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05-0134 (PLBG)V z� BUILDING & SAFETY DEPARTMENT P.O. Box 1504 (760).777-7012 ��►f-OF r, � 78-495 CALLE TAMPICO FAX (760) 77.7-7011 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT Application Number ,-05--000.0.0-1.3.4 Date 1/13/05 Property Address . . . . .5.34-1-5—AUENIDA VE -L -ASC -O APN:, 774-084-019-8 -000 Q - Application description . . . PLUMBING U a Property Zoning . . . . . COVE RESIDENTIAL 'Application valuation . . . . 2800 JAN 1 3 2005 Owner Contractor CITY ------------------------------ --'----------- - p� 0 Pr OLIVERA JOE SO CAL PLUMBING & REPIP NQ -T- GN T T T T 9-949,949-, (�'� (g( 0 :] ( 9 P. O. BOX 955 0 T TAT VT17S'92'�PCTTT CA 0 0 YUCCA VALLEY, CA 92286 Q2Z(760) 369-41.04 WCC: - EXEMPT WC: EXEMPT.. 11/30/05 CSLB: 793482 04/30/05 CCC: C36-C42-B - --------------------------------------------------------------------------- P.O. Box 1504 • �� VOICE (760) 777-7012 78-495 CALLE TAMrtco FAX (760) 777-7011 Ln QUtNTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: 05--).34, Date: -/-/3-0-5 Applicant: I Architect or Engineer: Applicant's Mailing Address: Architect or Engineer's Address: Lic. No.: tsUILUINU 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 7000) of Division 3 of the Business and Professionals �e, and ss Li A-.9 isja,fy�foice pff�ct 9^3V� rcense Class Lj [,/`�j(p '%lf icense No. y' J nereoy amrm unaer penauy or perjury that I 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 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 Contractors' 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).): U 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 or 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.). U 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 e Contractors' State License Law.). am exempt under Sec. B.8 P.C. for this reason Date Own WORKERS' 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 Policy Number 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, I shall forthwith comply with those provisions. ate icant 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 ($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. 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 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, indemnity and hold harmless the City of La Ouinta, 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 enter upon the above-mentionerl mpprtyion rposes. ,Xate - Signature (Applicant or Agen — — — — — — — — — — — — - — — — - is il`�f� — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Application Number -05 .11. 134 Permit . . . . . PLUMBING SEWER Additional desc Permit Fee 30.00 Plan Check Fee .00 Issue Date Valuation 2800 Qty Unit Charge Per Extension BASE FEE 30.00 ----------------------------------------------------------------------------- Special Notes and Comments. SEPTIC ABANDON;SEWER CONNECT Fee summary Charged Paid Credited Due Permit Fee Total 30.00 .00 .00 30.00 P1an.Check Total .00 .00 .00 .00 Grand Total 30.00 .00 .00 30.00 FA ELLAVALli COACH WATER "DISTRICT 64RECEIPT DETAIL -.05.893, SH Date: - 6 .1k A< A-0 Wr" Account No(s) S 6 c eAddress" G $ -fl r �O 'ge—rVice(S 0,121adkfibiwW 0 -House' LA teral(s). 3a'! C1 ctorChecl El mettp8urcharg! �A�a-6l 61l �A—arg, - - - :-- spitati c a. A- ❑ Temp" poTr .y Construction r 0 Turn onharge. 0 dn'eol 14�' ea Account O'linspectioo Fee yTract Fee- if Ij-n 6'tre—ck F- s Waterd S6wer. - r. Tr—aCt y q 49 y 'nond PAyffent= A:Pori ASMI. 0 CU t0 9 Deposit - 0 F47e-r :TOTAL' $ d' py to: - Cash —S ef�-I a - il Water ai tSisiil gr Money Oder CYWI)t438-01189 'i C HAMMERPUMPING INC. R.O. Box 2448. CATHEDRAL CITY, CALIFORNIA 92235-2448 17CA1 2CA _ 7A A C ' JOB INVOICE (760i321-7448 ' CUSTOMER'S ORDER NO. DATE ORDERED 1_t„i S ORDER TAKEN BY DATE PROMISED 0 A.M. 0 P.M. BILL TO � 0Lj-112�_ PHONE' ADDRESS \ . CITYL � 5 HELPER - JOB NAME AND LOCATION " 0 DAY WORK DESCRIPTION OF WO - - - • 0 CONTRACT 0 EXTRA QUANT. DESCRIPTION OF MATERIAL USED PRICE AMOUNT Gallons Pumping Fee per 1000 gal. Dumping Fee per 1000 gal. Out of Area Fee Locating % Opening Fe our) Size Syste " 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 t LABOR - AMOUNT- TOTAL' MATERIALS •MECHANICS . Q HELPERS Q .TOTAL LABOR ' Ihereby acknowl comp) a ab SI URECOMPLETED _� TAX - TOTAL