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07-2058 (PLBG)` P.O. BOX 1504 78-495 CALLE TAMPICO ro LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application description Property Zoning: Application valuation: Applicant: 07-00002058 54940 AVENIDA RUBIO 774-292-031-16 -000000- PLUMBING. COVE RESIDENTIAL 300 Architect or Engineer: LICENSED CONTRACTOR'S DECLARATION -4 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Ihereby 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: License No.: ' Date: 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 an ,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. 70.4.4, Business and Prnfaminns Code; The Cnntrartors' State License Law. does not anoly to an nwner-nf property who.builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). , �ate�:�3,6, 1 Iam exempt under Sec. , B.&P.C. fforr this reaasonnOwner: �VO (/I AVO 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: In LQPERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-715L, Date: 7/13/07 Owner: PEABODY FRANK A VANPATTEN 54940 AVENIDA RUBIO LA QUINTA, CA 92253 D° Ownertor: JUL 16 2��� -------------- --- W1Y_QF1A_t L44TA FII4ANCE DEPT 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 - Policy Number 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 a 37/0'00 of the Labor Code, I shall forthwith comply with those provisions. ate: / Vplicant: 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 15100,0001. 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 anoliration, 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. - 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 to building construction, and hereby authorize representatives of this county to enter upon thea ve-mentioned property for inspection %purposes, 'Date:7 13 G ure (Applicant or Agent): Application Number . . 07-00002058 " Permit PLUMBING SEWER Additional desc . _ Permit Fee 30..00 Plan Check Fee 00 Issue Date. . . ._ Valuation . . . . 300' Expiration Date 1/09/08 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 60 00 .00 Grand Total 30.00 .00 .00 30.00 ' LQPERMIT < PO. BOX 1504 APPLICATION ONLY Building 78-495 CALLE TAMPICO Address LA QUINTA, CALIFORNIA 92253 t, jita/ %( V4, vt/ rAItI17^ BUILDING: TYPE CONST. A.P. Number OCC. GRP. Mailing � Address L L G / Legal Description Project Description City j � 110 Contractor _ _ l% ki LIZ 14 Address City Zi Tel. Sq. Ft. Size No. No. Dw. Stories Units State Lic. & Classif. t City Lic. # Arch., Engr., - Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. SIGNATURE DATE OWNER -BUILDER DECLARATION Estimated Valuation I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, or that he is exempt therefrom, and the basis for the alleged exemption. Any violation or Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. ❑ 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 Profes- sions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or im- provement is sold within one year of completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale). ❑ I, as owner of theroe the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) 0 1 am exempt under Sec. B. & P.C. for this reason Const. Mech. Electrical Plumbing S. M. 1. Grading Driveway Enc. Date Owner Infrastructure WORKER'S COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company O Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE TOTAL REMARKS (This section need not be completed if the permit is for one hundred dollars (5100) valuation • or less). 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 Workers' Compensation Laws of California. Date Owner NOTICE TO APPLICANT., If, alter making this Certificate of Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith - comply with such provisions or this permit shall be deemed revoked. ZONE: BY: Minimum Setback Distances: CONSTRUCTION LENDING AGENCY Front Setback frcm Center Line I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Rear Setback fro 71 Rear Prop.Line Lender's Name Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. Side Street Setback from Center Line Side Setback from Property Line 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 to building construction, and hereby authorize representatives of this city to enter the above-mentioned property for inspection purposes. FINAL DATE Issued by: INSPECTOR Date Permit Signature of applicant Date Mailing Address Validated by: Validation: City, State, Zip WHITE = BUILDING DEPARTMENT YELLOW = APPLICANT PINK = FINANCE ! COACHELLA VALLEY WATER DISTRICT CASH RECEIPT DETAIL 2 t �'t I < t�+" .l�i`tl i (/( Date: —�,✓ / Z d Received From: i, Address: Account No. `L ' i� (!J `1 ��. -LJ �I In (� �✓ Lot(s)' Z 61 Trail' Service Address �' C_1 G� yr �) G.A. Code } D Meter(s) _ $ ! D Service(s) D Backflow(s) - ❑ House Lateral(s) ❑. Detector Check(s) ❑ Meter -Surcharge (�� ✓, ._O•\ Sanitation Capacity Charge �� D W.S.B.F.C. - D 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 q Customer Deposit ❑ Other ,- G' �� ', I<�� f _I _ < i � r -� 5i!f, �"y TOTAL $ �r 9 C� Remarks' / G( VL.�_ ' i e� (.! 1� i t T OuNr tu. SA6� Cash ' G ::� Water Service G p Check Money. ... Cashier �:;' :.+�' s s�r Order `." .. CVWD-438 (1/05) h OWNER/BUILDER INFORMATION Dear Property Owner: An application fora building permit has been submitted in your name listing yourself as the builder of the property. improvements specified. For your protection you should be aware that as "Owner/Builder" you are the responsible party of record on such a permit. Building permits are not required to be signed by property owners unless they are personally performing their own work. If your. work is being performed by someone other than yourself, you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the City or County. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should' be aware of the following information for your benefit and protection. If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $200.00 or more for the entire project, and such persons are not licensed as contractors or subcontractors, then you may be an employer. If you are an employer, you must register with the State and Federal Government as an employer and you are subject to several obligations include State and Federal income tax withholding, federal social security taxes, worker's compensation insurance, disability insurance costs and unemployment compensation contributions.. There may be financial risks for you if you do not carry out these obligations, and these risks am especially serious with respect to worker's compensation insurance. For more specific information about your obligations under Federal Law, contact the Internal Revenue Service (and, if you wish, the U.S. Small Business Administration). For more specific information about your obligations under State Law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property. owners who are not licensed contractors are allowed to perform their work personally or through their, own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an "CwnerBuilder" building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their. own work personally. Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your community or at 1020 N. Street, Sacramento, California 95814. Please complete and return the enclosed owner -builder verification form so that we can confum that you are aware of these matters. The building permit will not be issued until the verification is returned. Very truly yours, CITY OF LA QUINTA DEPT. OF BUILDING AND SAFETY 78-495 Calle Tampico La Quinta, CA 92253 (760) 777-7012 FAX: (760) 777-7011 �el3 67. OWNER'S SIGNATU /DATE PROPERTY ADDRESS PERMIT NUMBER(S)