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05-2090 (PLBG)P.O. BOX 1504 78-495 CALLS. TAMPICO - LA QUINTA, CALIFORNIA 92253- Application 2253 Application Number. OSe 000020-9 'B Property Address: APN: 52910 AVENID Application description: 773-325-008-1 9 PrQperty Zonino, PLUMBING Application valuation: COVE RESID 31YQp5 . D' - U V V_U-WUc-d• rrry of 4 NG & SAFETY DEPARTMENT BUILDING PERMIT 'VOICE (760) 777-7012 FAX- (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 5/31/05 Owner: ---------------------------------- DESERT HORIZONA INVESTORS 1.915 MORENO BLVD. LA -QUID?TA, CA 93253 LQPERMIT Contractor: Applicant: Architect or Engineer: --------------------------------- SO CAL PLUMBING & RERIPE CO P.O. BOX 955 YUCCA VALLEY,, CA 92286 Lic . No,. -:-EXEMPT LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION • I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations: , Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided - License Class: 793482 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is ' - issued. /Ddte: c _ 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 OWNER -BUILDER DECLARATION insurance carrier and policy number are: hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier 4104 .Policy Number EXEMPT following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to I c=at, in the performance of the work for which this permit is issued, I shall not employ any , construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the - in any manner so as to become subject to the workers' compensation laws of California, . permit to file a signed statement that he or she is licensed pursuant to the provisions -of the Contractor's State _person and agree that, if I should become subject to the workers' compensation provisions of Section ' - - - License Law (Chapter 9 (commencing with Section, 7000) of Division 3 of the Business and Professions Code) or 3700 of the Labor Code, I.shall forthwith comply with those provisions. - 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).: e: (_) 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. 7044, Business and Professions Code: The WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL .. - - Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND ' and Who does the work himself or herself through his or her own employees, provided that the DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR -IN • - improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. - 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.). - APPLICANT ACKNOWLEDGEMENT ' (_) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the - . . 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of _ conditions and restrictions set forth on this application. - property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed 1. Each person upon whose behalf this application is made, each person at whose request and for pursuant to the Contractors' State License Law.). - '•. ._ - .- whose benefit work is performed under or pursuant to any permit issued as a result of this application, 1 I am exempt under Sec. , B.&P.C. for this reason • . the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City - of La Quints, its officers, agents and employees for any act or omission related to the work being - - - - performed under or following issuance of this permit. " " Date: - Owner: 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 " CONSTRUCTION LENDING AGENCY permit to cancellation. I hereby affirm under penalty of perjury that there is a construction lending agency for the performance'of the I certify that I have read this application and state that the above information is correct. I agree to comply with all - . work for which this permit is issued (Sec..3097, Civ. C.). - city and county ordinances and state laws relating to building construction, and hereby authorize representatives " _ above-mentioned property far of this county to en�nae Lender's Name:- Date; APPlican[ .. Lender's Address: - LQPERMIT �J Application Number . . . . 05-00002090 t. Permit . . . PLUMBING SEWER Additional desc . Permit Fee 30.00 Plan Check Fee .00 Issue Date Valuation 2500 Expiration Date 11/27/05 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 AY 6,1'05 13:08 FROM 7603983190 PAGE.002 S29/0 kejntc� 60J4 . . _,,TJX y;,. g - Y. Att3 . :iY9etet(ei.; . . . . . Iv &�O*Kopw4 i4 -6w"• " C. u. rr ti Z I ......... .......... ....... .... t M., 4r - S29/0 kejntc� 60J4 . . _,,TJX y;,. g - Y.