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04-6713 (PLBG)IL P.O. Box 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING PERMIT BUILDING & SAFETY DEPARTMENT (760).777-7012 FAX (760) 777-7011 INSPECTION REQUESTS (760) 777-7153 Application Number04-'00'006713 Date 10/12/04 Property Address ;= 80120 VISTA GRANDE APN: = 649-141-006-6 -3505 - Application description . . . PLUMBING Property Zoning . . . . . . . LOW DENSITY RESIDENTIAL Application valuation . . . . 3500 Owner ------------------------ CASTILLO M/M 80120 VISTA GRANDE LA QUINTA CA 92253 Contractor ------------------------ ALMS UNDERGROUND CONST, INC. 38703 VISTA DRIVE CATHEDRAL CITY CA 92234 WCC: VIRGINIA INC WC: 00500016007 01/01/05 CSLB: 482180 11/30/05 CCC: C42 -C21 ---------------------------------------------------------------------------- Permit . . . . . . PLUMBING SEWER Additional desc . . Permit Fee 30.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 3500 Qty Unit Charge Per Extension BASE FEE 30'.00 =--------------------------------------------------------------------------- Special Notes and Comments SEWER CONNECT/SEPTIC ABANDONEMENT. Fee summary Charged Paid Permit Fee Total 30.00 .00 Plan Check Total .00 .00 Grand Total 30.00 .00 Credited .00 .00 .00 Due 30.00 .00 30.00 1504 78- VOICEJ760) 777-7012 78-4955 CALLE TAMPICOi FAX`(76.0) 777-7011 LA QUINTA, CALIFORNIA 92253. INSPECTIONS (760) 77'7-7153 BUILDING & SAFETY DEPARTMENT jf Application Number: 017-7 " Date: /0 -/-2 - Applicant: Architect or Engineer: Applicant's Mailing. Address: Architect or Engineer's Address: ' Lic. No: BUILDING PERMIT DECLARATIONS r 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 Lice yin full farce and effect. �p a License Class License No. Date_N(V ^ G /. —Oki--Cont OWNER-BUILDER DECLARATION I hereby affirm under penalty-of perjury that I 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 the applicant to a civil penalty of not more than five hundred dollars ($500).): U 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.). (, • 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 „A the Contractors' State License Law.). f U I am exempt under Sec. BA P.C. for this reason Date Owner " WORKERS' COMPENSATION DECLARATION, I hereby affirm under penalty of perjury one of the following declarations: 1 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. 2r- 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 an Q St mer ire,; �� - Carrier 1/i /� �;'^�-=r ,. C Policy Number •O �'iJ l 6 J 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 tobecomesubject 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 forthwith comply with those provisions. CDate�'� — 0`7 /Applicant M Z%l ,� i� n-Cu D 1� 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. CONSTRUCTION LENDING AGENCY Y 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 i 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 Ouinta, 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 purposes. Date - — 6. /,Sig .Siga ,rp nature (Applicant or Agent): �r7. � tp� U YI ` ! ��40 - i M Ftl PING INC JOB�Nv01%i`� H ®SHL CiT', `�kLIEDRN ' •��° �~= °" ' � � • r - - �+► '-- ?• w•� �.-7�'• 'i - }� X7,6 , 7448 •^ ` CUSTOMER'S ORDER NO. DTE ORDERED / ORDER TAKEN BY DATE PROMISED 0 A.M. i T-0•�4 PHONE DDRESS - MLCHANI� J CITY H LPER J B+ [dE (9N{DFL-O TION •/--.. � 0 DAY WORK k ('�Df SCRIPTION�OF WORK,'L-' f/�''��'�-/-�� '� ❑CONTRACT DEXTRA i • • l :--ti_ 0250 �CC...1 F� u -'. QUANT. - DESCRIPTION OF MATERIAL"USED - 'y PRICE AMOUNT (�.. Gallons Pumping Fee per 1.000 gal.. r Dumping Fee per 1000 gal. �r �C s -S Out of Area Fee - Locating/ Opening Fee (per hour) Size System: ��----� �--Y� -r►�3 ~ � • r 1/ 1 I �•l/1 I .� • A SERVICE CHAWGE`OF-$2O-WILL BE DUE - ON ALL RETURNED CHECKS. Y. 18% PER YEAR WILL BE CHARGED ON PAST DUE ACCOUNTS OVER 30 DAYS. a ``'• { HOURS -' LABOR AMOUNT°TOT , + ,J MECHANICS @MATE48- HELPERS Ca? TOTAL ••: -LABOR sp. ' I hereby acknowledge the satisfactory completion of the above described work: TOTAL LABOR i TAX - SIGN URE. - aDATE COMPLETED ll✓ l{f TOTAL _A _. _ . '1 _ � � •` � !ter -�• r. �. Ar .40 ¢ i< Ffiet,� iYi o ti.iS:'i9 t y+aia y+ �• !'s w'Y 7�W� $t,3 lYy rK��xi,'� at» # , .r ,`45 ,nT •��'y! s �T �. r{Sy'��?x �. •ya. .c ` y 5� �' �a'�a � ,i;� t ,�,�`„� , COACHELLA VALLEY WATER DISTRICT . CASH RECEIPT DETAIL NO q �a /� /Q ®6 g?'"0' leceived From: Date \ddress:4. lccount No. L (` O �� (2 i a i Lot(,,) Tract Iervlce Address �-•''�� i . - G.A. Code �' Y 3' Meter(s). '^ 7 Service(s).. 3 Backflow(s) , 1, House Lateral(s) ] Detector-Check(s) .MeterSurcharge , / Y Sanitation Capacity Charge 7 W.S.B.F.C. 7 Temporary Construction"Meter -: l Turn on Charge. j I Uncollected Account"- Name - 1 Inspection Fee - Tract - Fe6- I -I Plan Check Fees Water) Sewer- Tract ewer=Tract - I 'Bond Payment - A.D. - Bond cR" Assmt. Customer Deposit Other A TOTAL $ t C, 1 ' Remarks: ! rat_ `i 0 1 /1; t1 i r� j Copy to, C :ash Water Service ,heck loney Irder ! .. Cashier 38(1 lag) - ...y..._,..:a„_5....�._?:_..'�..,�.a.u.;.ta._:_. �:y:. .».:_.�.:�._....1'c_a�..' .:. , .; ... •....�:y.:S..; .�.,....,.:.�.......:i......y. ..V.,'.s•, r..._s,_. r.... s 4 CVWD 1