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12-1399 (PLBG)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: / 12-,00001399 r Property Address: 52320 AVENIDA VELASCO APN: 773-265-004-4 -000000- Application description: PLUMBING Property Zoning: COVE RESIDENTIAL Application valuation: 1400 Applicant: Architect or Engineer: ( V A' ------------------ LICENSED CONTRACTOR'S DECLARATION BUILDING & SAFETY DEPARTMENT .' BUILDING PERMIT Owner: STADTHER RANDY 52320 AVENIDA VELASCO LA QUINTA, CA.92253 (760)564-3225 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: A, B, C8, 16, License No.: 793482 <_ Date: //,� ntr or - -BUILDER DECLARATION y 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 1, 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.). 1 _ ) I am exempt under Sec. , B.&P.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 ISec. 3097, Civ. C.). Lender's Name: - Lender's Address: LQPERMIT Contractor: SO CAL &ASSOCIATES P.O. BOX 940 YUCCA VALLEY, CA 922 (760)369-4104 LiC. No.: 793482 VOICE (760) 777-7012. FAX (760)-777-7011 INSPECTIONS (760) 777-7153 Date: = 11/30/12 ----------------- 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 haveandwill 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 EVEREST NATL Policy Number 7600007142121 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 Cod withthose provisions. Date:/Z_121-41plic WARNING: FAILURE TO ORKERS' 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. • 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 entejy'pn the abo� entioned w. Application Number•.. 12-00001399 Permit PLUMBING SEWER Additional desc " _- Permit Fee . . .30.00 Plan Check Fee -. .00 Issue Date. . . . . Valuation 1400 Expiration Date 5/29/13 Qty' Unit Charge Per Extension BASE FEE 15.00 1.00 15.0000 EA .PLB BUILDING SEWER 15.00 Special Notes and Comments SEPTIC ABANDONMENT.,/,SEWER HOOK UP ------------------------------------------------- Other Fees BLDG STDS.ADMIN (SB•1473), 1.00 Fee summary Charged _ -Paid Credited Due Permit Fee Total. 30.00', .00. .00 30.00 Plan_Check Total 00 00 .00 .00 Other Fee Total 1.00 .00- .00. 1.00 Grand Total. 31,0,0' ` . 00 . .00 ' 31.00 LQPERMIT : - - - ASA -P PUMPING, Inc. ern ens �ee� - ern err A�eG Uc 8042 855 851 Fax 760 365-4118.1-800-334-7255 P.O. Box 2318 • Cathedral City, CA 92235 asappumping@aol.com DATE ESCROW x BILL TO PHONE ADDRESS n20 144-2 FAX CITY TECHNICIAN JOB NAME ATqD LOCATION _ < DESCRIPTION OF WORK QUANT. 7DESCRIPTION OF SERVICES PRICE AMOUNT Pumping Fee per 1000 gal. Rooter Service Camera Labor $75/1-1R Septic Inspection Locating / Opening Fee $75/1-1 Jetting Service Out of Area Fee After Hours Fee Comments: SYSTEM FAILING' ❑YES ❑ NO ' A FAILING SYSTEM MAY FILL BACK UP WITHIN A FEW DAYS AND CONTINUE TO HA FUEL CHARGE $ 2 00 TOTAL MATERIALS TOTAL LABOR WA :Not responsible for seconds mage, chipped concr / / TAX TOTAL Bin.# C1ty of La Quinta Butift a Safety Division P.O. Box 1504,78-495 Calle Tampico ta.Qutnta, CA 92253 -:(760) 777-7012 Building Permit Application and Tracking Sheet Permit # \� Project Address: Owner's Name:. A. P. Number. Address: Legal Description: Contractor: © City, ST, Zip: Telephone: Address: , Project Description: City, ST, Zip:Vw Telephone: State Lic. # : City Lic. M. Arch., Engr., Designer. Address: City., ST, Zip: Telephone: ' ' Construction Type:. Occupancy:- ccupancy:State Lic. #:� State.:.,w�%»,r- ' Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person: Sq. Ft.:#Stories: # Units Telephone # of Contact Person: Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'd TRACMG PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cala. Reviewed, ready for corrections Plan Check Deposit. . Truss Cates. Called Contact Person Plan Check Balance Title 24 Cates. Plans picked up Construction Flood plain plan Plans resubmitted.'. Mechanical Grading plan 2u Review, ready for correctionsfrssue Electrical Subeontaetor List Called Contact Person Pfumblag Grant Deed Plans picked up S.M.L H.O.A. Approval Plans resubmitted Grading IN HOUSE:- 7i° Review; ready for correctionsfissue Developer Impact Fee Planning Approval. Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees