05-1156 (PLBG)I
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BUILDING & SAFETY DEPARTMENT
OX 1504 (760).777-7012
i CALLE TAMPICO FAX (760) 777-7011
INTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
y � er 05=,0010-0-1"15.6:-- � Date
Pro'-• � Address . . . . . .53'5-85 VA ENIDA JUAREZ
774-103-016-4 -000000-
Application description . . . PLUMBING
Property Zoning . . . . COVE RESIDENTIAL
Application valuation . . . . 300
Owner Contractor'
------------------------ ------------------------
FIELD RICHARD L OWNER
53YP AVENIDA JUAREZ
LA QUINTA CA 92253
3/25/05
-
------------------------------------------
Permit . . . . PLUMBING SEWER
------------
------
---------------
Additional desc
Permit Fee . . . . 30.00
P1an*Check
Fee
.00
Issue Date '.
Valuation
. . .
. 300
Qty Unit Charge Per
Extension
BASE FEE
----------------------------------------------------------------------------
30.00
Special Notes and Comments
SEWER CONNECT/SEPTIC ABANDONEMENT
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
r
P.O. BOX 1504 � VOICE (760) 777-7012
78-495 CALLS TAh1PICD FAX (760)� 777-7t)I I' -
LA QutNTA, CALIFORNIA 92253 INSPECTIONS (760) 777-71-53
BUILDING & SAFETY DEPARTMENT
Application Number: Date: Z "�
Applicant: Owilen I
Architect or Engineer:
Applicant's Mailing Address:
Architect or Engineer's Address:
Lic. No.:
tfUIL UINU rtKMIT 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 Class License No.
Date 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).):
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.).
U I am exempt under Sec. -A,1, P.C. for this reason
Dat-_ '��j _o �j 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:
Carrier Policy 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 thos provisions.
Date ` O � E aplicant.,
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.
ENCY
I hereby affirm under penalty of perjury that there is a construction lending lfor ON
g age cythe peDrformanING C�ce of he work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name
Lender's Address
ACKNOWLEDGEMENTAPPLICANT
IMPORTANT Application is hereby made to the Director of Building and Safety for permit
subject to he 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 Ouinta, 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 coun to enter upon the above-mentioned property for inspection purposes.
rlDate 3" ���0 1 Signature (Applicant or Agent): ��a?
COACHELLA VALLEY WATER DISTRICT CASH RECEIPT DETAIL
N40W '107331
Received From: t� C(11`i` % i�/ Date:
S' 5 l v t=�� a
Address: ida, �- •,�• ,�
AccountNo. �� �' Lot s) Tract ;
i
Service Address . ~ .• , �'/'� r �� Ll tyt' , .-.� ----:- G.A. Code
❑ Meter(s)
❑ Service(s)
❑ House Lateral(s) ~
❑ Detector Check(s)
❑ Meter Surcharge _
�anitat'ion Capacity Charge G�
❑. W.S.B.F.C.
❑ S9.W.S.C.
❑ Temporary Construction Meter n
❑ Tum on Charge
❑ Uncollected Account - Name
❑ Inspection Fee - Tract -
Fee -
❑ Plan Check Fees Water / Sewer -
Tract -
❑ Bond Payment - A: D. - Bond Assmt
❑ Customer Deposit
❑ Other L
TOTAL $ �? � � � � �J' ,
Remarks: �'�� � � L
y► copy to: ' tlJ1
Cash Water Service +
Check�1t'
Money ; l ;v ;y Cashier
Order s ''? i " CVWD-439 (t/OS)
VALLEY WIDE PUMPING SERVICE JOB INVOICE
"Your Waste Is Our Problem" 09648
100 S. Sunrise Way SUIte 133
- PALM SPRINGS, CA 92262--
(760) 322-2400 (760) 347-3545
CUSTOMER'S ORDER NO.
DATE ORDERED
ORDER TAKEN BY
DATE PROMISED O A.M.
❑ P.M.
BILL TO _
!
PHONE
ADDRESS�t
Pumping Fee per 1000 gal.
CITY
E P
JOWNAME AND LOCATION
� -
0 DAY WORK
❑ CONTRACT
O EXTRA
DESCRIPTION OF WORK
Dumping Fee per 1000 gal.
5
QUANT.
DESCRIPTION OFMATERIALUSED
PRICE
Gallons f
/AMOUNT
Pumping Fee per 1000 gal.
Dumping Fee per 1000 gal.
Out of Area Fee
Locating / Opening Fee (per hour)
Size System: A 121�1
/
A SERVICE CHARGE OF $20 WILL BE DUE
ON ALL RETURNED CHECKS.
A FINANCE CHARGE OF 11/2% PER MONTH, 18% PER YEAR
WILL BE CHARGED ON PAST DUE ACCOUNTS OVER 30 DAYS.
HOURS
LABOR _
AMOUNT
TOTAL
MATERIALS
MECHANICS @
TOTAL
LABOR
HELPERS @
I hereby acknowledge the satisfactory
completion of the above described work:
TOTAL LABOR
TAX
SIGNATURE
DATE COMPLETED
TOTAL
%i
d
To Reorder Call NESS CUST&M-printing service TOLL FREE 1-800-888.6327 NEBS, Inc., Peterborough, NH 03458. _n Ref. No: G 710703566
NOTICE :TO OWNER
Under the California Mechanics Lien, Law any contractor, subcontractor, laborer, supplier
or other person who'helps'to improve your property, but Is not paid for his/her work or
supplies, has a right to enforce a claim against your property. This means that after a court
hearing, your property could be sold by a-dourt officer and the proceeds of'Yhe sale used to
satisfy the indebtedness. This can happen even If you have paid your contractor in full If the
subcontractors, laborers or suppliers remain unpaid.
To preserve their right to file a claim'or lien against your property, certain ciaimanfs such
as subcontractors or material suppliers are required to provide you with a document entitled
"Preliminary Notice." Original (or prime) contractors and laborers for wages do not have to
provide this notice. A Preliminary Notice is not a lien against your property. its purpose is to
notify you of persons who may have a right to file a lien against your property if they are not
paid. Generally, the maximum time allowed for filing a claim or lien against your property is
ninety (90) Days after completion of your project.
TO INSURE EXTRA PROTECTION FOR YOURSELF AND YOUR PROPERTY,
YOU MAY WISH TO TAKE ONE OR MORE OF THE FOLLOWING STEPS:
1) Require that payments be made directly to subcontractors and material suppliers through
a joint control. Any joint control agreement should include the addendum approved by the
Registrar of Contractors.
S.
2) Issue joint checks for payment, made out to both your contractor and subcontractors or
material suppliers involved in the project,This will help to.insure that all persons due payment
are actually paid.
3) After UPON making payment on any completed phase of the project, and before making
any further payments, require your contractor to provide you with unconditional lien releases
signed by each material supplier, subcontractor and laborer involved in that portion of the
work for which payment was made. -On projects involving improvements -to a single family
residence or a duplex owned by individuals, the persons signing these releases lose the right
to file a claim against your property. in other types of construction this protection may still be
important, but may not be as complete. TO PROTECT YOURSELF UNDER THIS OPTION YOU
MUST BE CERTAIN THAT ALL MATERIAL SUPPLIERS, SUBCONTRACTORS OR LABORERS
HAVE SIGNED.
OWNER/BUILDER INFORMATION
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified.
For your protection you should be aware that as "Owner/Builder" you are the responsible party of record on such a
permit. Building permits are not required to be signed by property owners unless they are personally performing their
own work. If your work is being performed by someone other than yourself, you may protect yourself from possible
liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a business license
from the City or County. They are also required by law to put their license number on all permits for which they
apply.
If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be
aware of the following information for your benefit and protection:
If you employ or otherwise engage any persons other than your immediate family, and the work (including materials
and other costs) is $200.00 or more for the entire project, and such persons are not licensed as contractors or
subcontractors, then you may be an employer.
If you are an employer, you must register with the State and Federal Government as an employer and you are subject
to several obligations include State and Federal income tax withholding, federal sociial security taxes, worker's
compensation insurance, disability insurance costs and unemployment compensation contributions.
There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with
respect to worker's compensation insurance.
For more specific information about your obligations under Federal Law, contact the Internal Revenue Service (and, if
you wish, the U.S. Small Business Administration). For more specific information about your obligations under State
Law, contact the Department of Benefit Payments and the Division of Industrial Accidents.
If the structure is intended for sale, property owners who are not licensed contracts are allowed to perform their
work personally or through their own employees, without a licensed contractor or subcontractor, only under limited
conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an "Owner/Builder" building
permit, erroneously implying that the property owner is providing his or her own labor and material personally.
Building permits are not required to be signed by property owners unless they are performing their own work
personally.
Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your
community or at 1020 N. Street, Sacramento, California 95814.
Please complete and return the enclosed owner -builder verification form so that we can confirm that you are aware of
these matters., -The building permit.will not be issued until.the verification is. returned.
Very truly yours,
CITY OF LA QUINTA
DEPT. OF BUILDING AND SAFETY_
78-495 Calle Tampico
La Quinta, CA 92253
(760) 777-7012
60) 777-7011
O ER'S SIGNATURE/DATE
PROPERTY ADDRESS
PERMIT NUMBER(S)