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06-1733 (PLBG)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: r06-00001733 Property Address: 46895 WASHINGTON ST APN: 643-194-008-63 -2117 Application description: PLUMBING Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 2600 Applicant: Architect or. Engineer: ----------------- LICENSED CONTRACTOR'S DECLARATION BUILDING & SAFETY DEPARTMENT BUILDING PERMIT . 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. LicenseClasls: C36 -C42 -B L tDate: ✓� Contrac 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, 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 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 Owner: ROBERTS HAROLD A 46985 HWY 111 LA QUINTA, CA 92253 Contractor: SO CAL PLUMBING & REPIPE P.O. BOX 955 YUCCA VALLEY, CA 92286 (760)369-4104 Lic. No.: 793482 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 5/03/06 C O MAY 4 2006 CITY OF LA QUINTA FINANCE DEPT. ------------------ 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 1 shouldbecome subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date: •APPIi 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 to enter upon the above-mentioned pro ,Date: Signature IApplican Agem .'Application Number . . . 06-00001733 r � , Permit . . . PLUMBING SEWER Additional desc . Permit Fee 30.00.` Plan Check Fee .00, Issue Date Valuation 2600, Expiration Date 10/30/06 Qty Unit Charge Per Extension BASE FEE 30.00 Special Notes and Comments SEWER CONNECT -SEPTIC ABANDONEMENT 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 40 LQPERMIT Bin # City of La Quinn Building at Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 heetPI Building Permit Application and Tracking Sheet- Permit # (� Project roject Address:' L4 COS q Owner's Name: I A. P. Number: Address: Legal Description: Contractor: City, ST, // "� Telepho l�&�� Address: Project ription: City, ST, Zip: LOA Telephone: �3 State Lic. # : Arch., Engr., Designer: Z City Lie. #: N F Address: City, ST, Zip: Telephone:Construction State Lic. #: Name of Contact Person: o �•. i* Type: Occupancy: Project type (circle one): New Add'n Alter Repair Demo Sq. Ft.: # Stories: #Units: Telephone # of Contact Person: LJ Estimated Value of Project APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Energy Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading,plan 20° Review, ready for corrections/issue Electrical . Subcontactor.List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- Jn° Review, ready for correctionsrissue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees 114 AwSmAmPm PLIMP11116 Lic #C42 855 851 / OW 3L0' 100 / '-1-0UU-33r4- / ZOO CUSTOMER'S ORDER NO. DAT RD ED FAX 760 328-6607 i� O P.O. Box 2318 • Cathedral City, CA 92235 ORDER TAKEN BY DATE PROMISED ❑ A.M. Pumping Fee per 1000 gal. ❑ P.M. BILL TO V1V ` PHONE ADDRESS , 6, Y t MEC ANI CITY14 HELPER JOB NAME AND LOCATION ❑DAY WORK � DESCRIPTION OF WORK / Out of Area Fee ❑ CONTRACT ❑ EXTRA OUANT DESCRIPTION OF MATERIAL USED, PRICE AMOUNT Gallons �.,...-� Pumping Fee per 1000 gal. Dumping Fee per 1000 gal. Out of Area Fee I Locating / Opening fee (per hour) 1 Size System: 1 1 1 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 responsible for secondary damage such as water damage, chipped concrete, mark on street or driveways or trees. SIGNATURE DATE COMPLETED TAX TOTAL aAA