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12-0557 (PLBG)P.O. BOX 1504 78-495 CALLE TAMPICO. LA QUINTA, CALIFORNIA 92253 Application Number: x-12-00000557 _ Property Address: 53,500 AVENIDA VELASCO APN: 774-125-001-1 -000.000- Application description: PLUMBING Property Zoning: - COVE RESIDENTIAL Application valuation: 3200 c&ht 4 4 Q" BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: ALEXANDER GONZALEZ 53500 AVENIDA VELASCO LA QUINTA,'CA-92253 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760)'777-7153 Date: 5/21/12. Contractor: D Lr \ Applicant: Architect or. Engineer: HAMMER PUMPING INC �/ g P.O. BOX 2448 MAY �o1 CATHEDRAL CITY, CA .9223 r7 (760)360-7448 %� LiC. No.: 661018 CITY pF"IAQU�NTA 1 , FINANCE DEPT. ------------ -- ----- ---------------" - --------- -- LI E ONT CTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION I hereby affirm nder pe ty of perjury tha am I• ense er provisions of Chapter 9 (commencing with - - I hereby affirm under penalty of perjury one of the following declarations: Section 7 00) Divi on 3 of the Busin and rofessio Is e, and my License is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided License C ss: 1 47 C36 License o.: 661018 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ate' ac 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 OW - ILDER DECLARATION insurance carrier and policy.number are: I hereby affir under pena y of perjury that I am exempt from the Contractor's State License Law for the Carrier NATIONAL UNION Policy Number 9106Q.6— following 06following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to _ I certify that, in the perfor ork for whit t ermit is i ued, I shall not employ any construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any er so as to become ubject to eworker nsation laws of California, permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State nd agree th , if I should become osubi ct tot workers' compen provisions of Section License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or. 3700 of th Labor Code, I shall frth th ply with those isions. 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).: e: Z ppli ant: . (_ 1 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 (Sec. 7044, Business and Professions Code: The WARNING: FAILURE TO SE KERS' COMPENSATION COVERAGE IS UNLA L, AND SHALL Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ON NDRED THOUSAND and who does the work himself or herself through his or her own employees, provided that the DOLLARS J$1 00,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN improvements are not intended or offered for sale. If,, however, the building or improvement is sold within' SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. one year of completion, the owner -builder wilthave the burden of proving .that he or she did not build or - improve for the purpose of sale.). APPLICANT ACKNOWLEDGEMENT (_ I 1, as owner of the property, am, exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for -a permit subject to the . 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application. property who builds or improves thereon, and who contracts for the projects with a contractorls) licensed 1 . Each person upon whose behalf this application is made, each person at whose request and for pursuant to the Contractors' State License Law.).- whose benefit work is performed under or pursuant to any permit issued as a result of this application, ( 1 I am exempt under Sec. , B.&P.C. for this reason 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. Date: • Owner: 2. Any permit issued as a result of this application becomes null and void if ork is not menced - within 180 days from date of issua such p it, or cessation of work for 180 day will subject CONSTRUCTION LENDING AGENCY permit to cancellation. I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify that I have read this application and ate that the above i formation ' correct. I a to c ply with all work for which this permit is issued (Sec. 3097, Civ. C.). city aguntyinances and state laws rIating to building co truction, d hereby authorize r entativesofthister upon the above -men ioned property for ' spection rposeLender's Name: ate: "5' ature IApplicant Agen Lenders Address: , LQPERMIT LQPERMIT : Application Number 12-00000557 Permit PLUMBING SEWER Additional desc Permit Fee. 30.00 Plan Check Fee .00 Issue Date Valuation 3200 Expiration Date 11/17/12 Qty Unit Charge Per Extension BASE FEE 30.00 Special,Notes and Comments SEPTIC ABANDON, SEWER CONNECT. 2010 CODES. -------------------_------------------------- Other Fees . . . . BLDG STDS ADMIN (SB1473) 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 31.00 .00 .00 31.,00 LQPERMIT T _ .'�;, Y -•,.`-`+:'x .z^^ 7 777 77 MY'. .. S - LT mz�* r "COACHELLANALLEI( WATER DISTRICT. f }y 0 =�sOx1058; COACHELLA, C 92-236":' ALIFORNIA(760) 398 2651 ;'5t1 MP :, � f � INVOICE Date 5/,97/2012 z SUBJECT SCC ONLY 53500 AV VELASCO LA QUINTA LID 688458 t GONSALEZ� ALEXANDER : y, . , �w....., , w. , Project' -'-_j'2-3690',". X53500 AVENIDA VELI�SCO'� Project Date,:. x ' - 412 312 01 2 k : Amount: Due - $4 231.00 LAQUINTA CA 92253. GEO 06-0612-4 J Planner. CAROL PFANNKUCHE ., • .. - •. h,. l TO INSUREEPROPEWCREDI7 :PLEASE RETURN THIS'PORTION WITH �5 REMfTTANCE AND INCLUDE:THE PROJECT ON YOUR CHECK. Aiff ... .1K f1 i ' 1.q0 FFr 5CC COLLECTION` $1'836 00'. $1;836 1 OQ FJy SEG TREATMENT"$2 395 00 $4 231 00 j PAID:, # 4-35(0$8631 [SAY 1;7` COACHELLk Vr+LLEI' WATER DISTRICT 0 131n.# City. Of La QUtntd Btilk tng eL Safety Division P.O. Box 1504,'78-49S Calle Tampico 1.a.QLdnta, CA 92233 -:(760) 777-7012 Building Permit Application, and Tracking Sheet Perinit # ? Project Address: So QO Owner's Name:. �7 D ►'� '-e of A. P. Number: Address: . Legal Description: Contractor. a V, tip e(Z U City, ST, Zip: Telephone: <a � `< :�: Address: Project Description: f City, ST, Zip: �— Telephone: .r State Lic. # : City Lir #, Arch., Engr., Designs: Address: City., ST. Zip.- ip:Telephone: Telephone: State Lia 9: - v :. ,r Name of Contact Person: 5 tJOti.l �� Construction Type:. Occupancy: Project type (circle one): New Add'n Alts Repair Demo Sq. Ft.: # Stories: #Univ Telephone # of Contact Person: 3 2 6 Estimated value of Project: 'f;)2 Q APPLICANT: DO NOT WRITE BELOW THIS UNE # Submittal Req'd Rec'd TRACMG PERMIT FEES Plan Sets Plan Check submitted - Item Amount Str¢ctuial Cales. Reviewed, ready for corrections Plan Check Deposit. . Truss Calcs. Called Contact Person Plan Check Balance Title 24 Cates... Plans picked up Construction Flood plain plan Plans resubmitted.. Mechanical Grading plan r! Review, ready for correctionstissue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up MI. ILO.A. Approval Plans resubmitted Grading . IN HOUSE:- 3" Review, ready for eorrectionsllssae Developer Impact Fee Planning Approval Called Contact Person A.LP.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees