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05-3607 (PLBG)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application description: Property. Zoning: Application Valuation: . Applicant: 05-0000360T' 80125 VISTA GRANDE 649-143-004-13 -3505 - PLUMBING LOW DENSITY RESIDENTIAL 2500 Architect or BUILDING & SAFETY DEPARTMENT . BUILDING PERMIT I PC 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: C36 -C42 -B 93482 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 than five hundred dollars 1$500).: (_ 1 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 orimprovement 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 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 contractors) licensed pursuant to the Contractors' State License Law.). v ( 1 I am exempt under Sec. , B.&P.C. for this reason Date:. Owner: CONSTRUCTION LENDING AGENCY I . 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: LQPERMIT _ Owner: NEEVEL EDWARD C 80125 VISTA GRANDE LA QUINTA, CA 92253 Contractor: SO CAL PLUMBING & REPIPE CO P.O. BOX 955 YUCCA VALLEY, CA 92286 (760)369-4104 Lica. No.: 793482. VOICE (760) 777-7012 FAX.(760) 777-7011 INSPECTIONS (760) 777-7153 Date:. 8/12/05 ------------------ 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. .FSI 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, I shall forthwith _omnh, wm.h .hoso-provisions. - - Bate:le ears 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 1 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 ente on a above-mentione r inspection purposes. -Date:04� gnature (Applica Application Number . . . . 05-00003607 Permit . . PLUMBING SEWER Additional deso . Permit Fee 30.00 Plan Check Fee 00 Issue DateValuation 2500 Expiration Date 2/08%06 Qty Unit Charge Per Extension. BASE FEE 30.00 - - - ------------------------------------------- Special Notes and Comments SEPTIC ABANDON; SEWER CONNECT 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 - LQPERMIT Bin # Permit # 1f Project Address,s.� I A. P. Number: Legal Description: X Contractor: , i� Address: X City, ST, Zip: X Telephone-, State Lic. # Arch., Engr., Designer: Address: City. ST, Zip: Telephone: State Lic. #: 1C Name of Contact Person: X Telephone *of Contact Person: M Submittal Plan Sets Structural Calcs. Truss Calcs. Energy Calcs. Flood plain plan Grading plan Subcontactor List Grant Deed H.O.A. Approval IN HOUSE: - Planning Approval Pub. Wks. Appr School Fees City of La Quinta Building at Safety Division P -O. Box 1 SO4, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Owner's Name: Address: Cin. ST. Zip.: FTelephone: > Project Description: Construction Type: Occupancy: Project type (circle one): New ' Add'n Alter Repair Demo Sq. Ft.: # Ll 'ts: —t KI 7-- " Estimated Value of Pr'ct: APPLICANT: DO NOT WRITE BELOW THIS INE Recd TRACKING PERMIT FEES Plan Check submitted Item Reviewed, ready for corrections Plan Check Deposit Called Contacl.Person Plan Check Balance Plans picked up Construction Plans resubmitted Mechanical 2'W Review, ready for correctionslissue Electrical Called Contact Person Plumbing Plans picked up 5.111.1. Plans resubmitted Grading Review, ready for correctionslssut Developer Impact Fee Called Contact Person A.I.P.P. Date of permit issue Total Permit Fees Amount COACHELLA VALLEY WATER DISTRICT CASH RECEIPT DETAIL .4 f�, N2 1096,32 a, a A, Received From: �,_ I f y C_T_ Address: _W VIAWN- (X�Wb ZA o UIAVI-A Account No.- 0. (e) — Lot(s) Tract Service Address So f2s-7 ym—/A E G.A. Code 0 Meter(s) b Service(s) 0 Backflow(s) 0 House Lateral(s) 0 Detector Check(s) 11 Meter Surcharge Sanitation Capacity Charge 0 W.S.B.F.C. 0 S.I.W.S.C. 0 Temporary Construction Meter 0 Turn on Charge 0 Uncollected Account - Name 0 Inspection Fee - Tract - Fee - 0 Plan Check Fees Water / Sewer - Tract - 0 Bond Payment -A.D. - —Bond - 0 Customer Deposit 0 Other 00 TOTAL $ Remarks: &/7//—of/ zzy &E Copy to: 'V V7P_ — 0 Cash 1777. Check Money Order Water Service Cashier CVWD-438 (1105) 061 15 Q-90-7164(3 EDWARD C. NEEVEL 09325 55 M 17.7 7 ELIZABETH NEEVEL ,4v, 80125 VISTA GRANDE 760-863-4486 LA QUINTA, CA 92253 U)A T E 3 AY rf 0 cr Fkoy LW 71L Al `1!:3222716274 0932546255110 1777 V M; . .Washington Mutual 'iW6shiigtonMtnualftnk.FA: 4 Palm Qoset FimnCial Center 1135 72 W'Way 111.7000 92260 21�48hMVOCB.Z6 S ft. ..A• r `1!:3222716274 0932546255110 1777 V