05-3623 (PLBG)'P.O. BOX 1504
78-495 CALLE TAMPICO
LA �UINTA, CALIFORNIA 92253.
h' Application Number:
Property Address:
C APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
VOICE (760) 777-7012
FAX (760) 777-7011
BUILDING & SAFETY DEPARTMENT -INSPECTIONS (760) 777-7153
BUILDING PERMIT
r05-00003623�': , Owner:
52-065 AVENIDA VALLEJO BELL MARTYN ESMOND
773-222-014-3 -000000- D 52065'AVENIDA VALLEJO
PLUMBING LA QUINTA,. CA 92253
COVE RESIDENTIAL -------
.-------------------- ------
1000 AUG 1 5
C17 -Y Contractor:
Architect or Engine F►NAiV E pQUIINTA' Owner
T.
Date: 8/15/05
LQPERMIT - -
j— — — — — — — — - —'— — — — — — — — — — — — — — — — — - — — —'— — — — — — — --- — — — — — — — — —
Y� LICENSED CONTRACTOR'S DECLARATION-
— — — — --- - — — - — — — - - — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — —
WORKER'S COMPENSATION DECLARATION "
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with = "
I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business and Professionals Code, 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 Class: License No.: -
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
_ -
issued. "
Date: Contractor:
_ I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
workers:
.
Code, for the performance of work for which this permit is issued. My workers' compensation -
- OWNER -BUILDER DECLARATION
insurance carrier and policy number are: "
hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for'the
"Carrier Policy Number '
- following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to
- certify that, in the performance of the work for which this permit is issued, 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 manner so as to become subject to the workers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
and agree that, if I should become subject to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
-
3700 of the Labor Code, I shallhwith comply with those provisions. '
• that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by _
„ 4,�
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: "
Date. e: "A (Applicant:
- (� ) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
C=:
- the structure is not intended or'offered for sale (Sec. 7044, Business and Professions Code: The
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, 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 ONE HUNDRED THOUSAND'
and who does the work,himself or herself through his or her own employees, provided that the
DOLLARS ($100,000). 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 will have the burden of proving that he or she did not build or
- - -
�; improve for the purpose of sale.). -
APPLICANT ACKNOWLEDGEMENT
.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.,
. r - property, who builds or improves thereon, and who contracts for the projects with a contractor(s) 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,
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 andemployees for any act or omission related to the work being
performed under or following issuance of this permit.
\SSS '0wz�
Datet
2. Any permit issued as a result of this application becomes null andvoidif work is not commenced -
-
within 180 days from date of issuance of. such permit, or cessation of work for 180 days 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 1 have read this application and state that the above information is correct. I agree to comply with all ,
- work for which this permit is issued ISec. 3097, Civ. C.). -
city and county ordinances and state laws relating to building construction, and hereby.authorize representatives
- -
of this county to enter upon the above-mentioned property fo spection pur
Lender's Name:
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�fSi
Date-. -y", J
e -(Applicant -or -Agent),
Lender's Address:
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LQPERMIT - -
Application Number. 05-00003623.
'
Permit' .. - PLUMBING SEWER
Additional desc
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Permit Fee.; 30.00
Plan Check Fee
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;:Issue Date
Valuation
.00
0
Expiration .Date 2/11/06
t e
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Qty Unit Charge Per '
Extension
BASE .FEE
30.00
s
Special Notes and Comments
SEWER CONNECT/SEP-TIC ABANDONEMENT
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Fee summary ..Charged ,',Paid
Credited
Due
Permit Fee Total 30.00 ..00
.00
30.00 -,
Plan Check Total .00
.00 .00 '
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Grand Total,' 30.00
.00 .00
30.00
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COACHELLA VALLEY WATER DIS.TRIdT `�• ''
;CASH RECEIPT DETAIL ?N° 95.6-05
Received F 1/� 4 r ` ' Y Date v'
Address:
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Service Address _r
'G.A. Code
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''52-065 AVENIDA,VALLE
UINTA
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BANK OF AMERIC
PALM DESEFiL9RAN4'H 05855 x % c - rr 4
73$20 EL PASEO PH 760.340.1887;
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' ®IMAGE CHECKS, 1097 •.�a3t�'3 i•,,;,�•� ,F'^,� �+,. 1 •
6UN ANO MOON L •• 1-800-562.8768 www.imagechecks.com
VALLEY WIDE PUMPING *SERVICE
"Your Waste Is Our Problem"
JOB INVOICE
09911 !
1 U J. ClUlfflbt: IfIftly 0101W. 1,)0
CUSTOMER'S ORDER NO.
DATE ORDERED
PALM SPRINGS- CA -.92262 -
Gallons 0�� 11-5 M&P e,
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Pumping Fee per 1000 'gal.
(76% 322-2400 .(760)'347-3545-.
DER TAKEN BY
DATE PROMISED 0 A.M�
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PHONE
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QUANT.
DESCRIPTION OF MATERIAL USED
PRICE
AMOUNT
Gallons 0�� 11-5 M&P e,
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Dumping Fee per 1000 gal. -
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A SERVICE CHARGE OF $20 WILL BE DUE
ON ALL RETURNED CHECKS.
A FINANCE CHARGE OF 11/2% PER MONTH, 18% PER YEAR
WILL BE CHARGED ON PAST DUE ACCOUNTS OVER 30 DAYS.
HOURS
LABOR
AMOUNT
F TOTAL..
MATERIALS
MECHANICS @
TOTAL
LABOR
HELPERS
I hereby acknowle'dge the satisfactory
comp!,etion, of the above described work: TOTAL LABOR
TAX
SIGNAT RE
DATE COMPLETED
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To Reorder Call NEBS CUSTGPIA'printing service TOLL FREE 1-800.888-6327 NEBS, Inc., Peterborough, NH 03458. Ref. No: G 710703566
�9V0919 ITo
Under the Californla Mschanlcs Lien Law any contractor, subcontractor, laborer, supplier
or other person who helps to improve your property; but is not paid for his/her work or
suppiics, has a right to enforce a claim against your property. This means that after a court
hzering, your -property could bd sold by a court officer and the proceeds of the sale used to
satisfy the Indebtedness. This can happen even if you have paid your contractor in full If the
subcontractors, laborers or suppliers remain unpaid.
To prenztve their right to file a claim or lien against your property, certain claimants such
as subcontractors or material suppliers are required to provide you with a document entitled
"Preliminary Notice." Original (or prime) contractors and laborers for wages do not have to
provide this notice. A Preliminary Notice is not a lien against your property. Its purpose is to
notify you of perzons who may have a right to file a lien against your property if they are not
paid. Generally, the maximum time allowed for filing a claim or lien against your property Is
ninety (90) Days after completion of your project.
TO INSURE EXTRA PROTECTION FOR YOURSELF AND YOUR PROPERTY,
YOU MV AY WISH TO TAKE ONE OR PADRE OF THE FOLLOWING STEPS:
1) Require that payments be made directly to subcontractors and material suppliers through
a joint control. Any joint control agreement should include the addendum approved by the
Registrar of Contractors.
2) Issue joint checks for payment, made out to both your contractor and subcontractors or
material suppliers involved in the project. This will help to insure that all persons due payment
are actually paid.
3) After UPON! making payment on any completed phase of the project, and before making
any further payments, require your contractor to provide you with unconditional lien releases
signed by each material supplier, subcontractor and laborer involved in that portion of the
worli for which payment waa made. On projects involving improvements to a single family
rzsidence or a duplcx owned by Individuals, tho persons signing these releases lose the right
to Me a claim &Salnst your property. In other types of construction this protection may still be
Imporinnt, but may not be as complete. TO PROTECT YOURSELF UNDER THIS OPTION YOU
MUST BE CERTAIN THAT ALL MATERIAL SUPPLIERS, SUBCONTRACTORS OR LABORERS
i-iAVE SIGME0.
o .I
QF 787495 CALLE TAMPICO - LA QUINTA, CALIFORNIK92253
'TELEPHONE (760) 777-7012 FAX (760) 777-701.1 .
O"ER/BUILDER INFORMATION
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified.-.,
For your protection you should,be aware that as "Owner/Builder" you are the responsible party: of record on such a.
permit. Building permits are not required to be signed byproperty owners unless they are personally performing their
own work. If your work is being performed by someone other than yourself, you may protect yourself from possible
liability if that person applies for the proper permit in his or her name.
Contractors are required by law to, be licensed and bonded by 'the,. State of California and to have a business license`
'from the City or County. They are also required by law to put their license number on- all permits for which they
apply.
If you plan to do your own work, with the exception of various,trades that you plan to subcontract, you should be
aware of the following information for your- benefit and protection: ,
If you employ or otherwise engage' any persons other than your immediate family, and the work (including materials
and other. costs) is $200.00 or more for the entire project and such persons' are not licensed as contractors or
subcontractors, then you may be an employer.-,„
If you are an employer, you must register with. the State and'Federal Government as an employer and you are subject
'to several obligations include State and Federal income tax withholding, federal social security taxes, worker's
compensation insurance, disability,,insurance costs,and unemployment compensation contributions.
There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with
respect to worker's compensation insurance.
For more specific information about your obligations under Federal Law, contact the Internal Revenue Service (and, if
you wish, the U.S. Small Business Administration). For more specific information about your obligations under State
Law, contact the Department of Benefit Payments and the Division of Industrial Accidents.
If the structure is intended for sale', property owners who are note licensed contracts are allowed to perform their
work personally or through their own employees,without a licensed contractor or subcontractor' only under limited
conditions.
A•frequent practice of unlicensed persons professing to be, contractors is to.secure an,"Owner/Builder" building
permit, erroneously. implying that the property. owner is providing his or her own labor- and material personally.
Building permits are not required to be signed by,property owners unless they -are performing their, own work
personally.
Information about licensed contractors maybe obtained by contacting the Contractors' State License Board in your
community or at 1020 N: Street, Sacramento, California 95814. ,
Please complete and return the enclosed owner -builder verification form so that we can confirm that you are aware of
these matters. The building permit will not be -issued until'the,verification is'returned.' '
very truly yours,
.CITY OF LA QUINTA
DEPT. OF BUILDING AND SAFETY
78-495, Calle Tampico
-La Quinta, CA 92253
(760) 777-7012
FAX:: (760) 777-7011
OWNER'$ SIGNATURE/DATE
PROPERTY ADDRESS
PERMIT NUMBER(S)