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05-4729 (PLBG)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: I)5-00004-729' Property Address: 78198 CALLE APN: 770 -011 -009 - Application description: PLUMBING Property Zoning: LOW DENSITY Application valuation: 500 Applicant NORTE RESIDENTIA] Architect or T,it�t 4 4 Q" BUILDING & SAFETY DEPARTMENT BUILDING PERMIT 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: C36 / License No.: 828264 �6ate;�f� Contractorf 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 any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: (_ 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 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. , BAP.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: LQPERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 10/20/05 Owner: WILLIAMSON ELAINE 78198 CALLE NORTE LA QUINTA, CA 92253 Contractor: FOY, SCOTT A. 79-499 COUNTRY CLUB DR STE 9. INDIO, CA 92201 (760)360-0927 Lic. No.: 828264 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 STATE FUND I- Policy Number 1576840 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, !)call forthwith comply with those provisions. pplicant: WARNING: FAILURE TO SECURE WORKE�COMPENSATIONCOVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application. 1. Each person upon whose behalf this application is made, each person at whose request,and for whose benefit work is performed under or pursuant to any permit issued as a result of this application, the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county nter upon the above-mentioned pronectoor inspection purposes. Date:WSignature (Applicant or Agent): . LQPERMIT Application Number . . . . . 05-00004729 Permit PLUMBING Additional desc . Permit 'Fee. 22.50. Plan Check Fee_ .00 ; Issue Date Valuation 0 Expiration Date'.,. 4/18/06 Qty Unit Charge Per. Extension BASE FEE •15.00 1.00 7.5000 EA.. PLB WATER HEATER/VENT 7.50 -- - - - - - - - - -- -------------- Special Notes and Comments ----------------- ------ --------------- WATER HEATER CHANGE -OUT Fee summary Charged Paid Credited Due Permit Fee.Total 22.50 --- .00 ----- .00. 22.50 Plan Check Total. .00 .00 .00 .00 Grand Total 22.50 i .00- .00 22.50 LQPERMIT Bin # . Permit # Project Address- �$ Cjy ` A. P. Number. -7 .Legal •Description: " Contractor: Address: Cit}, Sr; zip: Telephone: ��O �OrIZI State Lic. # rity h., Eitge, Designer:dress: , ST, Zip: Telephone: State Lic. #• Name of Contact Person: Telephone # of Contact Person: # Submittal Plan Sets Structural Calcs. Truss •Calcs. Title 24 Calcs: Flood plain -plan Grading plan Subcontactor List Grant Deed H.O.A. Approval IN IIOUSE:- - Planning Approval Pub.1N'ks. Appr School Fees Lic. #: 57q 1 O Total Permit Construction Type.. Occ uP aric • ct Project Je t}P e (ci rc le one):. New Add'n Alter Re air Demo mo Sq. Ft.: - # Stories: #Units;. Estimated Value of Project: S APPLICANT: DO NOT WRITE BELOW THIS LINE Rec'd TRACKING PERMIT FEES Plan Check submitted - Item Amount Reviewed, read}' for corrections Plan Check Deposii Called Contact Person Plan Check Balance Plans picked up Construction Plans resubmitted 1ltechanical 2'' Review, read} for corrections/issue Electrical Called Contact Person Plumbing Plans picked up . S.l•1.I. _. Plans resubmitted Grading Jr° Review, ready for corrections/issue Developer Impact Fee ' Called Contact Person . A.I.P.P. Date of permit issue Total Permit DETAIL STARTS HERE j FAX PURCHASE ORDERS nate: 10/13/2,30! FROM: THE HOME DEPOT Page: 2 STORE 6630: LA QUINTA FA?: (700) 775-26$7 79900 HIGHWAY 111 PHONE: 76 0)347-8722 Ext. 382 LA QUINI'A, CA 92253 this number toil nvOce --,----------------= The Nome Depot) P.O. Nbr 30455296=-==-, For Customer: WILLIAMSON, Er•z�t�,y====== 293-867 WATER HEATER INSTALLATION INSTALLATION SITE: WILLIAMSON, ELAINE 78-198 CALLS NORTE PHONE: (7�a) 777-96d17 Ext. LA QUINTA, CA 92253 CUSTOMER NAME: ELAINE WILLIAMSON TR1 Y CFi�1RGE : $0.01 PHONE: (760) 777-9647 WORK ORDER: 7.75684 REP #: I04 Ext No merchandise selected. MERCHANDISE WILL ARRIVE AT SITE VIA THE FOLLOWING: WATER HEATER INSTALLATION OPTIONAL LABOR PURCHASED: 15 ..PERMIT AS REQUIRED (SEE PRICE LIST) LA QUINTA Quantity: 1.00 UM: EA Price Ea.. $22.00 Extension: $22.00 INSTALLATION LABOR SUBTOTAL - $22.00 TC A ___ ___ A7_A. r �+7 +.1tJ1 -L Li�l 1 VLV l.l=Ai%Vi� TOTAL: : --'- ------ $22.00 $22.00 0000220n ------=---=--=-�__=__-�---�---==End -- P.O --,� . 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