04-6002 (PLBG)t
0``
BUILDING & SAFETY DEPARTMENT
c ti'w� -�,..P.:O: BOX 1504 (760).777-7012
CO) F' '9 78 495, CALLE TAMPICO FAX (760) 777-7011
iQU,I,NTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
of
Ap�1Fie§?t on Number 04-0000`6002 Date 8/23/04
Property Address . . . . . . 52332 AVENIDA JUAREZ '•.'�
APN: 773 -251 -024 -2.0 -000000 -
Application description PLUMBING
Property Zoning . . . . COVE RESIDENTIAL
Application valuation . . . . 4000
Owner Contractor
NANCY SUGAR - SO CAL PLUMBING & REPIPE CO z
52332 AVENIDA JUAREZ P.O. BOX 955
LA QUINTA CA 92253 YUCCA VALLEY CA 92286
(760) 369-4104
WCC: EXEMPT
WC: EXEMPT 11/20/04
CSLB: '793482 04/30/05•
CCC: B -C36 t
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Permit. . . . . . . PLUMBING SEWER
Additional desc
Permit Fee -- —30.00 Plan Check Fee .00.
Issue Date . . . . Valuation . . . . 4000
Qty Unit.Charge Per Extension
BASE FEE ,30.00
-
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Special Notes and Comments
SEPTIC ABANDON; SEWER•CONNECTION
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 .0.0 .00 30.00
P.O. BOX 1504
VOICE (760) 777-7012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: ext- 600 0, Date:
Applicant: I Architect or Engineer:
Applicant's Mailing Address:
Architect or Engineer's Address:
A) M
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
Lode , and my Lic a is i ful rce an &�
License Class License No.
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I amexempt 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 ($500).):
U I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044,
Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work
himself or herself or through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is
sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.).
U I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors'
State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to
the Contractors' State License Law.).
(_,) I am exempt under Sec. BA P.C. for this reason
Date
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
_.I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance
of the work for which this permit is issued.
,$„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 ins a carrier and policy number are:
ar r icy Number
I certify that, in the performance of the work for which this 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.
ppint
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
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 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
const
ruction, resentatives of this county to enter u o the aboue roperfy for inspection purposes.
Date (Applicant or
Received From: '..-ii G.,
Address:
Account No.
Service Address
0 Meter(s)
• Service(s)
• Backflow(s)
0 House Lateral(s)
• bet ector Check(s)
• Meter Surcharge
Sanitation Capacity Charge
0 W.S.B.F.C.
0 Temporary Construction Meter
0 Turn on Charge
0 Uncollected Account - Name
0 Inspection Fee - Tract -
Fee -
0 Plan Check Fees Water / Sewer -
Tract -
0 Bond Payment - A.D. --Bond
Assmt.
0 Customer Deposit
0 Other—
Remarks: y' , ^:
c1dopy to:
COACHEL-1A VALLEYA'ATER DISTRICT
CASH RECEIPT DETAIL
Eli
lk
skJ S
I
10 3 4' - G
Date:--.
-ot(s)
Tract—
Order
G.A. Code
TOTAL $
Cash
Check
Money
Order
Water Service' ---
Cashier
CVWD - 438 (11189)
HAMMER PUMPING INC. JOB INVOICE
P.O. Box 2448
CATHEDRAL CITY, CALIFORNIA 92235-2448
f 7nn) QRn _ 7AAR
(760) 321.7448
CUSTOMER'S ORDER N0.
=RED _—
ORDER TAKEN BY
DATE PROMISED ❑ .M.
❑ P.M.
BILL TO � � � �
PHONE
ADDRESS
CITY
M ANI
ELPER
OB N A OCATION
JF-2:3c
❑ DAY WORK
CRIPTION WOR
❑ CONTRACT
❑ EXTRA
QUANT.
DESCRIPTION OF MATERIAL USED
PRICE
AMOUNT
Gallons
_®O_
Pumping Fee per 1000 gal.
a��
Lo Z)
crz
4-he-1yo
Dumping Fee per 1000 gal.
Out of Area Fee
Locating / Opening Fee (per hour)
Size System:
A SERVICE CHARGE OF $20 WILL BE DUE
ON ALL RETURNED CHECKS.
18% PER YEAR WILL BE CHARGED ON
PAST DUE ACCOUNTS OVER 30 DAYS.
HOURS
LABOR AMOUNT
TOTAL
MATERIALS
MECHANICS Q
HELPERS @
TOTAL
LABOR
I hereby ackno a satisfactory 161 LABOR
comp o the above descri
SI RE D TE COMPLETED
TAX
TOTAL