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05-2306 (PLBG)
Jr P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application description Property Zoning: Application valuation.= Applicant: M., 05=000023061 51270 CALLE JACUMBA 770-166-001-24 -000000- PLUMBING MEDIUM DENSI�R-GaS-1 `6i'Y 4 4 Q" Dr Engineer: T BUILDING & SAFETY DEPARTMENT BUILDING PERMIT 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 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 an pplicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: ( 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 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 - -- - - - - Date: 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: ON F Lender's Address: 0 A LQPERMIT Owner: JAIME VASQUEZ 51270 CALLE JACOMBA LA QUINTA, CA 92253 Contractor: Owner VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 6/13/05 WORKER'S 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 thio 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 Number tW"rcertify 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 forthwith comply with those provisions. D_V . Date: 5'-13 scant: 1 {// WARNING: FAILURE TO SECURE ORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS 1$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 this county to enter upon 'above-mentioned property for inspection purposes. Date ignature (Applicant or Agent): pgi&294�11L[llii 40W 6-1 Application Number . . . . . 05-00002306 Permit . . PLUMBING SEWER Additional desc . Permit Fee . . . . 30.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 3000 Expiration Date 12/10/05 Qty Unit Charge Per. Extension BASE FEE 30.00 ---------------------------------------------------------------------------- Special Notes and Comments SEPTIC ABANDON; SEWER CONNECT 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 LQPERMIT .. . . Bin # Permit # n 3p�0 t� Project Address: A. P. Number: .Legal Description: Contractor: Address: City, ST, Zip: Telephone: . State Lic. # Arch., Engr., Designer: . Address`. City, ST, Zip: Telephone: State Lic. #: Name of Contact Person: Telephone # of Contact Person: City of La Quinta f Building &I Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, C4 92253 - (760) 777-7012 Building Permit Application and Tracking ShPPr Lic. #: I Owner's Name: APPLICANT: DO NC # Submittal Rcq'd Rec'd Telephone: %! .......... Project Description: e.4)V T r Construction Type: Occupancy: Project type (circle one):. New Add'n Alter Repair Demo Sq. Ft.: # Stories: # Units: Estimated Value of Project: Vo T WRITE BELOW THIS LINE TRACKING PERMIT FEES ed Item Amount corrections Plan Check Deposit on Plan Check Balance Construction Alechanical r corrections/issue Electrical on Plumbing t Grading corrections/issue Developer Impact Fee Dn A.I.P.P. Total Permit Fees i COACH LLAv�VALLEY WATER DISTRICT CASH RECEIPT DETAIL N2 108698 Received From: ' Q 'z Address: ex Account No. . Lot(s) Tract Service Address G:A. Code ❑ Meter(s) $ ❑ Service(s) ❑ Backflow(s) ❑ House Lateral(s) ❑ Detector Check(s) ❑ M ter Surcharge IR Sanitation Capacity Charge ❑ W.S.B.F.C. ❑ S.I.W.S.C. ❑ Temporary Construction Meter I ❑ Turn on Charge ❑ Uncollected Account :► Name ❑ Inspection Fee - Tract' - Fee - ❑ Plan Check Fees Water / Sewer - ' Tract - ❑ Bond Payment - A.D.•-' Bond Assmt ❑ Customer Deposit ❑ Other TOTAL � $ ` Remarks: ebb Va ,oPY to: Cash Water Service Check Money Cashier Order CVWD-438 (1/05) i i OWNER/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 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. 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. a 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. J 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 not 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 may be 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 QUINTS DEPT. OF BUILDING AND SAFETY 78-495 Calle Tampico La Quinta, CA 92253 (760) 777-7012 FAX: (760) 777-7011 rWNER'S SIGNACP MIDATE PROPERTY ADDRESS O.V-- a3D� PERMIT NUMBER(S) J !i HAMMER PUMPING INC. JOB INVOICE P.O. Box 2448 CATHEDRAL CITY, CALIFORNIA 92235-2448 17srn sAn-SAAR i7 -6 -0 -iii -1-7,44-8 CUSTOMER'S ORDER NO. DA E ORDERED ORDER TAKEN BY DATE PROMISED ❑ A.M. ❑ P.M. BILL TO PHONE ADDRESS MECHANIC CITY HELPER JO NAME AND LOCATION(/'yam-i t 1 o�[ -"7-0 �(.[ l Vl l..�U �/"'^'" ]7��1 Vim. C� ❑DAY WORK DESCRIPTION OF�WjORK ACT 0 EXTRA QUANT. DESCRIPTION OF MATERIAL USED PRICE AMOUNT Gallons ©� Pumping Fee per 1000 gal. Dumping Fee per 1000 gal. S O Out of Area Fee Locating / Opening Fee (per hour) Size System: 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. HOURS LABOR AMOUNT TOTAL MATERIALS MECHANICS Q HELPERS Q TOTAL LABOR I hereby acknowledge the satisfactory completion of the above described work: TOTAL LABOR TAX SIGNATURE � tc.Q DATE COMPLETED _ 1 c'7 S TOTAL G b S 0 0 HAMMER PUMPINGINC. P.O. Box 2448 CATHEDRAL CITY, CALIFORNIA 92235-2448 17arn ,aan _ SAAR 1f JOB INVOICE (760) 321- 7448 CUSTOMER'S ORDER NO. ARE ORDERED ORDER TAKEN BY DATE PROMISED ❑ A.M. ❑ P.M. BILL TO PHONE ADDRESS ME HANIIC _� Lf V y CITY HELPER JO,B•NAM N LOCATIO �� O a �� l 7 �` ❑ DAY WORK ❑CONTRACT ❑ EXTRA DPOF WORK }/ L) d t. -YEspo Ku QUANT. DESCRIPTION 6F MATERIAL USED PRICE.: AMOUNT Gallons Pumping Fee per 1000 gal. Ov O Dumping Fee per 1000 gal. j O Out of Area Fee Locating / Opening Fee (per hour) Size System: y� 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. HOURS LABOR AMOUNT TOTAL MATERIALS MECHANICS @ HELPERS Q TOTAL LABOR I hereby acknowledge the satisfactory completion of the above described work: TOTAL LABOR TAX SIGNATURE _ DATE COMPLETED �o 15 TOTAL ©r7