04-5375 (PLBG)BUILDING & SAFETY`DEPARTMENT
—V, " ` P90. BOX 1504
c��.: � O ! I
(760).777-17012
`SOF I1 ' 0 7;8=495 CALLS TAMPICO FAX (760) 777-7011
LA-®® UINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
60
S BUILDING PERMIT
Ap77% cat nUNumber X04-00005375' Date 7/07/•04
Prop:.erty Address . . . . . 54865 AVENIDA RAMIREZ
::_--L-----" , -295-018-6
AP, 774 -000000 -
Application description PLUMBING.'
Property Zoning COVE RESIDENTIAL
. Applicat'ion.'valuation 2'350
Owner Contractor
BEAL KENNETH E ALMS UNDERGROUND CONST, INC.
P.O BOX 446 38703 VISTA DRIVE
LA QUIN.TA. CA 92253 CATHEDRAL CI -Y CA 92234 .'
WCC.: VI.RGINIA INC
WC: 00500016007. '01/01/05
. ... C$LB• 482_80.'..1'1/30/05
CCC: C42 -C21
-------
Permit-': PLUMBING SEWER
Additional'desc
Permit Fee . . 30.00 Plan Checki-Fee '00
Issue Date Valuation 2350
Qty Unit Charge Per Extension
BASE FEE I o t- S 000 -.3 Z Z- 02.6O 3 0.0 0
----------------------------------------------------------------------
Special Notes and. Comments
SEWER CONNECT/SEPTIC ABANDONEMENT .
Fee summary'. Charged. Paid Credited Due.
Permit Fee Total 30.00 .00 .00 3.0.00
Plan Check. Total 00 00 .00 00
Grand Total .30.00 00 :00 30.00
e
P.O. BOX 1504 • 44"
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:
Applicant: ' (e?, 7N4-
Applicant's Mailing Address:
Date:
Architect or En in r
Architect or Engineer's Address:
Lic. No.:
BUILDING 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 Clasb_ L!�?o License No. K
Date — _ " QY 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).):
U 1, 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 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 contractors) licensed pursuant to
the Contractors' State License Law.).
U 1 am exempt under Sec. 4 , BA P.C. for this reason
Date Owner
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/9-: ,✓ G Policy Number
_
I . certify that, in the performance of the work for which t�iis 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
forthwith comply with those provisions..
Date ? E Applicant Z; ►, / n, eo <fy % I > //•
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 ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN .
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name
Lender's Address
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application.
1. Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit
issued as a result of this application, the owner, and the applicant, each agrees to, and shall, defend, indemnify and hold harmless the City of La Quinta, its
officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit.
2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit or
cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize. representatives of this county to enter upon the above- mentioried property for inspection purposes.
Date Signature (Applicant or Agent): .,Z �j/O / Q CIL n ��
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Return check to requestor X Mail check--
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Name / Title of person requesting check
T. Hartung-
Department
artung Department individual is associated with:
Building & Safety
Check payable to:
ALMS UN-DERGROUND. CONSTRUCTION, INC. Amount:$: 24.00
(Name) (Vendor No.)
38-,703 Vista Drive Account Number:
(Address) (plumbing permit fee)
Cathedral City, CA 92234 Project Number: '
Check description and invoice number:'
•Partial,refund o•f permit #04=5375 per,attache d request noting that two
permit were issued in error.(80% refund of $30 = $24.00)
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AUG -24-2004 09:35WFROM: , ' T0:7777011
P: 1"•
' ALMS UNDERGROUND CONSTRUCTION, INC.
38743 Vista Drive; Cathedral City, Ca 92234
- ' 760-324-1911, FAX`,760-324-9541
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AUG. 24, 2404
wTWO PERMITS WHERE ISSUED FOR THE WORK WE I)IU .AT 54-865 AVENIDA - 4
'
RLIMIREZ
THOSE PERMIT NUMBERS ARE: 04-5375', 04-5274—
WE ARE REQUESTING THAT PERMIT 04»637513E REFUNDED.:
:THANK YOU,
crus cH .EYFPA(l
BOOKKEEPER T..
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