05-2177 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
( 05-00002177
4 52780 AVENIDA DIAZ
773-312-004-23 -000000-
PLUMBING
COVE RESIDENTIAL
2900
Architect or
P `Iq
T414t 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
ROGERS SHIRLEY M
*NOT ON FILE
UNKNOWN, CA 99999
D 0 Contractor:
DATELAND CONSTRUCTION CO INC
50305 HIGHWAY 111
JUN 07 2005 COACHELLA,. CA 92236
(760)398-5544
CITY OF LAQUINTA Lic. No.: 396698
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 theBusiness and Professionals Code, and my License is in full force and effect.
License Class: A -C12 -C34- L'censeN 396698
Date: 7 ontractor:
/ 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).:
(_ 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.).
1 _ 1 I am exempt under Sec. , BAP.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:
LQPERNUT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/07/05
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 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 STATE FUND Policy Number
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 C e I shall ort ith comply those pro v'sions
.
f aJ te: AO6 cant
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.
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 tt000eenterruupp°n the above-mentioned prope insp cti purposes.
Date:--, Signature (Applicant or Agent':
Application Number
Permit . . .
Additional desc .
Permit Fee
Issue Date . . . .
Expiration Date .
. . . . 05-00002177
PLUMBING SEWER
30.00 Plan Check Fee .
Valuation . . . .
12/04/05
.00
2900
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
LQPERD4T
i COACHELLA VALLEY WATE (STRICT CASH RECEIPT DETAIL® 8640
Received From { ' �� ` Date: � ' �y
(
Address: �
Account No, /�% ! �'Lots
Service Address C'�>' `U Illi s �_ (�.�� 1 r (C Z G.A. Code
O Meter. $
O Services)
O Backflow(s)
O House Lateral(s)
O Detector Check(s)
O Meter Surcharge
-sanitation Capacity Charge
❑ W.S.B.F.C.
O S.I.W.S.C.
O Temporary Construction Meter
O Tum on Charge
O Uncollected Account - Name
O Inspection Fee - Tract -
Fee -
O , Plan Check Fees Water / Sewer -
Tract -
❑ Bond Payment - A.D. --Bo n!t Assmt
❑ Customer Deposit
O Other -
.- TOTAL
Remarks: -
"pi toc ' <
Cash Water'Service"
Check 155
Money Cashier
-Order -
HAMMER PUMPING INC.
P.O. Box 2448
CATHEDRAL CITY, CALIFORNIA 92235-2448
(760) 360 - 7448
(760) 321- 7448
BILL TO
ADDRESS
CITY
�U3, NFgME _t, N q..LO CATII
DESCRIPTION OF WORK
Gallons
Pumping Fee per 1000 gal.
Dumping Fee per 1000 gal.
Out of Area Fee
Locating / Opening Fee (per hour)
Size System.
•
JOB INVOICE
CUSTOMER" ORDER NO. DATE ;ORDF.REE
ORDER 1AKEN BY DATE PROMISE❑ A.M.
❑ RM.
PHONE
MecHnf�llr,.
❑ DAY WORK
L CONTRACT
I EXTRA
i lr rL �i,
PRI[=E AMOUNT
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.
liRS LABOR rtMDUNT TOTAL
MECHANICS ® MATERIALS
TOTAL
HELPERS @ LABOR
I hereby acknowledgeEthesatisfactory TOTAL LABOR TAX
completion of the aboescribed work:
aATuIkE DATE COMPLETED
TOTAL