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04-5274 (PLBG)BUILDING & SAFETY DEPARTMENT P.O. Box 1504 -,(760).777-7012 "c�tV- 78-495 CALLE TAMPICO " FAX (760) 777-7011 " LA QUINTA, CALIFORNIA 92253 INSPECTION --REQUESTS ("760) 777-7153 BUILDING PERMIT Application Number 04-00005274" 86.5 Date" 6/30%04 Property Address .. . . . . . 54AVENI`DA RAMIREZ APN: 774-295-018-6-000000- Application"description PLUMBING Property Zoning,COVE RESIDENT -IAL Application valuation.: 2350 Owner Contractor REAL KENNETH JANETTE ALMS UNDERGROUND.•CONST, INC. 5.4865 AVENIDA.."RAMIREZ. 3,8703. VISTA DRIVE. : LA"`.QUI"NT.A... CA 92253 CATHEDRAL CITY CA 92234" . ":WCC.: - : , "VIRGINIA" INC WC: 00.5.t001"6007. Q1./0'1/05 CSLB':... ' .4821-80 11/30/"05 - " PCC.: C42 C21" Permit PLUMBING SEWER Additional desc Permit Fee" 3,0.00 Plan Check Fee .00. Issue Date Valuation 2350 Qty Unit Charge" Per Extension BASE FEE" 30.00 --- Special Notes and..Comments --"----- - - ---- -.--- -SEWER.CONNECT/SEPTIC ABANDONEMENT Fee. summary . :Permi:t. Fee. Total Plan Check Total' Grand Total Charged ' . Paid - 30....00 .": .00 00 00 30.00, .00 Credited ----------- .,GO -0 0 .40 Due ----------- .30.00. . 0 0•. 30.00 A JUN 0. 4 " 00,2 P.O. BOX 1504 -ot. 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: O 1� Date: - Applicant: I Architect or Engineer: Applicant's Mailing Address: Architect or Engineer's Address: Lic. No.. BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION 1 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 *mm full force nd effect. c� License Class.) )Sz / �� License_ No.l -7 / OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that 1 am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any sty or county that requires a Perrnit 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).): U I, as owner of the property, or my employees with wages es 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 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) ficensed pursuant to the Contractors' State license Law.). U I am exempt under Sec. B.3 P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION 1 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 wok for which this permit is issued. _ 1 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 workejs' compgnsation insurance carrier and poli number are: f Cartief i Vi r�, I +� o, Ju r2Tj�: Policy Number _ O O ��O c7 1 07 l l I cedVy that, in the performs ce of the work for which this permit is issued, l shag 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 fofthwith comply with those provOiBbs. "m le3o.1 "-,,Q 2.01DN e,,,;ri��► `WARNING: FAILURE -TO SECUREOW RKERS, COMPEN ON 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. 1 hereby affirm under persalt of CONSTRUCTION LENDING AGENCY y perjury that there is a construction lending agency for the perrommance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name Lenders 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 Ouinta, its officers, agents and employees for any act or omission related to lfte 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 wok 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 cored. 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authodw.representatives of this countye r upon the abo tioned property for inspection/purposes. ure Date 3 W-Z� —(Applicant or Agent): rJ?-v✓ 06/211,2004 00:00 ',. 7603470954 SANDRA •-.PAGE -01 N COACNELW VALLEY WATER DISTRICTNq 956 " CASH RECEIPT DETAIL LC L-3 jecelvedFrom: r t; l tots) Account No. ^ ♦ \ -� f o G.A. CodO $ r , Service'Address i ❑ Meter($) - C] service(s) ❑ .HOus8,Latef8l(S).�— y ❑ Oetactor Cneck(s) i (.a { ❑ Meter 3urcherpe3 &,561tation Capacity Charge ❑ W,S.B.F.C. 0 Temporary Construction Meter ❑ Turn On Charge ❑ Uncollected Account - Name ❑ 'Inspection Fee - Tract - Fee - [] Plan Check Fees Water !'Sewer Tract ❑ Bond Payment - A,D. - Bonder^� - ❑ Customer Deposit i ❑ Other ' 7- �• TOTAL $, -,- t i I Waterservioe; Cash ' I _ l ± Cashier vwt7-(ti,re9)....._ check I /! ;; JUN -21-2004 MON 10:58AM ID:, • PAGE:1- y