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07-3077 (PLBG)4 4Q P.O. BOX 1504. ^'' VOICE (760) 777-7012 °- 78-495 CALLE TAMPICO FAX. (760) 777-7011 LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT. INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 12/b4/07 Application Number: 07-00003077 Owner: Property Address: 51322 CALLE PALOMA DEBORAH HALL APN:. 770-173-002-179 -000000- Property Zoning:. LOW DENSITY RESIDENTIAL Application valuation: 3500 rK D Contractor: Applicant'.' Architect or Engineer: HAMMER PUMPING. INC rt - A e� P O•BOX 2448 �cc �r;E.000/y ,• ti CATHEDRAL CITY, CA 922.5. (760)360-7448 C1ry®>'gAgi�a11� Lic N8'..:* 661018 Net ------------------------- LICE SED TRA TOR'S DECLARATION WORKER'S COMPENSATION DECLARATION I hereby affirm under pen Ity of perjury th t I m titan uncle_ provisions of Chapter`9'�(commencing with • I hereby affirm under penalty of perjury one of the following declarations: _ - ` Section 7000) of.Mivisio 3 of the 8usin s% d Profession " ode, and,my. License is in full force and effect._ _ I have and' will maintain a certificate of consent to self -insure for workers' compensation, as provided License CI s: ,124`-2 '` Li ns o.: .661018 for by -Section, 3700 of4the Labor Code, for the; performance of'. the workforwhich`thls permit is .z. f issued _ - - Date: -,Z 0 12 ntractj -- J + _ I have'and wilhmaintain workers' comperisation insurance, as required by Section 3700 of the Labor ?'� F • - Code for the, performance of%the work for which this permit is,issued My workers' compensation r OWNER.BUILDER,DECLARATION :' - `- _ insurance carrier and policy, number. are: I Hereby affirm under penalty, of perjury that I am exempt.from th;'Contractor's State' License Law for the ,:Carrier STATE FUND `• Policy Number 1828655-2007. 3 S fallowing reason'(Sec. 70i.1':S, Business and Professions Code: Any. cityor county that requires a permit to _ I certifythat; in the performance of the worfor which this permit is issued, I shall not employ any construct, alter-.im`prove„demolish; or repair any structure, prior to its issuance, also requires the, applicant for the :person -in annerso � to be' t to the workers' compensation laws of California; permit to file a sigriedjstatement that he or she is licensed pursuant to the provisions of the Contractor's State and agr that, if I should Abe oma s ct o f workers' compensation provisions of Section ' License taw:(Chapter;9. (commencing with Section 7000) of Division 3 of,the Business' and'Professions'Code) or 3700 f-the°Labor Code;.l all fo with l ly with those provisions. ' that he or she is exempt therefrom and the -basis for the alleged exemption. Any vzolation'of Section 703i.5 by - •r 'any'applicant for a:permit subjects the applicant to a civil penalty of not more than five hundred,dollars ($500).: Dates pplicant I, as owner, of tne.property, or my.employees with wages a; their sole compensation, will doafie work, and the structure. is not intended or offered for sale (Sec; 7044;;Business and Professions Code: The - WARNING:'-FAIL URE•to RE ORKERS' COMPENSATION'COV AGE IS UNLAWFUL, AND SHALL-' Contractors' State,License Law,00es not apply'to•an owner; of property who builds{orimproves•thereon, SUBJECT AN EMPLOYER .TO ;CRIMINAL'PENALTIES.AND CIVIL F S UP TO.ONE•HUNDRED THOUSAND .and wFio:does the work himself or herself. through his or her own employees,'provided'that the -DOLLARS IS:100 0001.<•IN ADDITION 70 T4;' CST DECOMPENSATION; DAMAGES AS PROVIDED FOR -IN ..improvements are not intended or offered for sale -1f, however, the building or improvement is sold within SECTION 3706 OF THE -LABOR •CODE, INTEREST,•AND ATTORNEY'S FEES.. .one yearyof completion, the owner -builder will have the6urden of proving thathe or she did not build or 'improve.for the purpose ofaalea. - - ' e APPLICANT ACKNOWLEDGEMENT 1 _ 1 I, as owner of'the property,•am'exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the.Director of Building and Safety for a'per6t subject to the "•x'7044; Business.and,Professions Code: They Contractors! StateLicense Law does 'not -apply to an°owner of - . conditions an8'res6icfiohs'set forth'oe"this application. ° ''"• "`"+ - - ,.. n r•w property who builds or improves thereon, and who'contracts for the projects with a contractor(s) licensed 1.' Each person upon whose behalf this application is made;'each persons at whose request and for ' pursuant to the Contractors' State License Law.). - whose benefit work is performed'under or pursuant to any permitissued as a,result of this application, (_) I•am exempt u_nder.Sec. , B.&P.C. for this reason the owner,,and the applicant, each agrees to, and shall defend,' indemnify. andholdharmless 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. - • I Date: Owner: 2. Any permit issued as a result of.this application becomes null �nis oid if work is not commenced. within 180, days from date of issuance -of- permit, or cesn of for 180 days will subject CONSTRUCTION LENDING AGENCY permit to cancellation. �� - I hereby affirm under penalty of perjury that there.is a construction lending agency for the performance of the I certify that I have read this application�nd s" tate that the abo a informaUcorrect. nee to comply with all work for which this permit is issued (Sec. 3097, Civ. C.). city and county rdinances and state I� s relating to building onstrucp n, and hereby autho representatives of this coun t enter on the above-mentioned property f nspection purposes. Lender's Name: / Sig, atureilApp zpan't,or Ag U: - Lender's Address: LQPERMIT Application Number . . . 07-00003077 .3i Permit . .. . . . PLUMBING SEWER Additional desc . Permit Fee 30.00 Plan Check Fee .00 Issue Date . . . . Valuation 3500 Expiration Date 6/01/08 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 Fee summary Charged Paid -------------------------------------- Credited Due Permit Fee Total 30.00 ---------- .00 ---------- .00 30.00 Plan Check Total .00 .00 .00 .00 Grand Total 30.00 .00 .00 30.00 LQPERMIT 'Bin # City of La'Qunta Building U Safety'bivision . P:O. Box 1504,,,78-4,95 ,Calle Tampico La Quinta, QV92253,(760),.777-7012 Buildin Permit: A icatk and Trackin '`Sheet g pp. g 'Permit # n 1 '�J ` Project Address: Owner's Name , Q - , l .� , . L L A. P. Number:. Address: " Legal Descriptio . City, ST, Zip:., . Contractor: .., n . Telephone. ' Addres Project Description: '2 City; ST,Zip: �(�'� �\ �• ( �'*L:; Calrt ^ C7 d t State Lic. # : City Lic. #: Arch., Engr., Designer: Address: City, ST, Zip: t Telephone: _ aid � Construction,Type: Occupancy: State Lic. #: Projecf type (circle one):-, New Add'n Alter Repair Demo Name of Contact Person: � ` L Sq. ,Et.: #Stories: < # Units. Telephone # of Contact Person: t'D` :Estimated Value of Project:��� APPLICANT: DO'.NOT WRITE?BELOW•THIS LINE # Submittal Req'd Recd ` TRACKING... PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready.for corrections' a w Plan Check Deposit Truss Catcs: ,Called Contact Persona, Plan, Check Balance Energy Calcs. P1.lans picked up, " .. Construction Flood plain plan Plans resubmitted• : Mechanical Grading plan 2°" Review; ready for corrections/issue -. Electrical Subcontactor List Called ContactTerson Plumbing Grant Deed Plans picked up ; S.M.I. H.O.A. Approval Plans "resubmitted Grading; IN HOUSE:- ''" Review; ready for corrections/issue' Developer Impact Fee Planning Approval Called Contact Person Pub. Wks. Appr Date of permit issue School Fees A. Total Permit Fees V COACHELLA VALLEY' WATER DISTRICT CASH RECEIPT DUP& W 1.21174 Date.. -_!t d 700 Received Frc Address:' Account No. 6�70(04f tDc%O t(s) Tract S/ — �3- oLa� C G.A. Code Service AGMSS • meter(s) • Service(s) O Backftow(s) [I House Laterals) C3 Detector Check(s) 0 Meter Surcharge Dk-Sanitation Capacity Charge 0 W.S.BF.C. 0 S.I.W.S.C. 0 Temporary Construction Meter [3 Turn on Charge [3 Uncollected Account - Name 0 Inspection Fee-Tract- Fee ee-Tract-Fee - p Plan Check Fees Water / Sewer - Tract - b Bond Payment - A.D. - BondAs6ffd- 0 Customer Deposit 0 Other Remarks. *COPY tw. Cash Check Money Order 1-4-lq ff-alflw . ve�ifv C' C 3/99G TOTAL $ Water Cashier 4 www.hammerpumping.com 760/360-7448 7601321-7448 FAX 760/324-6434 Customer Name Address ity . _. _?',J Ph# rL(: Additional Service -❑ Required ❑ Recommended i Description/ Remarks/ Drawings r r' P.O. BOX 2448'- Cathed.pal Cit CA 92235-2448 - LIC# 6610181 JOB INVOICE f J08 DATE:'. i TIME IN: , ~ I TIME - TECHNICIAN•tl1 TECHNICIAN 02 HELPER)S) IIG I /c? 11%-0,n^ 11 ORDERED BY: ` P.O. W _ START DATE: K Y ` END DATE: JOB LOCATION ' SERVICE ❑ BACK UP ❑CONTRACT MAINTENANCE ❑ REPAIR ❑ MAINTENANCE ❑ ESTIMATE 9 CONSTRUCTION ❑ OTHER E COMMENTS ❑ Leach System Failing ❑ Roots ❑ Excessive sludge/grease SERVICE PUMPING PLUMBING ]SEPTIC ❑ SEWER LINE ❑ SEEPAGE PIT ❑ WATER MAIN ❑ GREASE ❑ TOILET / SINK ❑ DRYWELL ❑ SPRINKLER ❑'CA trH BASIN ❑ GAS ❑ OTHER ❑ Drain '; ❑ Other QTY SERVICE ii a OMPLETED CONSTRUCTION SERVICE ❑ Leach Line. ❑ Snake / Rooter ❑ Seepage Pit ❑ Hydro Jet ❑ Sewer, Hook-up ❑ Video Inspection ❑ Tank lstall ❑ C-42 ❑ Other ; ❑ Products /.Parts ❑ Leak Detection AMOUNT TOTAL /NEXT SERVICE Y f DUE ON ❑ Billing PAID BY:,, TOTAL AMOUNT DUE i %Z i ❑check# :redit Card -- MC !VISA # EXP.DATE FA charge of $20 will be due on all returned checks 8% per year will be charged on past due accounts. 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.} y r Sowed!