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06-0897 (PLBG)!'q P.O. BOX 1504 78-495 CALLS TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 06 -00000897' - Property Address: 79785 OLYMPIA FIELDS APN: 775-152-045- - Application description: PLUMBING Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 600 = Applicant: Architect or Engineer: IPw Me w ARTMENT 11T Owner: HOVEN JOHN P/CHERYL TRUST 3504 POINSETTIA'AVE MANHATTAN BEACH, CA 90266 Contractor: EDWARDS CONSTRUCTION, BOB 51455 DESERT CLUB DRIVE. LA QUINTA, CA 92253 (760)777-8202 Lic. No.: 684857 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 3/06/06 LICENSED CONTRACTOR'S DECLARATION ----------------------------— WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations: Section 00 of Division 3 of tb u 'nes and a sionals Code, 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 Lice a las B \ Licen a No.: - 684 857 _ for by Section 3700 of the Labor Code, for the performance of the work for which this permit is Date• % ` � V-ntractor: v \, 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 OWNER -BUILDER DECLARATION insurance carrier and policy number are: I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier CA INS Policy Number 460023330102 following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to _ I certify that, in the performance of the work for which this permit is issued, I shall not employ any construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the nners to become subject t he -workers' compensation laws of California, per>ag.re.ha permit to file a signed statement that he or she is.licensed pursuant to the provisions of the Contractor's State andI sho Id eco a subj o th workers' compensation rovisions of Section License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or .37r Co a sha f comp w'th those provisions 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 1$500).: 1 _ I 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 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND and who does the work himself or herself through his or her own employees, provided that the DOLLARS 1$100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. 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.l. (_) 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: ki too, LQPERMIT 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 Quints, 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 stategatteinfornonis correct. 1 agree to comply with all city and c n ordinances and state laws relatingn, a d hereby authorize presentativesof this t to enter upon the above-mentioned p roses. ate: Si ure (Applicant or Agen Application Number 06-00000897 Permit PLUMBING Additional desc . Permit Fee \ 18.00 Plan Check Fee .. Issue Date Valuation' .4.50 0, Expiration Date 9/02/06 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS 3.00 ----- - Special Notes and Comments ---------------------------------------- RELOCATE & SLEEVE 1/2" EXISTING GAS LINE TO NEW LOCATION Fee summary Charged Paid Credited Due c----------------- ------- ---------- ------- --- ----- Permit.Fee Total 18.00 .00 .00 18.00 Plan Check Total 4.50 .00 .00 4.50 Grand Total 22.50 .00 .00 22.50 Bin # Permit #a� Project Address: A. P. Number: Contractor: Address: City, ST, Zip: Telephone: State Lie. # Arch., Engr., Designer: Address: City, -ST, Zip: Telephone: ` State Lie. #: Name of Contact Person: Telephone # of Contact Person: # Submittal R Plan Sets Structural Calcs. Truss Calcs. Energy Calcs. Flood plain plan Grading.plan` Subcontactor List Grant Deed H.O.A. Approval IN HOUSE: - Planning Approval Pub. Wks. Appr School Fees City of. La Quinta Building U Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet l��Ir Owner's Name: Address: City, ST, Zip: L Telephone: Project Description: r Total PermE. Fees Construction Type: Occupancy: Project type (circle one): New Add'n Alter Repair . Demo Sq. Ft: # Stories: # Units: - 'Estimated- Value of Project: 1 APPLICANT: DO NOT WRITE BELOW THIS LINE Rec'd TRACKING. Plan.Check submitted PERMIT FEES Item Amount Reviewed; ready for corrections Plan Check Deposit Plan Check 3alance Called Contact Person Plaits picked up Construction Plans resubmitted Mechanical 2°" Review, ready for correctionsrissue Electrical Called Contact Person Plumbing 'Plans picked up S.M.I. Plans resubmitted Grading Review, ready for correctionsrssue Developer Impact Fee Called Contact Person Date of permit issue A.I.P.P. Total PermE. Fees Laz r, to t f- tw--- •� t ,-. . .. .. �: � . ..r ; � r - , .; U �� ..