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04-4866 (PLBG)0) • s BUILDING & SAFETY DEPARTMENT BOX 1504 (760).777-7012 OFT1�'� 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153. BUILDING PERMIT Application Number 04 -00004866' Date 6/10/04 Property Address . . .. . . 4 0 `VIA HERMOSA APN: 646-100-019-19 -20052 - Application description . . . PLUMBING Property Zoning . . . . . LOW DENSITY RESIDENTIAL Application valuation,. 500 Owner Contractor ` - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -t- - - - - -h- - ADAMS, MARY CORTEZ &.ASSO"IATES _48105 VIA HERMO.SA 7847 SVL BOX LA QUINTA CA 92253 VICTORVILLE CA 92392 WCC: STATE FUND WC:' 177015504 01/01/05 -CSLB: 651042 07/31/04 CCC:. C3.6 . Permit . . . PLUMBING Additional desc Permit Fee 22.50 Plan Check Fee. 5..63 Issue Date Valuation 0 Qty, Unit Charge Per Extension BASE'.FEE. ;.a 15.00 1.00 .7.5000 EA ?LB, WATER HEATER/VENT ------------------------------------------------------------------------------- Special Notes and Comments WATER HEATER CHANGE OUT. Fee summary Charged, 'Paid`• °Credited Due ---------------------------------- -------------- ---------- Permit Fee Total. 22.50 0.0 .00 22.50 Plan Check Total 5.63 .00 .00 5.63 Grand Total 28.13 .00 00 28.13 JUN 10.2004. CITY OF LA WNTA FIfdAWCE O��T P.O. BOX 1504 a/�� 78-495 CALLS TAMPICO N VOICE (760) 777-7,01.LA QUINTA, CALIFORNIA 92253 4 4 FAX (760) 777.701 ; INSPECTIONS (760) 777-7153, BUILDING & SAFETY DEPARTMENT Application Number: && & Applicant: Date: �o -/D Uy • Architect or Engineer: Applicant's Mailing Address: Architect or Engineer's Address: Lic. No.: BUILDING PERMIT DECLARATIONS I hereby affirm under penaltyof LICENSED CONTRACTOR'S DECLARATION perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 01 the Business and Professionals Code, and my License is.' ful fo and effect. / �— �License Class _ License No. / i Date B Contractor -.e / � Z I herebyaffirm under OWNER -BUILDER DECLARATION penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5. Business and Professms 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 31f 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).): U 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. 7004. Business and Professions Code: The Contractors' State License Law does not apply to an owner of Property himself or herself or through his or her own employees• provided that the improvements are not intended or ft red fordsalle.r If. however. thePrOvesnbuandi di who Does the worts 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.).mprovement is 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 1 am exempt under Sec. , BA P.C. for this reason Date Owner I hereby affirm under penalty of perjury one of the following des arattiionsRS' COMPENSATION DECLARATION 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�e = 0 of the Labor Code• for the performance of the work for which this permit is ,,,-Carrier L ers' compensationn'peurance carrier ap�;cv�m S ::::Policy Number _ I certify that, in the performance of the work for ,ssued. compensation laws of Calif omia, and agree t, if should rbecome subj I shad notMeromers' Coploy mport person in any manner so as to become subject to the workers fort /cemplY with those Provisions. pensation provisions of Section 3700 of the Labor Code, 1 shall Date % Applicant r �� WARN INE FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLA FUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES 6 F ONE HUNDRED THOUSAND DOLLARS ($RNEY'0)• IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. I hereby affirm under penalty of perjury that there is a construction lCON ending aRUCTION LENDING AGENCY g gency for the Performance of the work for which this Lender's Name permit is issued (Sec. 3097, Civ. C.). Lenders Address IMPORTANT APPLICANT ACKNOWLEDGEMENT 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 harnbss the City of ca ion. its officers, agents and employees for any act or omission related to the work hero . La 2. Any Permit issued as a result of this application becomes nu and void if wore is rw Commence resfollowing dys from date of issuance of such peffniL or cessation of work for 189 days will subject permit to cancel) 6 I certify that I have read this application and state that the above info tion constructio and reby auth=ignature entatives of this* to ter u correct I �� to with all city and county ordinances and state laws relating to building jjj��°°° roperty for inspection purposes. �te pplicant or Agent): ► v' C�