14-0608 (PLBG)P.O. BOX 1.504 /
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 14-00000608
Property Address: 51180 AVENIDA OBREGON
APN: 773-052-008-8 -000000-
Application description: PLUMBING
Property Zoning: MEDIUM DENSITY RES
Application valuation: 3300
Applicant: Architect or Engineer:
00\1
------------- : ----
LICENSED CONTRACTOR'S,DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
1 hereby affirm under penalty of perjury that I am licens d under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Profe ionals Code, and my, License is in full force -and effect.
License Class: B C10 License No.: 746198
DatJWt Contractor:
V'
OW ER -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 cityor, 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 ezempt'therefrom and the basis for the alleged exemption. Any violationof Section 7031 .5 by
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
(_ 1 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
Contractors' State License Law does notapply to an owner of property who builds or improves thereon,
and who does the work himself or herself through his or her own'eiriployees, 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 ofsale.).
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' StateLicense`Law does notapply 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 _ 1 I am exempt under Sec. , B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION ENDING AGENCY
I hereby affirm under penalty of perjury that there is a constructi 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:
KIM DAVIS
51180 AVENIDA OBREGON
LA QUINTA, CA 92253
Contractor:
A & M CONSTRUCTION
P.O. BOX 366
LA QUINTA, CA 92247
(760)564-4832"-
Lic. No.: 746198
VOICE (760) 777-7012
FAX (760) 777-1011
INSPECTIONS (760) 777-7153
Date: 5/19/14
WORKER'S COMPENSATION DECLARATION
I hereby affirm underpenalty 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 Laboi Code, for the performance of the work for which this permit is
r, sued.
hhave and will maintain workers' compensation insurance, as•required by, Section 3700 of the Labor
Code, for'the'performance of the workfor which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier STATE FUND Policy Number 9039845-14
_ 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 to become subject to'ihe.workers' compensation laws of California,
and agree that, if I shoul ecome subjecyto the workers' compensation provisions of Section
3700 of the Labor Code, shall forthwith comply with th, ovisions.
Date` Applicant -
WARNING: FAILURE TO SECURE WO ERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYE R,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 thisapplicationis 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.
1 certify that I have read this application and state that the a e information is correct. I agree to comply with all
city and county ordinances and state laws relating to buildi construction, and hereby authorize representatives
of this county to enter upon the above-mentioned property r inspection purposes.
Date: Signature (Applicant or Agent),
Application Number . . . . . 14-00000608
Permit . .
. PLUMBING 2013
Additional desc .
.
Permit Fee . . .
. 11.92
Plan Check Fee
.00
Issue Date . . .
.
Valuation . . .
. 0
Expiration Date .
. 11/05/14
Qty Unit Charge Per
Extension
1.00 11.9200 EA PLBG BUILDING
SEWER
11.92
----------------------------------------------------------------------------
Special Notes and
Comments
PLUMBING - SEPTIC
ABANDONMENT, CONNECT
TO SEWER. 2013 CALIFORNIA BUILDING
CODES.
----------------------------------------------------------------------------
Other Fees . . .
. . . . . . PERMIT
ISSUANCE M/P/E
90.57
PLAN CHECK, PLUMBING
11.92
Fee summary
-----------------
Charged Paid
--------------------
Credited
--------------------
Due
Permit Fee Total
11.92
.00 .00
11.92
Plan Check Total
.00
.00 .00
.00
Other Fee Total
102.49
.00 .00
102.49
Grand Total
114.41
.00 .00
114.41
LQPERMIT
I
COACHELLA VALLEY WATER DISTRICT
QtSTHRti P-.O. BOX 1058, COACHELLA, CALIFORNIA 92236 (760) 398-2651
INVOICE Date; 4/1/2014
SUBJECT: SANTA CARMELITA, 51180 AVENIDA OBREGON, LA QUINTA, LOTS 7 & 8, LID 680462, "SCC FEE ONLY"
A & M HOME BUILDERS Project: 14-5365
PO BOX 366
Project. Date: 4/11/2014
Amou.nt.Due: $4,851.00
LA QUINTA, CA 92247 GEO: 06-06-01-3
Planner: SANDRA VILLALOBOS
TO INSURE PROPER, CREDIT, PLEASE RETURN THIS PORTION WITH
REMITTANCE AND INCLUDE THE PROJECT ON YOUR CHECK
- --- - ---------------
SUBJECT: SANTA CARMELITA,* 51180-AVENIDA OBREGON, LA QUINTA, LOTS 7*& 8,11D 680462, "SCC FEE ONLY"
COACHELLA VALLEY WATER DISTRICT
P.O. BOX 1058, COACHELLA, CALIFORNIA 92236 (760) 398-2651 Pagel
0
1.0.0 FF -Jsc0-cbLLIt&ION.
$2,415.00 $2,415.00
1.00 FJ ISCC-TREATMENT
$2,436.00 $2,436.001
$4,851.00
SUBJECT: SANTA CARMELITA,* 51180-AVENIDA OBREGON, LA QUINTA, LOTS 7*& 8,11D 680462, "SCC FEE ONLY"
COACHELLA VALLEY WATER DISTRICT
P.O. BOX 1058, COACHELLA, CALIFORNIA 92236 (760) 398-2651 Pagel
0
Bin # _
�ir C(�• . of La •
Y Qurnta
Building. 8r SafetyDivision
P.O. Box 1504, 78-495 Calklampico
La` Quinta, CA 92253 - (760) 777-7012
Building Permit.Application.and"Tracking Sheet
Permit #
Project Address: V '—
Owner's Name: t'. 19C
A. P. Number:
'Address: 57 ^ 1,,:6 D &Vp_
Legal Description:
Contractor: AM
City, ST, Zip:
Tele hone: `:�'•�>��'>����-;•::::.:.:•.
:::rttir.•:rf :�
Address:
Project Description:
City, ST, Zip: �i �1/ / d� �0'�
s-el1J• f?/% 1��} L i/1 l
Telephone:
State Lic. # :
City Lic. #:
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
P
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.... fid s.ni^X': ::i!4}.�.........:.:.
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Construction Type:. Occupancy:
State Lic. #:
. ,
`Project type (circle one): New Add n Alter Repair Demo
Name of Contact Person:
Person:-.Sq.-
Sq. Ft.:
# Stories:
#Units:
Telephone # of Contact Person:
Value of Project: ?l" 72 N^
APPLICANT: DO NOT.WRITE BELOW THIS LINE
-#
Submittal
Req'd
•Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready. for corrections
Plan Check Deposit
Truss Cafes.
.`Called Contact Person
Plan Check'Ilalance
Title 24 Calcs.
.Plans, picked up
Construction
Flood plain plan
Plans resubmitted.•
Mechanical
Grading plan
p
2°" Review, ready for corrections/issue
,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 corredionsrssue
Developer Impact Fee
Planning Approval
Called Contact Person-
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees