05-0660 (PLBG)U � .
BUILDING & SAFETY DEPARTMENT.
D (760).777-7012 _
OFTtiti9 7A FAX (760) 777-7011
LAUINTA, uA�LIF IA 92253 INSPEC:TION`R1EQ.1fESTS (760) 777-7153
CITY OF LA QUINTA
FINANCE DEPT. B ILDING PERMIT
Application Number . . . . 05-00000660 Date 2/24/05
Property Address . . . 53385-AVENIDA RAMIREZ-
APN: 7747081-018-7-00'0000-
.Application-description 'PLUMBING
.Property Zoning . COVE RESIDENTIAL
Application valuation 500.0
Owner Contractor
MARTINEZ BENIGNO/T VASQUEZ OWNER
53385 AVENIA RAMIREZ
LA QUINTA CA 92253
Permit PLUMBING SEWER
Additional desc.
Permit Fee . . .30.00 Plan Check Fee .00
Issue Date Valuation . . 5000
Qty Unit Charge Per, Extension
BASE FEE ` 1-30,.,00
Special Notes and Comments
SEWER CONNECT/SEPTIC ABANDONEMENT
Fee,summary. Charged Paid Credited Due
Permit Fee Total 30.00 00 00, 30.00
Plan Check Total .00 .00 .01) .00
Grand Total 30.00:00x:'30 0;0
P.O. Box 1504 • .V
VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: (`)J —'JG� c� I Date: Z V Ir
Applicant: n
Applicant's Mailing Address:
Architect or Engineer:
Architect or Engineer's Address:
Lic. No.:
LSUILUING PERMIT DECLARATIONS
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 Class License No.
Date Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' 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 Contractors' 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).):
Qty) 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 or 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.).
U 1, 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.).
U I am exempt under Spec.. BA P.C. for this reason
%Date
WORKERS' 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 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:
Cartier 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 3700 of the Labor Code, I shall
forthwithcomplywith those provisions.
Date i v� f� <.pplicant y
WARNING: FAILURE TO SECURE WORKERS' COMPENSATI 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.
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
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 to building
construction, and hereby authorize representatives of this county to enter upon the above-mentioned property for inspection purposes.
Date) v �«Signature (Applicant or Agent):
��--
3
f
OWNERBUILDER INFORMATION
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the kuilder of the property
improvements specified.
For your protection you should be aware that as "Owner/Builder" you are the responsible pary 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 ✓ourself 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 are 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 contracts 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 "Owner/Builder" building
permit, erroneously implying that the property owner is providing his or her own labor anc 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 confirm 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:
OWNER'S NATURE/DA
PROPERTY ADDRESS
PERMIT NUMBER(S)
COACH ElJC VALLEYWATERDISTRICT
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S { CASH RECEIPT DETAIL 10660
Received From: ��< .�- ` 1:._ .• 1 " �• 7 i / (.�/ Date.
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Address: �j
AccountNo. j } .Cf 1...�I
Service Address '� r Lot(s) l—_�;! r Tract
' - , i �l / i ) l �Y ; t` G.A. Code
❑ Meter(s)
❑ Service(s)
❑ Backflow(s) 1
' >l
❑ House Lateral(s)
❑ Detector Check(s)
❑ Meter Surcharge ,
GYBanitation Capacity Charge
❑ W.S'.B.F.C. j
❑ Temporary Construction Meter T
❑ Turn on Charge
❑ Uncollected Account Name
❑ Inspection Fee -Tract - i
Fee -
❑ Plan Check Fees Water / Sewer - ;
Tract— }
❑ Bond Payment - A.D. - Band
Assmt. .
❑ Customer Deposit
❑ Other
TOTAL
Remarks:
zGo to:
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Cash t,i *a5 ` Water Service 1, ; ��,
Check i
Money
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Order t
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£ 4 + vt Ca /
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__ `_,_- _--•-� rzW __.�,._. .._.._—,.._a�_.._r..��s.... �....� "i CVWD-438(11/89) i
A-1, Cesspool Service Inc.
P.O..Box 580188, North Palm Springs, CA. 92258
`Since 1959'
(760) 329-6875 Fax (760) 251-3405
State Lie. #265214
www.alcesspool.com
JOB INVOICE
T, 7
JOB ADDRESS
Waste Discharge Fee per 1000 Gallons
SERVICE (3 PUMP SEPTIC TANK HAS SEPTIC TANK BEEN DUO UP? 0 Yes 0 No
REQUESTED ��PUMP SEEPAGE PIT AT ITS RISER
'[SIFMT. ON SITE
/[3 OFFICE BILLINGI
.
DESCRIPTION OF PRICE AMOUNT
1000
Pumping Fee per 1000 Gallons (or fraction)
/ , -/,
I)A
Waste Discharge Fee per 1000 Gallons
Locating and Opening Fw(lhr. Min.)
7—
Out of Area Fee
tr v
[3 THE LEACHING SYSTEM HAS FAILED.
(3 THERE IS AN OBMUCTION -UPSTREW Of THE SEPTIC TANK.lI%lIIhr.rmwayitgam=j* 'jjflqRepippW..
13 WE RECOMMEND MADMNANCE PUMPING OF THE SEPTIC TANK EVERY
(3 YEAR (3 OTHjMYEAR 'Cl 2.3 YEARS
To tame built up solids. This will Increase the life ofyour leach4 system.
[I THIS PUMPING WILL PROVIDE ONLY TEMPORARY RELIEF AND NOT
SOLVE CUSTOMERS SEPTI¢ PROBLEM BECAUSE OF THE -ABOVE.
13 CUSTOMER HAS BEEN GIVEN' AN -EXPLAINATION11 PACKET,
A SERVICE CHARGE OF S22 WILL BE DUE;
ON ALL RETRUNED CHECKS.—
A FINANCE CHARGE OF 1112% PER MONTH, 13% PER YEAR, WILL BE
CHARGED ON PAST DUE ACCOUNTS OVER 30 DAYS.
W PAYMENT 13 BY CHECK
DRIVERS LIC tl' STATE_
I hereby acknowIledge, the as r%cbwy completion of the Move deicribed worn:
SIGNATURE
Total
G
A-1 Cesspool Service,' Inc. -
-P.0. Box 580188, North Palm Springs, CA. 92258 JOB INVOICE
'Since 1959'
(760) 329-6875 Fax (760) 251-3405
State Lie. #265214
www.alcesspool.com
SERVICE [j PUMP SEPTIC TANK HAS SEPTIC TANK BEEN DUO UP? ❑ Yes ❑ No ❑ PMT. ON SITE
REQUESTED APUMPSEEPAGEPTTATTTSRISER ❑OFFICE BILLING
QUANT.DESCRIPTION OF PRICE AMOUNT
1 3bo
Pumping Fee per 1000 Gallons (or fraction)
C.
Waste Discharge Fee per 1000 Gallons
Locating and Opening Fee (1hr. Min.)
Out of Area Fee
L---
n/
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`\ ❑ THE LEACHING SYSTEM HAS FAILED.
\ ❑ THERE IS•AN OBSTRUCTION "UPSTREAM" OF THE SEPTIC TANK
\\\\\\ It will b�necessary to contact a lime cleaning company.
❑tVlit RII90L0.( Ig1L0.AT{ Til1AAlOTi D�.O(P_ IDtR_9F TIIGOIIP 110 TldTf4 EVERV
13 YEAR—❑-O'TEiER-YEAR—[3-2-3 YEARS
To remove built up solids%lhhi�is will increase the life ofyour leading system.
❑ THIS PUMPING WILL PROVIDE ONLY TEMPORARY RELIEF AND NOT
SOLVE CUSTOMERS SEPTIC PROaLEM BECAUSE OF THE ABOVE.
❑ CUSTOMER HAS BEEN OI VEN ANLAINATIOW' PACKET.
A SERVICE CHARGE OF S�WILL BE DUE
ON ALL RETRUNED CiiECKS. .
A FINANCE CHARGE OF 112% PER MONTH, 18% PER YEAR, WILL BE
CHARGED ON PAST DUE ACCOUNTS OVER 30 DAYS.
1F PAYMENT IS BY CHECK
DRIVERS LTC. fl STATE _.--
I hereby acknowledge the satisfactory completion of the above described wloork:
slGNatoRE J
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G�
. ,I I e a
Or I - . V
Duet E
A-1 Cqps pool Service,. Inc.
P.O. Bug PBim Springs, CA. 92258B lNV610E
`Since 19591 - -
(760) 329-6875 Fig (760) 251-3405
State Lic. #265214 Customer Order No. Date ordered
1 .
www.alcesspool.com - J'Order aken By I Date Promised
Z -L-
N
SERVICE O'PUMP SEPTIC TANK HAS SEPTIC TANK BEEN DUO UP? [3 Yea 0 No 0 PMT. ON SITE
REQUESTED [3 PUMP SEEPAGE PIT ATM RISER . 0 OFFICE BILLING
QUANT. f)FSCRIPTInN nr PpirF: AMOUNT
U 2)
w
j�umping Fee per 1000 Gallons (or fraction)
/4"
-Waste Discharge Fee per 1000 Gallons
Locating and Opening Fee (lbr. Min.)
Out of Area Fee
/2/42 6 46--- -J-/
7
[3 THE LEACHING SYSTEM HAS FAILED.
[3 THERE IS AN OBSTRUCTION "UPSTREAM. OF THE SEPTIC TANK
It will be necessary to contact a Ime cleaning company.
J3 WE'RECOMMEND MAINTENANCE PUMPING OF THE SEPTIC TANK EVERY
13 YEAR J3 OTHER YEAR 13 2-3 YEARS
To remove built up solids. -This will iname the life ofyour leaching Mtem.
❑ THIS PUMPING WILL PROVIDE ONLY TEMPORARY RELIEF AND NOT
SOLVE CUSTOMERS SEPTIC PROBLEM BECAUSE OF THE ABOVE
❑ CUSTOMER HAS BEEN GIVEN AN "ExpLAjNATioN, PACKET.
A SERVICE CHARGE OF $22 WILL BE DUE
ON ALL RETRUNED CHECKS.
A FINANCE CHARGE OF 1 If2% PER MON711, 18% PER YEAR, WILL BE
CHARGED ON PAST DIM ACCOUNTS OVER 30 DAYS.:
IF PAYMENT IS BY CHECK
DRIVERS LIC. # STATE
I hereby adwowledge the satlzbotary compledan af the akove demilied worIL
SIGNATURE
Total
Due
/
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