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05-1743 (PLBG)BUILDING & SAFETY DEPARTMENT P.O. BOX 1504 C (760):7774012 �p -495 CALLE TAMPICO FAX (760) 777-7011 tiLA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS -(760.) .7.77-7153 Q oma' oS�� BUILDING PERMIT 0 O App ion Number . . 05-00001743 Date 5/06/05 r y Address . . 52862 EISENHOWER DR AP 773-331-.006721 -000000- cation description. PLUMBING Property Zoning.. COVE RESIDENTIAL Application valuation . . . 200` Owner Contractor --------------------------------- -------------- --------------- ---- SETH HOFFMAN Owner 52862 EISENHOWER DR LA QUINTA, CA 92253 i i i i P.O. BOX 1504 �Gta�w VOICE (760) 777-7012 78-495 CALLS TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: Ste— n % 3 Date: �' C Applicant: Applicant's Mailing Address: Architect or Engineer: Architect or Engineer's Address: Lic. No.: BUILDING PERMIT DECLARATIONS - LICENSED CONTRACTOR'S DECLARATION affirm I hereby arm 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 License No. Date Contractor OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that 1 am exempt from the Contractors' 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 Contractors' 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 Ott}¢ 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 or 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.). U 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.). U I am exempt under Sec. , BA PX. for thiy reasoj 5 • Q 7 Owner WORKERS' COVJENSATION 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 Policy Number I certify that, in the performance of the w9eq 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 ee that f I shou ecome suh1lect to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisio . 1 Date '51,60-6 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS L114L4WFqL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION J?7E E COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE; INTEREST, AND ATTORNEY'S FEES. 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 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 calation. I certify that I have read this application and state that the above i o anon is correct. I a ee to co ly with all city and county ordinances and state taws relating to building construction, and hereby authorize representatives of this county o ter upo the above enfion d rope y for inspection purposes. Date V V Signature (Applicant or Agent): ---------------------------------------------------------------------------- �. Application Number . . . . . 05-00001743 ---------------------------------------------------------------------------- Permit PLUMBING SEWER Additional desc Permit Fee . . . . 30.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 200 Expiration Date . . 11/02/05 Qty Unit Charge Per Extension BASE FEE 30.00 ---------------------------------------------------------------------------- Special Notes and Comments SEWER CONNECT & SEPTIC ABANDONEMENT OF 2 SYSTEMS ON.THIS PROPERTY. 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 A( COACHELLA VALLEY WATER DISTRICT CASH RECEIPT DETAIL 107973 Received From: �%-f fl T'./rLAAI Address: P a •a%i 1997, CA l.a. �u/.cjT..jL �+`]: ZZ.53 Account No. Lot(s) Z Z 6LX—, 114 S Tract_ C�- Z ��t Service Address .L•lt� [FTI�w�� L G.A. Code ❑ Meter(s) ❑ Service(s) ❑ Backflow(s) ❑ House Lateral(s) ❑ Detector Check(s) ❑ Meter Surcharge anitation Capacity Charge . ® �y7� �a : b -TS ❑ W.S.B.F.C. ❑ S.I.W.S.C. ❑ Temporary Construction Meter ❑ Turn on Charge ❑ Uncollected Account - Name ❑ Inspection Fee - Tract - Fee - ❑ Plan Check Fees Water / Sewer - Tract - ❑ Bond Payment - A.D, - Bond Assmt ❑ Customer Deposit ❑ Other C Z / o/ ,I TOTAL L..m-- Remarks: -_[( a��I. �7 "FO . Z. " Z1 �.�: 1 T -S yl � cam. Copy to: Cash / Water Service Check 0Z' Sv Money Cashier Order \\\ CVWD138 (1105) ' Douglas K. Ham June 5, 2003 Building Department City of La Quinta- Sirs: This letter will confirm our agreement to the design and placement of the block wall to be constructed along the lot line separating our Lots 5, 6,and 7, (fronting on Avenida Martinez at 52-835), and Seth Hoffman's Lots 20, 21, and 22 (fronting on Eisenhower Drive at 52-862) in Block 145, Santa Carmelita at Vale La Quinta, Unit #15. Said wall will be set on the property lines with 50/50 footings. Sincerely, K. Ham Irrevocable Trust 52.835 Avenida Martinez, U Quinta, CA 92253 Phone 760.564.7907 E-mail: dougkimboll@earthlink.net