09-0938 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 0-9-00000938
Property Address: 52295 AVENIDA HERRERA
APN: 773-263-025-4 -000000-
Application description: PLUMBING
Property Zoning: COVE RESIDENTIAL
Application valuation: 3000
T -&t 4 4 Q"
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 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
License Class: B C36 C42 License No.: 793482
Date:C%- 309 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 thanfive hundred dollars ($500).:
(_ )- 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.).
1 _ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
70.44, 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.).
(_ 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:
LQPER 11T
Owner: .
JONES RALPH S
Contractor:
SO CAL & ASSOCIATES
P.O. BOX 955
YUCCA VALLEY, CA 922
(760)369-4104
Lic. No.: 793482
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/03/09
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 STATE FUND Policy Number 1820769-2009
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 of the Labor Code, I shall fo i ose provisions.
Date: Applic
WARNING: FAILURE O SEC ERS' 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 �ignature
upon the above•mentioned nspection purposes.
Date: (Applicant or gent):
Application Number . . . . . 09-00000938
Permit . .
. PLUMBING SEWER
Additional desc .
Permit Fee
30.00
Plan Check Fee
.00
Issue Date
Valuation . . .
. 3000
Expiration Date
3/02/10
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 15.0000
EA PLB BUILDING SEWER
15.00
-------=--------------------------------------------------------------------
Special Notes and
Comments
SEPTIC ABANDONMENT
/ SEWER HOOK UP
----------------------------------------------------------------------------
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
LQPE"IFP
City of La Quinta
Building a Safety Division
Permit #
P.O. Box 1504, 78-495 Calle Tampico
n,�
La Quinta, CA 92253 - (760) 777-7012 K
1
BuildingPermit Application and Tracking Sheet
Project Andress: � Q,� S .
..�
"Oimer's Name: �},
A. P. Number:
AddrasFf
Contractor:I
Telephone jj�%�'� • ` y. �
Address:
Proet D ption:
City, ST, Zip:
Telephone:
State Lic. # : Lk Z
City Lic. C
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:<'
' ° '£ .: '. Construction Type:' Occupancy:
State Lic. #:
»?.r' Project" (circle one): New Add'n Alter Repair Demo
�jp'" ;�
,
Name of Contact Person:
Sq. Ft.:#Stories: # Units:
Telephone # of Contact Person: Estimated Value of Project:
APPLICANT: DO NOT WRITE. BELOW THIS LINE
# Submittal Req'd .
Rec'd TRACEING PERMIT FEES
Plan Sets.
Plan Check submitted Item Amount
Structural Caics.
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 co rrectionsrissue Electrical
Subcontactor List
Called Contact Person Plumbing
Grant Deed
Plans picked up. S.M.I.
R.O.A. Approval
Plans resubmitted Grading
IN HOUSE:-
''" 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
ASAP
PUMPING, Inca Uc #C42 855 851
760 328-7887. 760 365-4125
Fax 760 365-4118.1-800-334-7255
P.O. Box 2318 • Cathedral City, CA 92235
ESCROW x
DA RDER
BILL TO
PHONE
ADDRESS
FAX
CITY
MEC A IC
JOB NAME AND LOCATION
f'
DESCRIPTION OF WORK
V
OUANT
DES RIPTION OF SERVICES PRICE
AMOUNT
j��
Pumping Fee per 1000 gal.
Rooter Service
Camera
Labor $75/HR
Septic Inspection
Locating / Opening Fee $75/HR
Jetting Service ca
Out of Area Fee
Comments:
FUEL
SYSTEM FAILING* ❑YES ❑ NO CHARGE
• A FAILING SYSTEM MAY FILL BACK UP WITHIN A FEW DAYS AND TOTAL
MATERIALS
CONTINUE TO HAVE PROBLEMS IF NOT RECTIFIED. TOTAL
LABOR
$25 U U
condary dame er TAX
�dam�sge,chi�ncr-ete, me ways or trees.
DATE COMPLETED TOTAL
/ /
COACHELLA VALLEY WATER DISTRICT
P.O. BOX 1058, COACHELLA, CALIFORNIA 92236 (760) 398-2651
INVOICE Date: 9/3/2009
SUBJECT: 52-295 AVENIDA HERRERA, LA QUINTA, ACCT. NO. 606121,325.0.5
RALPH S. JONES Project: 9-1892
GEO: 6-6-12-1
Planner: JULIE KRETZ
3. TO INSURE PROPER CREDIT, PLEASE RETURN THIS PORTION WITH
REMITTANCE AND INCLUDE THE PROJECT ON YOUR CHECK
1.00 SCC -COLLECTION $1,658:001 $1,658.00
1.00 SCC -TREATMENT $2,337.00 $2,337.0
PAID $3,995.00
3�_Dt�
SEP 0 3.2009.
COACHELLA VALLEY
WATER DIST13ICT
SUBJECT: 52-295 AVENIDA HERRERA, LA QUINTA, ACCT. NO. 606121,325.0.5
G
} COACHELLA VALLEY WATER DISTRICT
", P.O. BOX 1058, COACHELLA, CALIFORNIA 92236 (760) 398-2651 Pagel