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10-0016 (PLBG)- P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 T&t 4Q" BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Application Number: C10 00000016 Property Address: 77933`CALLE-COLIMA APN: 774-134-012-2 -000000- Application description: PLUMBING Property Zoning: COVE RESIDENTIAL Application valuation: 2500 Applicant: Architect or En 'neer: ------------------ 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: C42 /License No.: 661018 /� Date: 1—b�-10 Contractor: /tel l a -a- s �- - �- - 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 7 031 .5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: 1 1 _ 1 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 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 _ 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: LQPEPJAIT Owner: ATCERMEN, TERRY 77933 CALLE COLIMA LA QUINTA, CA 92253 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 1/07/10 Contractor: D( a HAMMER PUMPING INC ( Q P O BOX 2448 CATHEDRAL CITY, CA 5 JAN (760)360-7448 Jlia-tt 0M n Lic. No.: 661018 7 2C�U CI rs. FLAO11;un at ------------------------------------------r------ WORKER'S 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. Nly workers' compensation insurance carrier and policy number are: Carrier SELF - INSURED Policy Number 2246 I certify that, in the performance of the work for which this permit is issued, 1 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: .10�7 '�l� Applicant: Vt� 4� &I VA—s- .� 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 (5100,0001. 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 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 i pection purposes. Date:-6�,1ta Signature (Applicant or Agent):' Application Number . . . . . 10-00000016 Permit . . . PLUMBING SEWER Additional desc . Permit Fee 30.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 2500 Expiration Date 7/06/10 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 15.0000 EA PLB BUILDING SEWER 15.00 ---------------------------------------------------------------------------- Special Notes and Comments SEPTIC ABANDONMENT/SEWER HOOK UP ---------------------------------------------------------------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged Paid Credited ----------------------------------------------- ---------- Due Permit Fee Total 30.00 .00 .00 30.00 Plan Check Total .00 .00 .00 .00 Other Fee Total 1.00 .00 .00 1.00 Grand Total 31.00 .00 .00 31.00 LQPERMIT P.O. BOX 4721 • Cathedral City, CA 92235-2448 • LIC# 661018 JOB INVOICE- JO NVOICE- FORDERED - TIME IN: TIME OUT. TEVICI N 9 TECHNICIAN 02 HELPER(S) : P.O. NSTART DATE: END DATE: www.hammerpumping.com 760/360-7448 760/321-7448 FAX 760/324-6434 Customer Name KIC i W1ti ►'►� 1/ Address Iry i Ph# Additional Service -❑ Required ❑ Recommended Description/ Remarks/ Drawings Card — MC ! VISA # JOB LOCATION REASON FOR SERVICE BACK UP CONTRACT MAINTENANCE REPAIR MAINTENANCE ESTIMATE CONSTRUCTION OTHER I hereby authorize Hammer Pumping, Inc. to charge my credit card for the above charges. I understand that by signing below 1 am agreeing to all charges Incurred on this ticket and that the work was completed to my satisfaction. 11.110-n V/ 1 - r 7 -to COMMENTS C' V1 Cir I% ❑ Leach System Failing ❑ Roots ❑ Excessive sludge/grease SERVICES COMPLETED /7GLOp AUKtKIVIHN / l`AKAUH COACHELLA VALLEY WATER DISTRICT CASH RECEIPT DETAIL Received From: Address: 4 • �� Account No. tis) Service Address * Meterls) C Service(s) C Backillowls) * House Lateral(s) O DetecterCheck(s) * Meter Surcharge ff Sa"nitatlon Capacity Charge O W.S.B.F.C,`' :1 Temporary CoAtructlon Meter C Turn on Charge C Uncollected Account - Name C Inspection Fee - Tract - Fee - ❑ Plan Check Fees Water I Sewer - Tract - G Bond Payment - A.D. - Bond Assmt. ❑ Customer Deposit C Other Remarks: 8 31 bb9bl b1 .r N° 93607 p.3 TOTAL s 6 -::)Copy to: `" 01 Cash Water Servl ce Check Money ' Cashier Order CYWD-438 (11(69) . Bin # City of La Quinta Building 8L Safety Division Permit # ✓ 11 P.O. Box 1504, 78-495 Calle Tampico lQ La Quinta CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Project Address: �— G Owner's Name: A. P. Number: Address: P Legal Description: City, ST, Zip: 4 Q Contractor: Telephone: Address: Project Description: City, ST, Zip: - - - — -S - - --- -- --- - - -- Telephone: `Q 3 4 State Lic. # : b A City Lic. #.- ` Arch., Engr., Designer. Structural Calcs. Address: City, ST, Zip: Telephone: #�. #y3#tW y Construction Type: Occupancy: State Lic. #: Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person: Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: Estimated Value of Project: LY2 APPLICANT: DO NOT WRITE BELOW THIS LINE N I Submittal Req'd Rec'd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2'" Review, ready for correctionsfissue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Pians resubmitted Grading IN HOUSE:- 3" Review, ready for correctionstissue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees