08-0332 (PLBG)T4ht 4 4a Q"
Architect or Engineer:
PIV
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
-------------------------- 7 ------------------------
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: B_C36 C42 LicenseNo.: 793482
ate: O 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 ($500).:
(_) 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 _ 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:
Lender's Address:
LQPEFAIIT
Owner:
SONYA. FORD
78659 AVENIDA
LA QUINTA, CA
LA FONDA
92253
Contractor:
SO CAL & ASSOCIATES
P.O. BOX 955
YUCCA VALLEY, CA 922
(760)369-4104
Lic. No.: 793482
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 717-7153
Date: 2/22/08
--------------------------------------------
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 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
3700 of the Labor Code, I shall forthwith comply with those provisions..
WARNING: PCIILURE TO SECURE AGE 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 this county to enter upon th above-mentioned property for inspection purposes.
pdltre:
.
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA
92253
Application Number:
C 08-00000332
Property Address:
78659 AVENIDA LA FONDA
APN:
770-171-002-145 -000000-
Application.description:
PLUMBING
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
3000
T4ht 4 4a Q"
Architect or Engineer:
PIV
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
-------------------------- 7 ------------------------
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: B_C36 C42 LicenseNo.: 793482
ate: O 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 ($500).:
(_) 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 _ 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:
Lender's Address:
LQPEFAIIT
Owner:
SONYA. FORD
78659 AVENIDA
LA QUINTA, CA
LA FONDA
92253
Contractor:
SO CAL & ASSOCIATES
P.O. BOX 955
YUCCA VALLEY, CA 922
(760)369-4104
Lic. No.: 793482
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 717-7153
Date: 2/22/08
--------------------------------------------
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 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
3700 of the Labor Code, I shall forthwith comply with those provisions..
WARNING: PCIILURE TO SECURE AGE 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 this county to enter upon th above-mentioned property for inspection purposes.
pdltre:
Application Number .
. . . 08-00000332
Permit . . .
PLUMBING SEWER
Additional desc .
Permit Fee
30.00
Plan Check Fee -.
.00
Issue Date . . . . .
Valuation . .
. 3000
Expiration Date
8/20/08
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
5
I Bin #
# Submittal Re
Plan Sets
Structural Calcs.
Truss Calcs.
Energy Calcs.
Flood plain plan,
Grading. plan
Subcontactor.List
Grant'Deed
H.O.A. Approval
IN HOUSE:-
Planning
OUSE:Planning Approval
Pub. Wks. Appr
School Fees
'City of La Quinta ..
'Building a Safety Division
P.O. Box 1 SO4, 78-49S Calle Tampico
U Quilita, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Owner's Name:=A
Address: f7 g'
City, ST, Zip: L1
. r [Telephone:
Project Description: .
I>//"
�1
Lic. #:
Construction Type:
Permit >�
Project Address:'
Project type (circle one):
A. P. Number:
1�
Legal Description:
# Stories: units'
Contractor:
Address:
Estimated Value of Pr
City, ST, Zip: ,
vtx
Telephone:
, LA
State Lic. # :
<
Arch., Engr., Designer:
Address:
Plan Check submitted
City, ST, Zip:
'Item
Telephone:
State Lic. #:
Name of Contact Person: V
Telephone # of Contact Person:
# Submittal Re
Plan Sets
Structural Calcs.
Truss Calcs.
Energy Calcs.
Flood plain plan,
Grading. plan
Subcontactor.List
Grant'Deed
H.O.A. Approval
IN HOUSE:-
Planning
OUSE:Planning Approval
Pub. Wks. Appr
School Fees
'City of La Quinta ..
'Building a Safety Division
P.O. Box 1 SO4, 78-49S Calle Tampico
U Quilita, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Owner's Name:=A
Address: f7 g'
City, ST, Zip: L1
. r [Telephone:
Project Description: .
I>//"
�1
Lic. #:
Total Permit Fees
Construction Type:
Occupancy:
Project type (circle one):
New Add'n 'Alter Repair Demo
1�
Sq. Ft.:
# Stories: units'
�l •
Estimated Value of Pr
APPLICANT: DO NOT WRITE BELOW THIS LINE
.
I'd
Recd
TRACMG .
PERMIT FEES
Plan Check submitted
'Item
Amount
Reviewed, ready for corrections
Plan Check Deposit
Called Contact Person
Plan Check Balance
Plans picked up
Construction
Plans resubmitted
Mechanical
2°" Review, ready for correctionsfissue
Electrical'.
Called Contact Person
Plumbing
Plans. picked up
S.M.I.
Plans resubmitted
Grading.
Review, ready for correctionsfissue
Developer Impact Fee
Called Contact Person
A.I.P.P.
Date of permit issue
Total Permit Fees
Z0/Z0 3E)Vd AIA(inaE Z0E9Eu90'_,I Sb:9T 800Z/TT/Z0
ASAP
PUMP/NG, Inc.
760 328-7887 • 1-800-334-7255 CUSTOMER'S OR[
FAX 760 328-6607 ORDER TAKEN BY
P.O. Box 2318 • Cathedral City, CA 92235
31 LL TO
NAME AND LOCATION
PTION OF WORK
Y/
Lic #C42 855 851
DATE PROMISED ❑ A.M.
❑ P.M.
PHONE
ME IC
HELPER
❑ DAY WORK
❑ CONTRACT
❑ EXTRA
QUANT
DESCRIPTION OF MATERIAL USED
PRICE
AMOUNT
Gallons
Pumping Fee per 1000 gal.
Camera/Power Snake
Out of Area Fee
•
Locating / Opening Fee (per hour)
$. 5/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 responsage such as water
dama ed concrete, marl eet or s or trees.
SIGNAT.0 COMPLETED
TAX
TOTAL
_
%