08-0708 (PLBG)• 4&did � oY�' '
P.O. BOX 1504 VOICE (760) 777-7012
78-95 CALLE TAMPICO - . FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT ;:'O INSPECTIONS (760)•777-7153
BUILDING PERMIT d
Date: 4/28/08
Application Number: 08-00000708 Owner:
Property Address: 53650 AVENIDA DIAZ- WHITLOCK ELIZAB H 4p/Q�
APN: 774-112-028-20 -000000- 53650 AVENIDA AZ 81
Application description: PLUMBING LA - QUINTA,- CA 92 cFryOF `OQ®
Property Zoning: COVE RESIDENTIAL ( /N.q
Application valuation: 2200 NCI�D�p/H�q
T
Contractor: -
Applicant: Architect -or Engineer: HAMMER PUMPING INC
P O BOX 2448
CATHEDRAL CITY, CA 92235
(760)360-7448
Lic. No.: 661018
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.
LicenseClass: C42 License No.: 661018
,Oat : Contra for
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 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.).
(_) 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 contractorls) licensed
pursuant to the Contractors' State License Law.).
1 I 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:
LQPERMIT
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 1828655-2008
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 70CL of the L o e I sb4jqrthwi omply with those provisions.
Date. ,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.
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 Quima, 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 1 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 ing construction, and hereby authorize representatives
of this county to enter upon the above-mentioned ro rt f6l-t, pectNa3ggjDses.
j Dateignature (Applicant or Age
Application Number.
. . . . . 08-00000708
Permit . .
. PLUMBING SEWER
Additional desc .
Permit Fee' . .
. 30.00
Plan Check
Fee
.00
Issue Date . . .
.
Valuation
. . .
. 2200
Expiration Date ..
10/25/08
Qty Unit Charge
Per
Extension
BASE FEE
30.00
--------------------------------
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
LQPERNI IT
COACHELLA VALLEY WATER DISTRICT CASH RECEIPT DETAIL
Received From:
Address: L 6C) r r '•7 f%1 ��( G • �/
Account No.
Service Addressr� C? % L y -r. , / t�'l I') / Gf G —
❑ Meter(s)
❑ Service(s)
❑ Backflow(s)
❑ House Lateral(s)
❑ Detector Check(s) —.
❑ Meter Surcharge _
G''• Sanitation Capacity Charge
❑ W.S.B.F.C.
❑ S.I.W.S.C.
- ' -p Temporary Construction Meter-
❑ Turn on Charge
❑ Uncollected Account - Name
❑ Inspection Fee - Tract -
Fee -
❑ Plan Check Fees Water / Sewer -
Tract -
❑ Bond Payment - A.D. - - Bond Assmt
Q Customer Deposit —"
❑ Other
Remarks:
0 Copy to:
Cash C/ �� ../ • >' J CJ
Check 1 i
Money
Order
�2�rC 'r
-77%
122872 A0
Date:
■
Bin #
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
i Permit #
Project Address: O �.� LQ
Owner's Name: �ti� G GDC
A- P. Number:
Address: _;�o _
Legal Description:
City, ST, Zip:
Contractor: dt lµ 1/t'l (i v� �(tiC
Telephone:)
Address: .ZJ dtj�1,K
Project Description:
City, 'ST, Zip: ��
Telephone: 7464
State Lie. # : GQG
Arch., Engr, Designer: .
City tic. #:.
Address:
City" ST, Zip:
Telephone:
State Lic. #:
Construction Type: Occupancy:
Project type (circle one): New Add'n ' Alter Repair Demo
Name of Contact Person:
._ .-
Ft.:
. Sq... ... -
#Stories:. ... #Units: •...
Telephone # ofContact•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 Cafes.
Called Contact Person
Pian Check Balance
Energy Cafes.
Plans picked up
Construction
Flood plain plan,
Plans resubmitted
Mechanical
Grading. plan*
21' Review, ready for corrections/issue
Electrical
Subcontactor-List
Called 'Contact Person
Plumbing
Grant -Deed
Plan§.picked up
S.M.I.
ILO.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'`' 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
www.hammerpumping.com
760/360-7448 7601321-7448 FAX 7601324-6434
Customer Name
Address
City
Ph#
Additional Service -M Required F] Recommended
P.O. BOX 2448 • Cathedral City, CA 92235-2448 • LIC# 661018 JOB INVOICE
J08 DATE: ��, �� ; TIME IN: y v TIME OUT,. TECHNICIAN TECHNICIAN 02 HELPER(S)
ORDERED BY: P.O. a START DATE: END DATE:
,1011 LOCATION
REASON FOR
SERVICE
BACK UP
CONTRACT
MAINTENANCE
REPAIR
❑ MAINTENANCE
4 ESTIMATE
® CONSTRUCTION
OTHER
Description/ Remarks/ Drawings
I
PAID BY:
Credit Card — MC / VISA # EXP.DATE
I hereby authorize Hammer Pumping, Inc. to charge my credit card for the above charges.
I understand that by signing below 1 am agreeing to all charges incurred on this ticket and
that the work was completed to my satisfaction.
Signature for job completion
COMMENTS
❑ Leach System Failing ❑ Roots ❑ Excessive sludge/grease
SERVICES COMPLETED