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05-3609 (PLBG)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA .92253 Application Number: Property Address: APN: Application description: Property Zoning: Application valuation: Applicant: 05-00003609 54100. AVENIDA CORTEZ 774-192-005-20 -00.0.000- PLUMBING COVE RESIDENTIAL 2500 T419 � 4 XP Q" Architect or Engineer: ------------------ LICENSED CONTRACTOR'S DECLARATION BUILDING & SAFETY DEPARTMENT BUILDING PERMIT AUG 121005 I hereby affirm under penalty of perjury that I'am licensed under provisions of Chapter 9 (commancing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License Class: C36 -C -B : 793482 n e Date: -'a Co r. OWNER -BUILDER DECLARATION I hereby affirm under penalty' of perjury that 1 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 0 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 Lew (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 (8600).: 1—) I, as owner ofthe property, ormy employeeswith wages as their sole compensations 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 era not intended or offered for sale. If, however, the, building or improvemert.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.). (_) I, as owner ofi.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, aril who contracts_ for the projects with a,contractor(s) licensed pursuant to the Contractors' State License Law.). (_ ► I am exempt.under Sec. B.6P.C. for this reason Date: Owner: CONSTRUCTION LENDING AGENCY 1 hereby affirm under penalty of�perjury that there is a construction lending agency forthe.performance of the work for which this permit is issued (Sec. 3097, Civ. C:). Lender's Name: _ Lender's Address: LQPERMIT Owner: CORDOVA FRED T 17302 GIBSON CIR HUNTINGTON BEACH, CA 92647 Contractor: SO CAL PLUMBING & REPIPE CO P.O. BOX 955 YUCCA VAL-LEY, CA 92286 (760)369-4104 Lic. No.: 793482 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 8/12/05 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-lnsure for workers' compensation, a's provided for by Section 3700 of the Labor Code, for the performance of the work for which this permlt.is issued. I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code,.forthe performance of the work for which.this permit:is issued. My workers' compensation insurance carrier -and policy number are: Carrier EXEMPT Policy Number EXEMPT 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.su6jectto the workers' compensation laws of California, and agree that, if, I should become subject to the workers' compensation provisions of Section 37�bor Code, I shall forthwith Com I witht Provisions. Dater plica WARNING: FAILURE TO CO TION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINE&LIP 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 acid 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 parmlttissued 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 Quints, its officals, agents and employees for any actor 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.cessetion of work for 180 days will subject permit to cancellation. 1 certify that 1 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 40"`T a above-mentioned property for inspection purposes. Date: Signature (Ap t o 9 Application Number 05-00003609 } Permit. . . . . PLUMBING SEWER Additionaldesc . . Permit Fee' 30.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 2500 Expiration Date . . 2/08/06 Qty Unit Charge Per Extension BASE FEE 30.00 ----------------------------------------------------- Special Notes and Comments SEWER HOOKUP/SEPTIC ABANDONMENT Fee summary Charged Paid Credited Due -------- ---------- ---------- Permit Fee Total 30.00 ---------- ---------- .00 .00 30.00 Plan Check Total .00 .00 .00 .00 Grand Total 3.0.00 .00 .00 30.00 LQPEMff 0:26m Fred/Belen Cordova 714.34!-8929 P.3 CoAci-ii:i,LAvAi.ii'YwAY�-f4f)IF,TnlCr,T ASH nECEIPT DETAIL ��~'�� ~* v Receivod Dais Armuni Na.-___-__-___-|nw' �x~=oau*^�"��V��"�_-��&�� '----_� ��__ u oowicv(u) // mvvw�w�) -'---_-_-�~---- ---- --------'------ ---- u *vuo*�m*�v^_~ U nmo*or C^*flk(nj -' -_ �'__--~~ -------'�-----' -------------' u MvtufsuFmnirgw--_--_. us.I.vxac.-- __- --_�_..-----�- ------------- --------------- ---'--_---_-^ C.1 mmpwmryo.)nmwc./vnwww-'-. u Turn an ' � � -' ---------r-� Ct UncollociodAccount unnmw*ou/^cvvm m�nw_--__--_----_~~^.-_-' -- -------------� --- �—'----'� I,'.; In^pwmwnmw-n*w-_-'---' --�' -'----� m* _�._'--~- ---------- �' 1.1 Plan planCheck rjumvmuv /Sow^ --------__- ' ---'-- -------- � .~~ n onnuppv*vn ~kp -__~. nCustomor Dopouit ��--�- --�-- -----� '' ~^^^----' ~�-- - --------r----' -~�-----------� mOrxL. * nvmu^u. *+~uo*xm: Caflh Wator Sowicu Ch*Ck 4- C*wo,.~~_--_------ C,ww*30(v06), � .