10-0489 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
1�
10-00000489,
Property Address:
78222 CALLE' FORTUNA
AP.N:
770-154-006-6 -000000-
Application description:
PLUMBING
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
2600
Tuyl 4 4v 4"
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.
License Class: C42 `��ense No.: 1018
rDate_� Contractor ��2//%%
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that.) 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.).
(_) 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 agencyfor the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name: _
Lender's Address:
LQPERMIT
Owner:
JEFF FREDERICK
78222 CALLE FORTUNA
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/08/10
Contractor: 1
HAMMER PUMPING INC
P O BOX 2448
CATHEDRAL CITY, CA 92235 JU
(760) 360-7448
Lic. No.: 661018 CEv�'`,-�nfE_r
------------------
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
_ 1 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 SELF - INSURED Policy Number 2246
1 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 Code, I forthwith co ply w/ith_th/ose provisioW.
—Date• 0—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 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 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 to building construction, and hereby authorize representatives
of this cou y t ,enter upon the above-mentioned property fo • ction purpos .
-Date: 0 Signature -(Applicant -or Agent):
Application Number . . . . . 10-00000489
Permit
PLUMBING SEWER
Additional desc .
Permit Fee
30.00
Plan Check Fee
00
Issue Date . . .
.
Valuation
2600
Expiration Date
12/05/10
Qty Unit Charge Per
Extension
BASE FEE
30.00
----------------------------------------------------------------------------
Special Notes and
Comments
SEPTIC ABANDON; SEWER CONNECT. 2007
CODES
----------------------------------------------------------------------------
Other Fees . .
. . BLDG STDS ADMIN (SB1473)
1.00
Fee summary
-----------------
Charged Paid
---------- ----------
Credited
---------- ----------
Due
Permit Fee Total
30.00
.00. .00
30.00.
Plan Check Total
.00
.00 .00
.00
Other Fee Total
1.00
.00 .00
1.00
Grand Total
31.00
.00 .00
31.00
LQPERMIT
` COACHELLA VALLEY WATER DISTRICT
P.O. BOX 1058, COACHELLA, CALIFORNIA 92236 (760) 398-2651
INVOICE Date: 512812010
SUBJECT: 78222 CALLE FORTUNA, LA QUINTA
JEFF FREDERICKS Project: 10-2334
2810TH CT Project Date: 5/27/2010
Amount Due: $3,995.00
OCEANSIDE, CA 92054 GEO: 06-07-06-3
Planner: REBECCA MILWARD
TO INSURE PROPER CREDIT, PLEASE RETURN THIS PORTION WITH
REMITTANCE AND INCLUDE THE PROJECT ON YOUR CHECK
SUBJECT: 78222 CALLE FORTUNA, LA QUINTA
Bin #
City of La Quint
Building 8z Safety Division
Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit # VP.O.
v
Project Address: —7 2,'Z Ccilt4e
Owner's Name:
A. P. Number:
Address: 2
Legal Description:
City, ST, Zip:
Contractor:^
e✓ to
Telephone: 00-11,[51
:-
Address: G e Q
Project Description:
City, ST, Zip: , <:{Z
Telephone: 6 ®. -t' t l'i°Q`•
:•.':;: :.r
State Lic. # -. _ Z .616JR
City Lie. #;
Arch., Engr., Designer.
Address:
City, ST, Zip:
Telephone:*
State Lie. #: s�� ` .
Construction T ype: Occrtpancy:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: Estimated Value of Project: 'Z Q
APPLICANT: DO NOT WRITE BELOW THIS LINE
to
Submittal
P q'd
Rec'd
TRACIUNG PERMIT FEES
Plan Sets
Plan Check submitted Item Amount
Structural Cales
Reviewed, ready for corrections Plan Check Deposit
Truss Calcs.
Called Contact Person Plan Check Balance
Title 24 Calcs.
Plans picked up Construction
Flood plain plan
Plans resubmitted Mechanical
Grading plan
2`! Review, ready for correctionsli sue Electrical
Subeoutactor 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.1.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
HMMER
www.hammerpumping.com
760/360-7448 7601321-7448 FAX 760/324-6434
Description/ Remarks/ Drawings
P.O. BOX 2448 • Catht..:ai�',;i CA 92235-2448 • LIC# 661018 JOB INVOICE
JOB DATE: _ IME IN: TME OUT. ITENICIAN 41 TECHNICIAN 02 7LPER(S)
ORDERED BV: P.O. Y I START DATE: END DATE:
JOB LOCATION
SERVICE
BACK UP
CONTRACT
MAINTENANCE
REPAIR
MAINTENANCE
ESTIMATE
CONSTRUCTION
OTHER
PAID BY:
:redit Card — MC i VISA # EXP.DATE
1 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.
7
COMMENTS
Eq, Se we or ' 1400 ]6 c�a
[] Leach System Failing ❑ Roots ❑ Excessive sludge/grease