07-3004 (PLBG)P.O. BOX 1504-
78-495
504.78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
4
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
r
07-00003004
52920 AVENIDA VALLEJO
773-324-009-18 -000000-
PLUMBING
COVE RESIDENTIAL
2500
Architect or Engineer:
———----——--———
LICENSED CONTRACTOR'S DECLARATION
4
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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: B C36 C42 License No.: 793482
Date/'v� Contractor:
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 1$500).:
(,_ 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.). -
(_ 1 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.).
( ) I am exempt under Sec. , B.&P.C. for this reason
Dater
Owner:
- 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: _
1 Lender's Address:
LQPERMIT
Owner:
ALTURA CREDIT UNION
P.O. BOX 908
RIVERSIDE, CA 92502.
(760)413-4.955
Contractor:
SO CAL & ASSOCIATES PL
P.O. BOX 95S
YUCCA VALLEY, CA 92286
(760)369-4104
Lic. No.: 793482
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/26/07
10k �� V
If13
�Oar, .
---- o4I
-----==---' �4���g� -----
r WORKER'S COMPENSATION DECLARA .10N;/j
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' c mpensation,r s 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 EXEMPT Policy Number EXEMPT
_ 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
�.. 3 00 of the L�Code,�shall �Wl���
Date: 1� Applic
WARNING: F LURE 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'STEES.
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'bpplicant, 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 this co tt tto ent pon the above-mentioned property for inspection
Date: " ' Signature (Applicant or �e
.Application Number 07-00003004..•
Permit, PLUMBING SEWER
Additional desc .
Permit Fee 30.00 Plan Check
Fee,..
.00
? Issue Date Valuation
. . .
. 2500
Expiration Date 5/24/08
Qty. _ Unit Charge Per
Extension
BASE FEE
15.00
1.00 -1S.0000 EA PLB BUILDING SEWER
15.00
----------------------------------_--------
Special Notes and Comments
------
---------------
SEPTIC ABANDONMENT/ SEWER HOOK UP
Fee summary Charged Paid Credited--_
Due
Permit Fee Total 30.00 .00
.00
30.00
Plan Check Total .00, .00
.00
.00
Grand Total 30.00 .00
.00
30.00
Bi" #
City of La Quinta
Building U Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
PerTrlit #
Project Address:
Owner's Name: ,D
A. P. Number:
Address:
Legal Description:
City, ST; Zip:
Contractor:v
Telephone:
M
Address:
Project Description:
City, ST, Zip:.
l C 122-
to
Telephone: 0--36-q-0171
City Lic: #:
State Lic. X: �(
Arch., Engr., Designer.
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person:
Constrgction Type: Occupancy:
Project type (circle one): New . Add'n Alter Repair
Sq. Ft.: # Stories: # Units:
Demo
Telephone # of Contact Person:
Estimated Value of Project
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING .
PERMIT FEES
Plan Sets
Plan Check submitted .
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans picked up .
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
god 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
IN HOUSE:-
''d Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called.Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
11/21/2007 09:42 FAX (a 002
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A.S.A.P.
PUMP/NG
Lic #C42 855 851
OY .3&60"! 00 / 1 -1-0W W.' 7J4` / ADO
FAX 760 328-6607
P.O. Box 2318 • Cathedral City, CA 92235
CUSTOMER'S ORDER NO.
D17 0 E ED
ORDER TAKEN BY
DATE PROMISED ❑ A.M.
❑ P.M.
BILLTO J�y
PHONE
ADDRESS
Pumping Fee per 1000 gal.
CITY
HELPER
JOB NAME AND LOCATION`
❑DAY WORK .
13 CONTRACT
❑EXTRA
DESCRIPTION OF WORK
Dumping Fee per 1000 gal.
QUANT.
DESCRIPTION OF MATERIA ID
`P_RICE
AMOUNT
Gallons
Pumping Fee per 1000 gal.
Dumping Fee per 1000 gal.
Out of Area Fee
Locating /Opening Fee (perh�our)—""�.1—� "
Size System:
0
1
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 concrete, or trees.
SIGNATOR E COMPLETED
TAX
TOTAL