05-3610 (PLBG)• P.O. BOX 1504
Titlt
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 05-00003610' Owner:
Property Address: 51170 AVENIDA HERRERA UNGARD SYLVIA JO
APN: 773-064-006-17 -000000-' 5433 N CALERA AVE
Application description: PLUMBING D d COVINA, CA 91722
Property Zoning: COVE RESIDENTIAL
Application valuation: 2500
AUG 12 2005 Contractor:
�t Applicant: `,- -Architect or�ngineeclTy � SO CAL PLUMBING & REPIPE CO
FINANCE D UI�A P.O. BOX 955
EPf YUCCA VALLEY, CA 92286
(760) 369-4104
Lic. No.: 793482
`7
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,an4 my License is in full force and effect.
License Class: C36 -C42 -B ' License N.-%7914_82
NER-BUILDER DECLARATION
I hereby affirm u derp¢T2 y o 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 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 ISec. 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 contractorls) licensed
pursuant to the Contractors' State License Law.).
( 1 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
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/12/05
WORKER'S COMPENSATION DECLARATION
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 I should become subject to the workers' compensation provisions of Section
,/ 3700 the Labo Code, I shall forthwith comply with those provisions.
aP a e: plic L
WARNING: FAILURE TO SE R NSATI0 COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER MINAL 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 ordinancespd d state laws relating to building construction, and hereby authorize representatives
of this county to enter n t eabove-mentioned property for inesti es.
Date: i� ignature (Applica gent
' Application Number . . . . . 05-00003610
Permit PLUMBING SEWER
Additional desc .
Permit Fee . . . . 30.00
Plan Check
Fee
.00.
Issue Date
Valuation
. . .
. 2500
Expiration Date 2/08/06
1. Qty Unit Charge Per
Extension
BASE FEE
30.00
----------------------------------------------------------------------------
Special Notes and Comments
SEPTIC ABANDON; SEWER CONNECT
Fee summary. Charged Paid
Credited
Due
-------------------------------------
Permit Fee Total 30.00
----------
.00
----------
.00
30.00
Plan Check Total.. .00_
.00•
r Grand Total 30.00
.00
.00
.b0
.00
30.00
Ge
LQPERMIT - -
FROM : LFI QUINTA REAL ESTATE PHONE NO. : 760 5644328 May. 25 20t5 01:20PM P3
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PUMP/NG
Lic #C42 855 851 /
I OU 340- 1001 1-ODU-334- f 400
FAX 760 328-6607
P.O. Box 2318 • dai thedral City, CA 92235
CUSTOMER'S ORDER NO.
DATE ORDERED
ORD I(7 BY
DA PROMISED ❑ A.M.
❑ P.M.
BILL TO
PHONE
ADDRESS
MECH IC
CITY
HEL ER
JOB NAME AND LOCATION
�
❑DAY WORK
DESCRIPTION OF WORK
❑ CONTRACT
❑ EXTRA
Gtr
QUANT
DESCRIPTION OF MATERIAL USED
PRICE
AMOUNT
Gallons
�?
Pumping Fee per 1000 gal.
Dumping Fee per 1000 gal.
Out of Area Fee
Locating/ Openi g -Fee (pe
Size Syste ..
f
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
ge; chipped rete, mar on sdiiveways or trees.
SIGNATURE _ DATF Go .CSTED
i�
TAX
TOTAL