06-1423 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
06-00001423
Property Address:
52719 AVENIDA VELASCO
APN:
773-294-024-11 -000000-
Application description:
PLUMBING
Property Zoning:
COVE RESIDENTIAL-
ESIDENTIAL-Application
Applicationvaluation:
3800
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Applicant: Architect or Engineer:
----------------------------------------------i
UCENSED ONTRACTOR'S DECLARATION
hereby affirm under penalty of per' that m lic nsed under provisions of Chapter' 9 (commencing with
Section 7000) of Division 3 of t Business a d P siona Code, and my License is in full force and effect.
License Cl4ss: C42 L ense No.: 661018
.
oat -A -116h oat—A—r ctor•
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 cityor 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 ($5001.:
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 '
f Contractors' State License Law does not apply to an owner of property who builds or improves thereon, r
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
i. 'improve for the purpose of sale.).
1 _ 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
C - 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 (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQPERMIT
Owner:
MITCHELL BRENDA
52719 AVENIDA VELASCO
LA QUINTA, CA 92253
Contractor:
HAMMER PUMPING INC
P O BOX 2448
CATHEDRAL CT,'T'Y, CA 92235
(760)321-7448
Lic. No.: 661018
VOICE (760) 7771'1012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/07/06
------------------
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 Policy Number 13717252006
I certify that, in the performance of the work for which this permit is issued, I shall not employ any'
person in an s to beco a subje the workers' compensation laws of California,
and. agree at, if 1 should ecome bject to e w rkers' compensation provisions of Section
700 of he Labor Code, all hwith comp) h those provisions.
/Date: scant:
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 1$ 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 tha information i corr ree to comply with all
city and county ordinances and state laws relatin o building co struction, a d her rite representatives
oft ' cou ty t enter upon the above-mentio d propert for ' spection rposes.
Date: ignature (Applicant or gent):
Application Number 06 -0.0001423
--
Permit PLUMBING SEWER
I
Additional desc .
Permit Fee . . . . 30.00
Plan Check
Fee
.00
Issue Date-
Valuation
".
3800
Expiration Date 10/04/06
Qty Unit Charge Per
Extension.
-� BASE FEE
30:00
Special Notes and -Comments
SEPTIC ABANDONEMENT/SEWER CONNECT
" 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
LQPERMIT
-
h
Bin#
�. ��A. •.
Uty, of La ;Qu n
Building` a Safety Division
P.O. Box 15.04, ,78-49.5'Calle Tampico`
Ls Quints, CA 92253 : (760) 777-7012
..Building Permit A li •
g pp cation and Tracking Sheet - •
Permit #'
,
Project Address:'Owner's
Name:
A. P. Number:
Address,:..52;
Legal Description: , .
City, ST, Zip: L A '.. li l� • - ZZ�L .
Contractor'.
Telephone;9 0 2--.30
Address:
Project • Description: -
City, ST, Zip: y
;.
a SS ?`7 L
Telephone: ------------
State Lic. #.: City. Lic. #:
Arch., Engr., Designer:
t
Address:
City, ST, Zip: ..
�.'
Telephone:
State Lic: #:
Name of Contact -Person: k
Construction Type: Occupancy: '
Project type (circle one): New: A_ dd'n. Alter . Repair 'Demo
Sq. Ft.;
#Stories:
#Units:.
Telephone # of Contact -Person:
- 6v
Estimated Value of Project: dp—.
'. APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING .
PERMIT FEES
Plan Sets
,
Plan Check submitted'
Item
Amount
Structural Calcs.
Reviewed, ready for corrections a
Plan Check Deposit F
#
Truss Calcs.
Called Contact Person
Plan Check' Balance
Energy Calcs.
Plans picked up
Construction
Flood plain plan.
Plans resubmitted
Mechanical
Grading. plan
2"" Review, ready for corrections/is"sue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed ' .
�,
Plans picked up
S.M.I. ,
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
Review, ready for corrections/issue
Developer Impact Fee
Planning Approval_
Called Contact Person
Pub. Wks. Appr
Date of permit issue
,.
School Fees
•
Total Permit Fees
JOB INVOICE
y
POST OFFICE BOX 2448
CATHEDRAL CITY, CA 92235-2448
(760) 360-7448 (760) 321-7448
LSC. #661018
Date
s
Ordered b Y
Bill To
Cust. Order #
Address
Ph. #
City
Mechanic f i
�./
Job Name and Location s%�,� ^ r ��-
,,
Helper .
Description of Work
4.
S
Amnt. Pumped Gal []Septic Tank ❑ Seepage Pit4' ❑ Cesspool ❑ Grease
Trap ❑ Other
❑ System is Failing ❑ System Passes ihsi pec(ion ❑ Excessive Sludge ❑ Roots
Quantity
Description of Work or Material Used
Price
Amount
�^
Pum & DumpFee per 1000 al
j
l
A
Locating & Opening Fee(per hour
Septic Inspection
Out of Area Fee
Fuel Surcharge
Snake Line ❑ Roof
Video Pie Inspection Camera 1st hour
Additional hours
High Pressure Water Jet
Additional Hours
Labor per hour
A service charge of $20 will be due on all returned checks
18% per year will be charged on past due accounts over 30 days
Total
3t/'. �;
Paid By .' ` -Na Next Service Due
Check # ❑ MasterCard/ Visas' ❑ BillingOn
Card # ,Exp_ -Date
Signature Date Completed
3 x.-06 2006 1.3.;56 ..4B H01 -'E :FDX TONE ' '
R/VBdFfpjry i i i ray J. o„r Ar.`
RIC7 CA,$}l IPTI NAIL
1
Y" l tlleae �' «J �/ t r L . ,•r te�`--++z+_ i .�.���
V4:
O Houee:.Leterel(ej
LO ae>pcmrCfiedctaj .
D Ate18t Sitrd,tr _
t `5.PhQ lon Cepadty Charge
O wo.a.FC.
p Taw "m Mleie►
IJ tum On Chn
[] unoolleated qpm _ Na�n
f 0 bwpecftn Feb-71act-
F—
d Plan ChecJc Fees Water/ S&W _
Team—..-
Sow
eamx— Bond ftYme!rt - A.D. - -
O Cus=omsr Doposn -
D
t2r,CoAY to:
16014
.7 2?44 P 02102 . .
—}.
TOTAL
.136
:Dale` -
TOTAL P.02 ! '