07-1468 (SFD)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
07-00001468
Property Address:
53775 EISENHOWER DR '
APN:
774-165-013-2 -000000-
Application description:
PLUMBING
Property Zoning:
COVE RESIDENTIAL'
Application valuation:
2800
T,it(t 4 4 Q"
Applicant: Architect or Engineer:
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
I hereby affirm under penalty of perjury that 1 am licensed under provisions of Chapter 9 (commencing with
Section 7006) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
License Class: BB C36 C42 License No.: 793482
Date: -t(s "/ Contract
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that 1 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 o'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 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, 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.).
(_ 1 I am exempt under Sec. , B.&P.C. for this reason
Date:
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.1.
Lender's Name: _
Lender's Address:
LQPEBMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Ate: 5/16/07
Owner:
GEIGER
53-775 EISENHOWERLA
QUINTA, CA 92253L
LtIN.
Contractor:SO
CAL & ASSOCIATES PLMBNP.O.
BOX 955
YUCCA VALLEY, CA 92286
(760)464-3147
LiC. No.: 793482
--)---------------------------------------------
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 t0 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 1 should become subject to the workers' compensation provisions of Section
' 3700 of the Labor Code, 1 shall forthwith comply with those provisions.
Date: Applica
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 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 county to enter upon the above-mentioned property for inspection puroosns_
Date: —16 Signature (Applicant or r trt—r
Application Number . . . . . . 07-00001468
Permit PLUMBING SEWER
Additional desc
Permit Fee . . . . 30.00 Plan Check
Fee
.00
Issue Date Valuation
. . .
. 2800.
. Expiration Date 11/12/07
Qty Unit Charge, Per
Extension'
BASE FEE
-------------------------------------------------I---------------------------
30.00
------------------------------------------------------------
- Special
Special Notes and Comments
ABANDON SEPTIC TANK AND -HOOK-UP TO CITY
..SEWER.
Fee summary Charged Paid Credited
Due
--------------------- ----------
7 ------
Permit Fee Total 30.00 .00
----------
.00
30.00
Plan Check Total .00 .00
.,00
-.00.
Grand Total 30.00 .00
.00
30.00
LQPMIIT
12
15
I
ASAP
PUMP/1116' Incl Lic #C42 855 851
760 328-7887 • 1-800-334-7255
CUSTOMER'S ORDER NO.
DATE ORDERED
AMOUNT
Gallons
FAX 760 328-6607
ORDER TAKEN BY
DATE PROMISED ❑ A.M.
❑ P.M.
P.O. Box 2318 • Cathedral City, CA 92235
BILL TO
PHONE
F
ADDRESS i
i�
V ✓�
ME�F�4NIC Maa
..,}�a_„IP
CITY
HELPER
JOB NAME AND LOCATION i
/
❑ DAY WORK
1
Out of Area Fee
DESCRIPTION OF WORK
❑ CONTRACT
❑ EXTRA
Locating / Opening Fee (per hour)
$,75/HR
OUANT
DESCRIPTION OF MATERIAL USED
PRICE
AMOUNT
Gallons
Pumping Fee per 1000 gal.
Camera/Power Snake
Out of Area Fee
Locating / Opening Fee (per hour)
$,75/HR
Size System:
r7 -
Fuel Charge
$25-
0 0
A SERVICE CHARGE OF $20 WILL BE DUE ON ALL RETURNED CHECKS.
18% PER YEAR WILL BE CHARGED ON PAST DUE
If ACCO YS.
TOTAL
MATERIALS
TOTAL
LABOR
iWAIVER: trisible for secondary damage such asj,,Efo
dam c ipped co e, Rstrf r rive
R TED
TAXSIGNAT
TOTAL
r
Bin #
City of La Quintan Ld
Building & Safety Division
P.O. Box 1504, 78-495 Calle Tampico p WO) _
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address:'
Owner's Name:
A. P. Number:
Address: -J 3 ) -7 S� I i¢x-�w.
Legal Description:
City, ST, Zip:
Contractor:
Telephone: —
Address:
Project Description:
City, ST, Zip: L Celk
Telephone:
cu LAO v
State Lic. # : . —j f 3 q'52,City
Lic. #:tk
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
Construction Type: Occupancy:
State Lic. #:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: M f ��LJ`
Sq. It:
#Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project: 9-001
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
Submittal
Req'd
Recd
TRACIQNG
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 Coles.
Plans picked up
Construction
Flood plain plan.
Plans resubmitted
Mechanical
Grading plan
2°' Review, ready for correctionstissue
Electrical
Subcontactor 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
Date of permit issue
School Fees
Total Permit Fees