04-7511 (PLBG)1 '
' , TA*t!t
BUILDING & SAFETY DEPARTMENT
P 0="B'o.X'u1SO4� (760).777-7012
OF9 78-495 CALLE TAMPICO' FAX. (760) 777-70,11'
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number . .
Property Address . . .
APN:
Application description
Property Zoning .
Application valuation
Owner
ATWOOD LEON A
P 0 BOX 1167
LA QUINTA CA 92253
04-00007511 ( Date 11/30/04
77255 CALLE NOGALES'
'773-311-001-26 -000000-
PLUMBING
COVE RESIDENTIAL
3000
Contractor
------------------------
OWNER
----------------------------------------------------------------------------
Permit . . . . . . PLUMBING SEWER
Additional desc
Permit Fee 30.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
3000
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
t
P.O. BOX 1504 �� VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 4INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number. J/ Date: U-30- 0
Applicant: 0
Applicant's Mailing Address:
Architect or Engineer:
Architect or Engineer's Address:
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
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. , BA P.C. for this reason
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
%ol 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.
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
construction and hereby authorize representatives of this county to enter upon the above-mentioned pr erty for inspection purposes.
Date � i ""`Signature (Applicant or Agent). __"
{
COACHELLA VALLEY WATER DISTRICT d 7
CASH RECEIPT DETAIL 10.5070 j
l
4; .; Af "'-I Date: fr'� '=-'r•. i ?/ �
Received From i
Address: e� ' .` •�;' , r' !,. , 0 i r %s` �' - i.
'
Account No. ' f car /. C: f Lot(s) Tract
Service Address f� j f z'a�
� r r >'.f �f". /t. ,`.�•r 1.. e. G.A. Code .
E
❑ Meter(s) , $
i
❑ Service(s) i
❑ Backflow(s)
. j
❑ House Lateral(s)
❑ DetectorCheck(s)
❑ Meter Surcharge i
P tanitation Capacity Charge ' `•� ` � �? f t f �•• ?
❑ W.S.B.F.C. i
❑ Temporary Construction Meter
❑ Turn on Charge l
❑ Uncollected Account - Name
❑ Inspection Fee - Tract -
Fee -�
❑ Plan Check Fees Water / Sewer -
Tract -
❑ Bond Payment - A.D. --Bond i
Assmt. {
❑ Customer Deposit j
❑ Other } i
TOTAL $ :+ f i ! • G',`.�
4.
Remarks:
ff6opy to:
Water Service
Cash ;.
Check
Money Cashier.
Order CVWD-438 (11/89)
HAMMER PUMPING INC.
P.O. Box 2448
CATHEDRAL CITY, CALIFORNIA 92235-2448
JOB INVOICE.
tioul 00V - I -vto
(760)321.-7448
CUSTOMER'S ORDER NO.
DATE ORDERED
Y �`.: C..) 7?
ORDER TAKEN BY
DATE PROMISED 17.1 A.M.
�; P.M.
BILL TO
PHONE
ADDRESS
ME MANIC
CITY ... . .......
LLPER
i.
DAY WORK
0 CONTRACT
DESCRIPTI N OF WORK
r -j EXTRA
7' ?
HAMMER PUMPING INC.
P.O. Box 2448
CATHEDRAL CITY, CALIFORNIA 92235-2448
JOB INVOICE.
tioul 00V - I -vto
(760)321.-7448
CUSTOMER'S ORDER NO.
DATE ORDERED
Y �`.: C..) 7?
ORDER TAKEN BY
DATE PROMISED 17.1 A.M.
�; P.M.
BILL TO
PHONE
ADDRESS
ME MANIC
CITY ... . .......
LLPER
JjQ (I NAME AN LOCATION C'.,
DAY WORK
0 CONTRACT
DESCRIPTI N OF WORK
r -j EXTRA
7' ?
QUANT.
DESCRIPTION OF IVIATERIAL- USED— 77777:
PRICE
AMOUNT
Pumping Fee per 1 000 gal.
Zl
Dumping Fee per 1000 gal.
. .......... ...... ..
......... .. .... .
Out of Area Fee
Locating Opening Fee (per hour) ......
Size System:
A SERVICE CHARGE OF $20 WILL' :9E--'.DLIE..::-.-.*-:
ON ALL RETURNED CHECKS.
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