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05-4156 (PLBG)r, P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 T, &-t °F 4 Q" BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Application Number: \. 05-00004156 Property Address: --54325 AVENIDA JUAREZ APN: 774-232-015-4 -000000- Application description: PLUMBING o Property Zoning: COVE RESIDENTIAL Application valuation: 4717 p � p 161p05 Applicant: Architect or Engineer SP -------------------------------------------------- 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 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 7031.5 by a`n� applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: (X 1 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 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 contractors) licensed pursuant to the Contractors' State License Law.). I—) 1 am exempt under Sec. , B.&P.C. for this reason r _ CONSTRUCTION NDING AGENCY • I hereby affirm under penalty of perjury that there is a construc n lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.I. Lender's Name: Q Lender's Address: f LQPERMIT . Owner: PIERRE MONIQUE JEAN 54325 AVENIDA JUAREZ LA QUINTA, CA 92253 Contractor: Owner VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 9/16/05 ---------------------------------7------------- 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. 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' co sa on provisions of Section 00 of the Labor , 1 shall forthwith comply with tho pr ovis ns. licant: ` JWAING-FAILURE TO SECURE WORKERS' COMP SATION COVERAGE IS UNLAWFUL, AND SHALL N EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS 1$100,0001 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 pe'rmit 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 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 authoriz tatives of this.sa my=,gnature terabove-mentioned propert inspection purposes. Dat Applicant or Agent): Application Number . . . . . 05-00004156 Permit . . . PLUMBING SEWER Additional desc . . Permit Fee . . . . 30.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 4717. Expiration Date 3/15/06 Qty Unit Charge Per Extension BASE FEE 30.00 ---------------------------------------------------------------------------- Special Notes and Comments SEPTIC ABANDON;SEWER CONNECT 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 F. LQPERMIT - Bin # Permit # Project Address: A. P. Number: Legal Description: Contractor: X Address: ,City. ST. Zip: X .. Teleph : X tate Lic. # : X• Arch.. Engr.. Designer: Address: City, ST, Zip: Telephone: State Lic. #: Name of Contact Person: Telephone # of Contact Person: x # Submittal Req'd Plan Sets Structural Cales. Truss Calcs. Title 24 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 8t Safety Division . P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Owner's Name: X 1 Address: XAW5 4;4 City. ST. Zip: K Telephone: -- Project Description: -X City Lic. #: Total Permit Fees Construction Type: e: P Occupancy: P ancy. Project le one): type (circle rc Add' n Alter Repair Demo Sq. Ft.: # Stories: T_#Units: Estimated Value ol"Project: X . t) c> APPLICANT: DO NOT WRITE BELOW THIS LINE Rec'd TRACKING PERMIT FEES Plan Check submitted Item Amount Reviewed, ready for corrections Plan Check Deposit Called Contact Person Plan Check Balance Plans picked up Construction Plans resubmitted Mechanical 2nd Review, ready for corrections/issue Electrical Called Contact Person Plans picked up rGrading Plans resubmitted d'd Review, ready for corrections/issue Developer Impact Fee Called Contact Person A.I.P.P. Date of permit issue Total Permit Fees ACHELLA ALLEY WATER DISTRICT -CASH RECEIPT DETAIL t Received From• 17/0/2• N400:1`1014, glCopy to: Cash Check U f. .Money s Order r Water Service ��- Cashier Cww-438 (1/05) st �. Address: Account No: -Lat(s)- Service Address ❑ Meter(s) Service(s) ❑ BackNow(s) ❑ House Lateral(s)' ❑ Detector Check(s) ❑ Meter.Surcharge S Po'$anitation Capacity Charge 142 ❑ W.S`.BY.C. ❑ S.I.W.S.C. ❑ Temporary Construction Meter ❑ Turn on Charge ❑ Uncollected: Account -Name ❑ Inspection Fee - Tract - Fee - ❑ Plan Check Fees Water / Sewer - a • Tract- ❑ Bond Payment - A.D. - Bond Assmt ❑ Customer Deposit ❑ Other Ramarksc 1wr in A� ---- - - glCopy to: Cash Check U f. .Money s Order r Water Service ��- Cashier Cww-438 (1/05) st �. 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. ra 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 social security taxes, worker's _ .. compensation insurance, disabilityinsurance 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 FAX: (760) 777-7011 OWNER'S SI AT RE/DATE PROPERTY ADDRESS as- 4!/510 PERMIT NUMBER(S) HAMMER PUMPING INC. k.= ,:_ JOB_ INVOICE _ P.O. Box 2448 CATHEDRAL CITY, CALIFORNIA 92235-2448 earn ,iAn - SAAR - (760) 321- 7448 i7,6 -0-i-32-1-7,44-8 CUSTOMER'S ORDER NO. DAT RDERED -/4 _p�y OR ER TAKEN BY DAT PROMISED ❑ A.M. BILL TO ' PHONE 0/11 a [A 112- . Sean P;���e .ZS 0—Se- ADDRESS //� /} .. ` �� MECHANIC CITY HELPe JOB NAME AND LOCATION Q ❑ DAY WORK ❑CONTRACT ❑EXTRA DESCRIPTION OF WORK r df ( 000 Out of Area Fee QUANT. DESCRIPTION OF MATERIAL USED PRICE AMOUNT Gallons ' Pumping Fee per 1000 gal. 1 ?-S .ZS 0—Se- Dumping Fee per 1000 gal. Q 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 @ HELPERS Q TOTAL LABOR I hereby acknowledge the satisfactory completion the above described wofrr , TOTAL LABOR TAX SIGNATURE., DATE COMPLETED _ t0,1TOTAL �(V :.