04-5271 (PLBG)P.O. BOx 1504
78;495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING PERMIT
B{IILDING & SAFETY DEPARTMENT
(760).7 77-7012
FAX (760) 777-7011
INSPECTION REQUESTS (760) 777-7153
Application Number . . . . . 'f 04 60:005271 Date 6/30/•04
Property.Address . . . . . .t "53605 AVENIDA CORTEZ
APN: 774-10.1-004-4 -000000-
Application description -PLUMBING
Property Zoning COVE RESIDENTIAL
Application valuation 2-350
Owner Contractor
MACMILLAN RICHARD H ALMS UNDERGROUND CONST,INC..
53605 AVENIDA CORTEZ 38703 VISTA DRIVE
LA QUINTA- CA 92253 CATHEDRAL CITY CA 92234
WCC:" VIRGINIA INC
WC: 0050.001.6007 01/01/05
CSLB: 482180 11/"30/05
CCC C42 -C2.1
Permit . . PLUMBING SEWER
Additional desc .
Permit Fee . . . . 30.00 Plan Check Fee .00
Issue Date Valuation- 2350
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 .010 .0-0 .0'.0
Grand Total 30.00 .010 :00 30.00
1"M U
JUN 0 2004 icI
D117
PP^1K :s
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P.O. Box 1504 VOICE (760) 777-7012
78.495 CALLE- TAMPICO QlArej FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (7.60) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: 41— 'C -Z-21 Date: 61 -3a
Applicant:
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 700 0) otDivision 3 of the Business and.,Professionals•
Code, and my license is•in full.force Bnd effect. /
4 2 I
Lkaeirse Clas'; -1 �i �- L'icensseNo. /J
-BUII�ER DECLARATION
l,herebyOnn under penalty of perjury tint 1 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 c onsbx cl, alter, improve. demolish, or repair any dr ucture„ prior to Its Issuance. also requires the applicaMJor the permit to file a signed
statement that he or she Is kensed.Pursuant to the provisions of the Contractors' SfaEa 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. Jany 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).y
U 1, 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 (Ser -7044.
Business and Professions Code. The Contractors' State License Law does not apply10 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. K however the buiking ornrprovement is
sold within one year of completion, the owner -buckler will have the burden of proving that he or 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 thepmject(Sea 7044. Business and Profession 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) licenced pursuant to
the Contractors' Sloe License Law.).
U I am exempt under See. • , BA P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
1 hereby affirm under penalty of.pedury one of the following declarations:
—I have and will maintain a certificate of consent to sellinaure for workers' compensation, as.provided for by Section A700 of the Labor,Code. for ft periormance
of the work for which this pennitis 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 tlds permit is
i issued. My 'compensation insurance,csr ierand porky number are:
center � L/► r19 i v, o. S.. rte PolieyNumber
—I o*ft that. in the perromrence of the -work for which grin permit is issued. I shall not empioy any person In any manner so as to become subject io the workers'
compensation laws of California, and agree.thaf, If I should. become subject to the workers' compensation provisions of Section' 3700,of the Labor Code. I shall
forthwith comply with those provision.
Da012_,7 t h -c. Z O D�_ Applicant acs
WARNING: FAILURE TO SECURE,WORKERS'COMPENSATa COVERAGE'IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLL,4RS ($'1O0,000),:IN ADDITION TO THE COST OF COMPENSATION,,DAMAGES AS PROVIDED, FOR IN .
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
CONSTRUCTION
LADING AGENCY
thereby under penalty of perjury dudt ore is a construction tend lending for the
y
performance of the work for wvhrldr this permit is issued (Sec. 3097. Civ. C:).
Lender's Name
Lender's Address
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a penrritsubject to the conditions and restrictions set forth on Oft application.
1. Each person upon whose behalf this application is made, each person at.whose request and for whose benetit.work in perfomred under or pursuant to any permit
issued as a result of this application, the owner, and the applicant; eachegrees to, and shall, defend, lndernnify:and hold harmless the Ctty of La Qunta, Its
officers, agents and employees,for any act or omission„related to the work being performed under or following issuance of this pemdt
2. Any permit issued as a result of this application becomes null and void 9 work is not commenced within 180 days from data of issuance of such permit, or
cessation of work for 160 days will subject permit to:cancellation.
I certify that t have readthis application and state that the above Information is coned I agree to comply with all city county ordinances and state laws relating to building
construction. and hereby authorize, representatives of this county to enter upon bove-me"Itionw ' for inspection purposes.
Date .TuH a ZOo Signature (Applicant or errf): ' 7-vr.o�
�— Ag
Address: V,!
Account No. Lot//s)
Service Address
❑ Meter(s)
O Service(s)
❑ Backtiow(s)
❑ House Lateral(s)
❑ DetectorCheck(s)
❑ Meter Surcharge
Oanitation Capacity. Chargers S
❑ WS.S.F.C.
❑ Temporary Construction Meter
❑ Turn on Charge.
❑ Uncollected Account- Name
❑ Inspection Fee - Tract -
Fee -
❑ Plan'Check Fees Water Sewer -
Tract -
❑ Bond Payment - A.D. -_Bond
Asamt
❑ Customer Deposit
❑ Other
• Remarks:
e±
t�op:
y to
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'
i
Cash
Check
Money
1
I Order
•WaterServi
r 9 Caattier
CVWD-438 (11188)
�12
HAMMER PUMPING INC. JOB INVOICE
P:O. Box 2448 r
CATHEDRAL CITY, CALIFORNIA 92235-2448
rant zan _ 7ddn
" -
i7'60)321-7448
CUSTOMER'S%ORDER'NO.,
DATE ORDERED
_ O r
ORDER TAKEN, BY
DATE PROMISED ❑ A.M.
_CI P.M.
.BILL TO
^/j
-
PHONE
.ADDRESS
MECHANIC`''' r
r
�7
CITY
,-
ELPERU
JOB'NAME AND LOCATION
V VV
O DAV WORK
I SCRIPTION OF WORK"
00(9 _r 1L-1 r�- i�1r-�
O CONTRACT
O EXTRA -
p
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G- ""a
DANT.
DESCRIPTION OF MATERIAL USED
PRICE.
AMOUNT
' ;6
-Gallons
Pumping Fee per 1.000 gal.
t� �)
Dumping'Fee per 1000 gal.
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 ®
TOTAL
LABOR
I hereby acknowledge the satisfactory TOTAL LABOR
complebon of the above described work:
TAX
SIGNATURE
�`r' i
1:2 7 ! /'r i
DATECOMPLETED
Y1 r ' '
TOTAL