05-1677 (PLBG)BUILDING & SAFETY DEPARTMENT
15.04
C (760),777-7.0,12
F - LLE TAMrCco FAX (760)'777-70T1
LA Q , CALIFORNIA 92253 INSPECTION REQUESTS (7,60) 7.77-7153
JUN 0'7 2005
BUILDING PERMIT
CIIsINMCE DEPT. Op: LA A
Application Number 05-0000.1677 Date 5/65/05
Property Address . . . . . . 77925 CALLS DURANGO
APN: 773 -234 -012 -1 -000,000 -
Application description PLUMBING
Property Zoning.. COVE RESIDENTIAL
Application valuation-. 1500
Owner Contractor
HASSON GABRIEL B DESERT EMPIRE PLUMBING & DRAIN
P O BOX 233 35.450 PEGASUS COURT
LA QUINTA,- CA 9225.3 PALM DESERT, CA 92211
(760)345 -6166
WCC; STATE'FUND
WC : 17,0.5218-20.04 10/01/05
CSLB: 80:3.145 01/,31/06
CCC: C36
d1'P.O. Box 1504 I1�� ° VOICE . (760) 777-7012
78-495 CALLS TAMPICO FAkV60),777-7011
LA QUINTA, CALIFORNIA 922'53 INSPEG,TIU S. (,7'60)'77T,-75;53
BUILDING & SAFETY DEPARTMENT
Application Number: 05-140,71 Date
Applicant: I Architect or Engineer .
Applicant's Mailing Address:
Architect or Engineer's' Address:
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of pery"ury that I am licensed under rovisions of Chapter 9 (commencing with Section 7000) of Division 3 of:the Business and Professionals
C nd my License. is in full roe and effect.
cense Class C �3 License
OWNER -BUILDER DECLARATION
1 herebyaffirm under penalty, of perjury that I am exempt'frorn the Contractors' State License Law for the7ollowing reason (Sec. 7031.5; Business and Professions Code: Any
city or county that requires a penniY.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 Contractors' State, Ucense�Low'(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' forthe alleged exemption. Any violation of Section 7031.5 by any applicant fora permit subjects
the applicant to a civil penalty of not more than five hundred dollars ($500).):
U I, as owner of the property, ormy'employees with wages as their sole compensation, will do. the work, and,the structure is not.intendedor offered for sale (Sec. 7044,
Business and Professions`Code: The Contractors' State License Law does not applyto.an owner of property who builds or improves: thereon, and who does the work'
himself or han.ettor through his or' tier own employees, provided that the improvements are not.inNnded'.or offered for sale. It +however, the building,or. Improvement is
sold within one year of completion; the owner -builder will have.theburden of proving that.he or she dtd not (wild or improve for the purpose of sale.).
U 1 as owner of the property, am exclusively contracting with licensed.contradors 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,contrador(s) licensed pursuant to -
the Contractors' State License Law.).
U I am exemptunder Sec. , BA P.C. for this reason
Date
WORKERS' C_ OMPENSA_ TION DECLARATION
I herebyaffrm, under penaltyof penury, one of the following declarations:
l 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.
-kof the work for which this penmit•is issued.
I have and will maintain workers' compensation insurance;.as' required by Section 3700 of the Labor Code, for the perfonnance.of the.work for which this permit is
issued. My_workers,compeation i nce carrier and policy number are:
mer SIR i X- Fuifd nsoliev Number / 7 ej SZ 1 9— 2 0 (
I certifythat, in the performance of the work for which this permit is.issuaid, l'shall not employ any persom)n any;manner so as to become subject -to the workers'
compensation laws of California, andagree that; if I, should, become subject to the workers' compensation provisions of Section 3700 of, ft.Labor Code, I shall
forthwith comply with those provisions. _
WARNING: FAILURE'TO SECURE WORKERS' COMPENSATION COVERAGE IS LINLAWFUL, 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 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury thatthere is a: construction'lending agency'for the performance of the work for which this perk is issued (Sec. 3097, Civ. C.).
Lender's Name
Lenders Address
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 ondhis 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'perrnil
issued as a result of this application, the owner, and the applicant, each agrees to, and shall, defend, indemnify and.hold,hamiless the City of La Quints, its
officers, agents and employees for anyact or omission related to the work being performed under or folowing 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 4rom date of issuance of such parrnit,.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,corred. I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize rep ntatives of this county to enter upon the above-mentioned property for inspection purposes.
D ` b ig'nature (Applicant or Agent):
r .
:.application Number . . . . . 05-00001677
Permit . . . . . . PLUMBING SEWER
Additional desc . .
Permit Fee . . . . 30.00
Issue Date . . . .
Expiration Date 10/29/05
Qty Unit Charge Per
BASE FEE
Plan Check Fee . . .00
Valuation . . . . 1500
Extension
30.00
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
.I COACHELLA VALLEY WATER DISTRICT CASH RECEIPT DETAIL p � 2 07671
Received From: �.i e C—I �� 'r 3f2I�L /y/mSo/w f'� -
Address: ��x rrP�4cFawl-vmj
Account No. CO Rb0 • +yLot(s)
Service Address f -7 �� a �
❑ Me1er(s)
❑ 5ervice{s)
❑ Backtiow(s)
❑ House Lateral(s) _
❑ Detector Check(s)
❑ Meter Surcharge
[(Sanitation Capacity Charge
!❑ .W.S.B.F.C.
I ❑ S.I.W.S.C.
L ❑ Temporary Construction Meter
❑ Turn on Charge
❑ Uncollected Account -Name
❑ Inspection Fee -Tract -
Fee - —
❑ Plan Check Fees Water / Sewer -
i
Tract -
❑ Bond Payment -A.D.- Bond-- Asspl)l
❑ Customer Depasii—
❑ Other
. CA. zS3
Tract
G.A. Code
]� /� / • TOTAL $ •�O
/t Remarks: � • v I � ► JLrV
Copy to: /
l
Water Service
Cashier
CVWD-438 (1/05)
194
A.S®A.P.
P[JMP/I1/G
Lic #C42 855851
f ou 440- f 00 f 0 '11 -auu-034, 00
FAX 760 328-6607
RO. Pok 2319 *..Cathedral City, CA .92235
CUSTOMERS ORDER NO.
DATE ORDERED
-:2 -0,5
ORDER TAKEN BY
DATE PROMISED 0 AM
0 P.M.
BILL Tor
PHONE
ADDRESS
MEC NIC
CITY.
HELPER If
JOB NAME AND LOCATION
.
0 -SAY WORK
DESCRIPTION Or WORa
ElCONTRACT
El EXTRA
QUANT.
DESCRIPTION OF MATERIAL USED
PRICE
AMOUNT
Gallons
tooe)
Pumping, Fee per 10O0gal.
Dumping Foe per 1000 gal.
41)
l 00
Out of Area Fee
Locating / Opening Fee (per hour)
e
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 10 DAYS.
TOTAL
MATERIALS
TOTAL
LABOR
WAIVER: Not responsible.for secondaiy.damage such as water
damage, chipped concrete, mark on West or a drivewa or trees. k
SIGhIATURE DATE:COMPLETED
K & /�- PT
TAX
FTOTAL