that I am Section 7000) of.Divisio 3 of the Bus ass and License Class:_ C42 Architect or Engineer: TOR'S DECLARATION provisions of Chapter 9 (commencing with tode,,an,d myLicense is in full force and effect. : 661018 v 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—) 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: LQPERA11T Owner: MERIDIAN MOULDING INC 330 CESNA CIRCLE CORONA*, CA 92880 Contractor: HAMMER PUMPING INC P O BOX 2448 CATHEDRAL CITY,_ CA 92235 (760)32.1-7448 Lic. No.: 661018 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 2/28/07 0 WORKER'S COMPENSATION DECLAR TION�,ti.�. 1^ 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 r ars'mpensation co,•as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is D4 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 STATE FUND Policy Number 1828655-2007 _. 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 to become je the workers' compensation laws of California, and agree hat, if I should b come sub' to the workers' compensation provisions of Section 700 o the Labgr C _, I , hall for ith co with those provisions. WARNING: FAILURE T10_5 CJAE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS 1$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 'qJmp'Y commenced within 180 days from date of issuance of such permit, or cessation of work s will subject permit to cancellation. - I certify that I have read this application and. to that the abov 'nformation is correct. I awith all cit and c nt ordinances and stat aws )alio to build,n con truction, d hereb autesentatives Y g. 9 V of thi o ntyrto enter upon the ova- .6tioned propg1 y for in action rposes. or LQPERMIT Application Number . . . . . 07-00000635 Permit . . . PLUMBING SEWER Additional desc . Permit Fee 30.00 P1an.Check Fee 00 Issue Date . . . . Valuation . . . . 3500 Expiration Date '. 8/27/07 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 Bin # City Of La Quinta Permit # Building U Safety Division P.O. Box 1504, 78-495 Calle Tampico /l AO La Quanta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Project Address: Owner'sName: 1 1 A. P. Number. Ou - Legal Description: Address: �j.0 CSS CZ Contractor: City, ST, Zip: (26.z�CA-Z U p Telephone: Address: City, ST, Zip: Project Description: C�� Telephon: GJ W State Lie. #': City Lic: #"�-� • • : arch., �n�r., Designer. w 5 � • Address: 3� City; ST, Zip:' _ �A 223 Telephone L (c • (0 5 Lic. #: Construction Type: occupancy:State Name of Contact -Person: �� Project type (circle one). New Add'n Alter Repair Demo Telephone # of Contact Person: Sq. Ft.: #Stories: :# Units: _ Estimated Value of Project: APPIJCANT: DO NOT WRITE'BELOW THIS LINE # Submittal Req+d J Reed TRACIMC Plea Sets Pfaa Check submitted PERMIT FEES Stractaral Celts. . Reviewed, ready for corrections Item Amount . Trans Cala. Pon Chick Deposit Called Contact Person Energy Calcs. Pleas Picked up Plan Check Balance Flood plain plan Pleas resubmitted Construction Grading. plea 2" Review, ready for eorrectioostissue Mechanical Subcoutactor Lift Called Contact -Person Electrical Great Deed Plans picked up Plumbing ILO.A. Approval Plans resubmitted SALL " IN HOUSE:-* Review, ready for. correctionsrusue Grading Planning Approval Developer Impact Fee Called Contact Person Pub. Wks. Appr Date of permit issue A.LP.P. School Fees Total Permit Fees 1. (( �/� CO CHEW1 VALLEY WATER DISTRICT CASH RECEIPT DETAIL Ie / Received From: -A (4, //t" I 1.4 (�l r o e �j Date �. Address Account No. 6—'C%212 2 W fin/ (: Lot(s) Tract Service Address J (3 G /' P d ? i r; GA. Code j O Meter(s) $ O Services) O Backflow(s) ' rO House Lateral(s)' ❑. Detector Check(s) i ❑ Meter Surcharge Sn i. E�nitation Capacity Charge `7 T�— ❑ W.S.B.F.C. I. ❑ S.I.W.S.C. _ O Temporary Construction Meter O. Tum on Charge O Uncollected Account - Name ❑ Inspection Fee - Tract - Fee.- i O Plan Check Fees. Water / Sewer - j Tract - ' O Bond Payment - A . - Bond Ass�*+t O Customer Deposit . ❑ Other i Remarks: j Copy to: G T i i Cash i Check Money I Order G-0 TOTAL $ b (/ Water Service_ Cashier -1018 POST OFFICE BOX 2448 CATHEDRAL CITY, CA 92235-2448 (760) 360-7448 (760) 321-7448 Time -In Time-out 1 4:, 0 Ordered by Bill To Cust. Order# Address Ph. # City M` Job Name and Location Helper Description of Work c-, Arnnt. Pumped a'Gal El$eptic Tank,.® seepage Pit El Cesspool [I Grease Trap [I Other El System is Failing E3 System Passes Inspection E] Excessive Sludge El Roots Quantity Description of Work or Material Used Price Amount Pump & Dump Fee per 1000 gal Locating & Opening Fee (per hour) Septic Inspection I Out of Area Fee Fuel Surcharge Snake Line El Roof" Video Pipe Inspection Camera 1st hour Additional hours High Ffdssure Water Jet Additional Hours Labor per hour [I After Hours Sat. Charge El Sun. Charge —0 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 Paid By Check # ❑ MasterCard / Visa [:]Billing Card # °Exp._ bate Signature Next Service Due On Date Completed