08-0570 (PLBG)P.O. BOX 1504
.t 78-495 CALLE TAMPICO
LA QUINT& CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 08-00000570 eLO CALL C- "'[-r--t4e:WLA
Property Address: 541.492 IPA MAR.TmTtN Z .
APN: 774-253-028-12 -000000-
Application description: PLUMBING
Property Zoning: COVE RESIDENTIAL
Application valuation: 2800
Applicant: Architect or Engineer:
P
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 Code, and my License is in full force and effect.
license Class: 13 C36 C42 License No.: 793482
Date:��ontri .
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 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 _ 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.).
( I 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
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:
ELKINS RESIDENCE
77810 CALLE TEMECULA
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS: (760) 777-7153
Contractor: [� U
SO CAL & ASSOCIA PLMBNG
P.O. BOX 955 {�
YUCCA VALLEY, C 2 86APR 08 2008
(760)369-4104
Lic. No.: 79348 CITYOFLAQUINTA
--------------- - - -
WORKER'S COMPENSATION DECLARATION
Date: 4/08/08
� t
10� I
t
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. 1820769-2008
1 certify that, in the performance of the work for which this permit is issued, 1 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 b6come-subject to the workers' compensation provisions'of Section
UU//rr 3700 of the Labor Code, I shall forthwith comply with those provisions.
Date: TL4A Applicant:
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.
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 thiscounty to to upon the above-mentioned property for inspection purposes.
Date: _gnature (Applicant or I,�
Application Number . . . . . 08-000005.70
Permit . . . PLUMBING SEWER
Additional desc .
Permit Fee. 30.00 Plan Check Fee .00
Issue.Date Valuation . . . . 2800
Expiration Date 10/05/08
Qty Unit Charge Per Extension
BASE. FEE 15.0'0
1.00•,.: 15.0000 EA PLB BUILDING SEWER 15.00.
-------------------------------------------- ---------------------------------
Special
---- -------------------Special Notes and Comments
SEWER HOOK-UP
Fee summary Charged Paid Credited Due
-------------------------7-----=-------------------------
Permit Fee Total 30.00 .00 .00 30.00
Plan Check Total .00 .00 .00 .00
Grand Total 30.00 .00 .00 30.00
LQPERNIIT
ASAP
PUMP/NG, Incl Lic #C42 855 851
760 328-7887 • 1-800-334-7255
FAX 760 328-6607
P.O. Box 2318 •Cathedral City, CA 92235
CUSTOMER'S ORDER NO.
DATE 0 D�
ORDER TAKEN BY
DAT ROMIS�D ❑ q M
❑ P.M.
BILL TO O �
PHONE
ADDRES,5- C•61 XV / (� .4_t
ME IC
CITY
HELPER
JOB NAME AND LOCATION
(Q
0 WORK
DESCRIPTION OF WORK i
❑ CONTRACT
❑EXTRA
ajemg
I-
QUANT
IDESCRIPTION OF MATERIAL USED
PRICE
AMOUNT
Gallons ��►j
��
Pumping Fee per 1000 gal.
Camera/Power Snake
Out of Area Fee
l
Locating / Opening Fee (per
$.75/HR
Size System:
Fuel Charge
$25
0 0
A SERVICE CHARGE OF $20 WILL BE DUE ON ALL RETURNED. CHECKS.
18% PER YEAR WILL BE CHARGED ON PAST DUE
ACCOUNTS OVER 30 DAYS.
TOTAL
MATERIALS
TOTAL
LABOR
WAIVER: Not responsible for secondary damage such as water " ,
'damage, chipped IF p lq!l1:;1;;11l r es.
SIGNATURE E COMPLETED
TAX
TOTAL
.
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COACHELLA VALLEY WATER DISTRICT CASH RECEIPT DETAIL
owe
ns',
x 122858 o
•. - " Date: '
Received From:
�r of.
ae• Q 2.'6Sat
' Address:orP'
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Tract
Ay
Account No:
,.. Lot(s)
Q e' ; e�C LSC
G.A. Code
fR
Service Address
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❑ Metei(s)
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❑ Service(s)-
❑ Backflows)
❑ House Lateral(s)
❑ Detector, Check('s)
' ❑ Meter Surcharge
O$anitation'Capacity Charged
❑ S.I.W.S.C.
❑- Temporary Construction Meter
w
- O Tumion'Charge-
❑ Unc&66teditcount - Name
`❑ Inspection Fee - Tract'
_
Fee
❑ Plan Check Fees Water !.Sewer
Tract 7
4
❑ Bond Payment -.A.D. Bond
Assmt t
O Customer Deposit
❑ Other
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TOTAL
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' Remarks:.
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Money: `
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City of La nuinta
Building u Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quilita, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: IVA0 l
A. P. Number:1 14ygs VEA114A
gM. GL
Til Z
Owner's Name:.�J SE Gtnai f}/y1 /i¢ . i�Li
Address: ` 2 ZeiA fAr
Legal Description:
Contractor: Sp Gq. t, oww- �
'City, ST, Zip: A- + i-a-�"l ZL5_3
Telephone: 6,q d SD -,f 7o /
Address: p= -06L—; Qr S-'�
Project Description:
City, -ST, Zip: ow -. aww
Telephone:
-
City Lic. #:
4&6V` U C.
State Lit. # : % 9
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lit. #:
Name of Contact Pelson:_Sq.
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Ft.: _ _ -_
_# Stories:. _ _ ..
#_Units:
Telephone # of Contact -Person: �(�l�G. t���l�
Estimated Value.of Project: 2-8d0 r
APPLICANT: DO NOT WRITE BELOW THIS LINE .
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structure[ Coles.
Reviewed,, ready for corrections
Plan Check Deposit
Truss Calc§,
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/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans. picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
INHOUSE:
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
��//g�
1Y7cre-�» ��
11