07-2765 (PLBG)114
j
T
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
07-00002765
Property Address:
54074 AVENIDA VILLA
APN:
774-224-004-6 -000000-
Application description:
PLUMBING
Property Zoning:
COVE RESIDENTIAL
Application valuation:
6000
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
------------------------------ ------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 00) f Division 3 of the Bu 'ness and Professionals Code, and my License is in full force and effect.
License lass A Lice a No.: 715646
Dat e�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).:
(_ 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 contractods) licensed
-• pursuant to the Contractors' State License Law.).
(_ 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:
LQPERMIT
Owner:
ESTRADA MIRNA
54074 AVENIDA VILLA•
LA QUINTA, CA 92253.
(760)449-1824
Contractor:
JUAREZ GRADING
54-125 AVENIDA RUBIO
LA QUINTA, CA 92253
(760)771-5715
Lic. No.: 715646
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760)-7771-7153
. Date: 10/15/07
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✓ _ 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 0019217-2007
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,
nd agree that, if I should become subject to the workers' compensation provisions of Section
700 of the Labor Code, I shall forthwith comply,41 r
ythose provisions.
Date:r Appl' ant:
WARNING: FAILURE TO SECURE WORKERS' COMPE SATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS. is 100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION3706 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 c my rdinances and state laws relating to building construction, and hereby a orize representatives
of th�is7!c��o nty�t enter upon the above -men ed prope ty for inspection purposes.
Dat[: V Signature (Applicant or A entl: r
Application Number 07-00002765
41- Permit PLUMBING SEWER.
,
Additional desc .
Permit Fee 30.00 Plan Check
Fee
.00
Issue Date . . . . Valuation
6000
Expiration Date 4/12/08,
Qty Unit Charge Per
Extension
BASE FEE
15.00
:1.00 15.0000 EAPLB BUILDING SEWER
15.00
------Notes and Comments=--.----------------------------------------,-
Special
-
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
. LQPERMIT
Bin #
City of La Quinta
Building & Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #i
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Project Address:
Owner's Name:
A. P. Number:
Address: V W `A A
Legal Description:
City, ST,.Zip:OU
Contractor.
e
Q
Telephone: Q . _ U g
Project Description:
Address: • S l 11�111N ftle.
City; ST, Zip: .
Ill
Q�
Telephone: ��
;
City Lic. #:
State Lic. # :
Arch., Engr., Designer:
Address:
City, ST, Zip:
<
Telephone:
State Lic. #:
Name of Contact Person:
Construction Type: Occu anc :
P Y
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: #Stories: #Units:
Telephone # of Contact Person:
Estimated. Value of Project: ( Q
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 Calcs.
Called Contact Person
Plan Check Balance
Energy Cates.
Plans picked up
Construct.on
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2°" Review, ready for corrections/issue
Electrical
Subcontaetor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.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
J
Date of permit issue
School Fees
Total Permit Fees
A-1 Cesspool Servic
P.O. Box 580188%North Palm Springs,
`Since 1959'
(760) 329-6875 Fax (760) 251.
State Lic. #265214
www.alcesspool.com
OICE
ADDRESS �� / 49—
CITY
CITY � � 1 HELPER
JOB ASEAESS AI
SERVICE ZyUMP SEPTIC TANK HAS SEPTI TANK BEEN DUG Yes ❑ No , PMT. ON SITE
REQUESTED PUMP SEEPAGE PIT AT ITS RISE ❑ OFFICE BILLING
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Pumping Fee per 1000 Gallons (or fr tion)
Waste Discharge Fee per 1000 Gallo
Locating and Opening Fee (lhr. Min.
Out of Area Fee
9/L dii l/� 7
r.
❑ THE LEACHING SYSTEM HAS FAILED.
❑ THERE IS AN OBSTRUCTION "UPSTREAM" OF TH SEPTIC TANK.
It will be necessary to contact a lme cleaning comp
❑ WE RECOMMEND MAINTENANCE PUMPING OF SEPTIC TANK EVERY
C] YEAR ❑ OTHER YEAR [32.3 YEARS e
To remove built up solids. This will increase the fife of your leaching system.
❑ THIS PUMPING WILL PROVIDE ONLY TEMPORARY RELIEF AND 140T
SOLVE CUSTOMERS SEPTIC PROBLEM BECAUSE OF THE ABOVE.
❑ CUSTOMER HAS BEEN GIVEN AN "EXPLAIN ION" PACKET.
A SERVICE CHARGE OF s22 WILL',BE DUE
ON ALL I ETRUNED CHECKS.
A FINANCE CHARGE OF 1 146 PElt MONTH,18,% PER,YEA&' WILL BE i
CHARGED ON PAST DUE ACCOUNT&OVEMO DAYS.
1P AH11E ff Is BY C �C
DRIVERS LIC. a �1 .� / STATE
thereby aeknowteEge the" safls�tact ry c PleNon of tb boesalbed w
SICNATUR� /�
17C/ i
Total
Due
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