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04-6049 (PLBG)�• o u��ttcv BUILDING & SAFETY DEPARTMENT yW� -P.N 1504 (760) 777-7012 -"�78 9� IICALLE TAMPICO FAX (760) 777-7011 26 L^A QUI.NTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 Uj clrroF.o.nuINTA BUILDING PERMIT FINANCE DEQ Application Number 04-00006049 Date . 8/25/04 Property Address 52865 AVENIDA VALLEJO APN: 773-323-019-6 -000000- Application description PLUMBING Property Zoning , COVE RESIDENTIAL Application valuation 1500• Owner Contractor SHAFER/MOORE OWNER 52865 AVENIDA-VALLEJO LA QUINTA- CA 92253 -=---------------------------------------------•------------------------------ Permit . . PLUMBING SEWER Additional desc - Permit Fee 30.00 Plan Check. Fee .00 Issue Date Valuation. 1500 Qty_ Unit Charge. Per Extension BASE FEE 30.00. ------------------------- Special Notes and Comments SEPTIC ABANDONMENT, SEWER CONNECTION Fee summary Charged' Paid Credited Due Permit Fee Total 30.0.0 .00 .00 30.00 Plan Check Total .00 .00 .00. .00 Grand Total 30.00 .00 "•.,00 30.00 ' r P.O. BOX 1504• �� VOICE (760) 777-7012_ 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 4INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: Applicant: Applicant's Mailing Address: Date: Architect or Engineer: Architect or Engineer's Address: Lic. No.: BUILDING 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 Code, and my License is in full force and effect. License Class License No. Date Contractor OWNER -BUILDER DECLARATION I hereby affirm under penalty of 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 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 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 the Contractors' State License Law.). U I am exempt under Sec. , BA P.C. for this reasc.n ._ - 12� 1014 Owner 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 Numbar V 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 �j forthwith comply with those provisions. Date_ (�O�{ 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. 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 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 this county to enter upon the above-mentioned property for inspection purposes. Date -- 0 Signature (Applicant or Agent): ��o P OWNERI BUILDER INFORMATION j Dear Property Owner: An application for a building permit has been submitted in your nam_ a 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 by property 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. Contractor`s 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 including 'State and Federal income tax withholding, federal social security taxes, worker's , compensation insurance, disability insurance costs and unemployment compensation contributions. There maybe 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 Adminstrationy. 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 not licensed contractors 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 may be obtained by contacting the Contractors" State License Board in your rcommunity or at 1020 N. Street, Sacramento, California 95814. Please complete and return the enclosed owner-builderverification 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) 777-701 OWNE SI NATURE/DAT c��2S� PROPERTY ADDRESS PERMIT NUMBER(s) , oaf - '7suV- COACHELLA VALLEY WATER DISTRICT CASH RECEIPT DETAIL Received From: i — I, 11 JJ&] •,, Vlt/`'t1/— LT". i�'l..rt-.�= Address: � 2 — • 2y JP Account No. (i2tQ(�� / nAV o -Q • S!3 Lots) Service Address ❑ Meter(s) ❑ Service(s) ❑ Backflow(s) ❑ House Lateral(s) ❑ DetectorCheck(s) ❑ Meter Surcharge Sanitation Capacity Charge ss, ❑ W.S.B.F.C. ❑ Temporary Construction Meter ❑ Turn on Charge ❑ Uncollected Account - Name ❑ Inspection Fee - Tract - Fee - ❑ Plan Check Fees Water I Sewer - Tract - ❑ Bond Payment - A.D. - Bond ❑. Customer Deposit,_ ❑ Other iR N° 103785 2J/O4-- G.A. Code ac? Cl ,t TOTAL $ 3 -'` ` /rRemarks: c /IfCopy to: Cash��/ Water Service Check - MoneyCashier ` / \J1 Order �/ CVWD-438 (11189) CANDY M SHAFER ,,' JAMISON ALEX.MOORE . PH 760-460844 52865 AVENIDA VALLEJO wr. LA QUINTA, CA §k63-5302 . _ V .i '6001 30-7426/3140 DATE A._. '�5 Zed �i� F,44' YPr T'ifE bb \��$1.v1('._?fav!�V.v�O_✓_ G`_"_�cx- ��M.-.'..._�-\i\ _-_.C�V� {7��':. �r rit i`�; ,,. ' USAA Federal Savings Bank Home Equity Serviang Department ` 10750 McDermott FWY San Antonio. Texas 78244-8799 {{ USM� ((22100) 498-7177 1-800-531-8065 ` 4314074 8 .2694 II'23111646011151I' 6001 VALLEY WIDE PUMPING SERVICE "Your Waste Is Our Probiem" ur_. JOB INVOICE 0933.3 , VV J. 0UI II IbC YYQy OUIIC 1,3J - " PALM SPRINGS, -CA 92262 CUSTOMER'S ORDER NO. DATE ORDERED el —.-q- -e,1760) ORDER TAKEN 8Y DATE PROMISED ❑ A.M. O P.M. C C 322-2400 (760)' 347-3545 BILL:A;O P ON ADDRESS Jy� CITY H6i46R+ LOBO AND LOCATION w�� C / �D-E DAY WORK SSCRRIPTION OF WORK ❑CONTRACT ❑ EXTRA G QUANT. DESCRIPTION OF MATERIAL USED PRICE' AMOUNT Gallons f ewO lJ S- 4 0 D Pumping Fee per 1000 gal. Dumping Fee per 1000 gal. Out;of Area Fee Locating / Opening Fee (per hour) r / Size System: A SERVICE CHARGE OF $20 WILL BE DUE ON ALL RETURNED CHECKS. A FINANCE CHARGE OF 11/2% PER MONTH, 18% PER YEAR WILL BE CHARGED ON PAST DUE ACCOUNTS OVER 30 DAYS. s H UR LABOR AMOUNT TOTAL MATERIALS - MECHANICS Q HE PERS Q TOTAL LABOR I hereby a nowledge the satisfactory TOTAL LABOR ompletio of the above described work:.TAJ(� SIG TURE DATE COMPLETED-, TOTAL 6 a To Re rder Call NESS CUST&M'printing service TOLL FREE 1.800-888.8327 NESS. Inc., Peterborough, NH 03458. Ref. No: G 710703566 Ob W, Dffgn Under the Caflfor n;s fis'schonIcz- Men Lata any c®vnwacwr, ouh,= ractov, 8aborer, c uppiiar ©v other paveo n T,;hm nc ip20 Improve your pvapav4y, but Is, nW Paid G®r MV'har wwk or: zouppHes, has a eOgM u0 e nffome a 6 a5m aglaunw$ your Twapa ry y. This means that Mff4ev a 00ane4 heal ncz, ViDur prape74p COMM'to so,W %V a cGw8 aMc©rr and the pvcceads ®G uhe sane �uZed ¢� sa Usfy ¢Gap- MahtedFnos . 7his can happovn Z vCn-W Vo u gave padd your coni vacWr on guuu 9, 4hs s�t�caavn4vac¢®v , Osbsysm ®r ,wppHays vems- in unpaid. ,o gmsene e tAMrkj,n ¢0 fflo 2 Camra or Henn agaurns4 your property, =-W n cWr.. 2"n s -ouch QC, Cr MomAa0 suapPH'ars ara vequgvad 4® proufldz you niKh a dccum, P- 4 QaDMed "Pveua¢vaama�v _N' OUce." OF6L-IM E (®v pvawn®) cantmc4®vg and 9mbuvess Gev wages do hot have 3® pv®ucdz Wz roc4uce. Q Pveflm war} Mathes as 0®4 a Han agauvas4 yow pv®pev4y. T4s purpose 63 40 nrl4f,fj Vau Of persons whe may/ have a vIght 4® Me a Han ag7auws4 your property K May ave w®4 gaud. Genova ft ¢fin VnMxIMU0A Uwe a0u0^sped 40v f,!H Dg n c0aIm or Han ag@MM 1fdav pv0pen y is Monty (90) D@ ys after c ampuee&cvn 04 your pr®3a:c4. M HISURE EKYRA PROTECTION FOR YOURSELF AVID YOUR P4&OPERTV, YOU MAY MSH TO 7ME GME OR MORE OF THE IFOLLMIAM STEPS: 1� R sgWra 4Ca24 Payments be Made MxGcHy 40 subcoMracWrs and ma4crW saappfiaays through a �cuca4 c®vnWM,Any jao n4 cDmrs9 agreame nt should Include the addendum approved by the RegiMmr of Contmows. 2) Ozsu e jount c(fi--cGo§ Gov paymaM, made out 2c, bwh your conRmc4®r and subco nlrac4®vs or vvuVwln➢ sappHevs MvcJaved Oro 4&no project. TMs MH Mp 4m insure that W persons lose payma;an4 are ncWaHy p�M. O) ANSF UPON MUCK¢ PQVMG n4 ®n any c®M[Wetad ph2se ®4 the pv®gqc¢, and ba4®va Mahing any ffuevd9nev PayMfi nQs, MgUIM y®Ur 00mt¢vnc4w 4¢n prCUMe you twith uncc ndMo nau Ron reg easea s8gr,Pd by ea"Ch M,2 cwIa9 sanppflsv, wend dab®rev oo voa ved In 4Gua4 perRion off the ^®vCs f0r e,nMCh PQIMW` a420 gado. On pvo�Wm In v0ue8ng aaaprovoments W a sBngoe Vamfly vasuc"Zmce or e dup!QA ®uunasd by &ndg viduaus, ffha persons Much¢ these Weasse Ices 2ha vight 40 We a c!& -!M pv®party. 0n othe? 4ypw Off construction this prc4ecUon may SM he 6Mp,0Mnt, Mal nnW bo as comp ate- TO iF'RWEC T VOURSE ,F UMDER THM OPTIOM YOU FIQU87 B111-- OCG WIN Trml-"T, QisL D'J'A' MAL SUPPIMERS, SUBOOMMACTCORS OGS LABORERS Gu��9B �u�Gd�Do