12-1037 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 12-00001037
Property Address: 52140 AVENIDA OBREGON
APN: 773-215-007-7 -000000-
Application description: PLUMBING
Property Zoning: COVE RESIDENTIAL
Application valuation: 2500
Applicant:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Architect -or Engineer:-
/ ul�_
Owner:
WONG LESTER
52140 AVENIDA OBREGON
LA QUINTA, CA 92253
Contractor:
ALMS UNDERGROUND CONST,.
38703 VISTA DRIVE
CATHEDRAL -CITY, CA 92234
(760)324-1911
Lia.. No.: 482180
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/11/12
SEP 112012
LA QUIN'
CE DEPT.
..LICENSED CONTRACTOR'S DECLARATION - ..WORKER'S COMPENSATION DECLARATION
I hereby affirm'under penalty of perjury that -1 am'licensed under provisions of Chapter 9:Icommencing with I hereby affirm under penalty of perjury one of the following declarations:
Se6tion:7000) ofDivision,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:.C21. C42 License No.: 482380 - for by Section 3700. of the Labor Code, for.the performance of the work for which this permit is
tt��e//ryp-�� ,n v /� - issued. -
•Date: ��T,Contractor: 1—T/O/'`� . leC��% ��. _ I have and willmaintain'workers' compensation insurance, asrequired .by.Section 3700 of the Labor
Code, for the performance of the work for which this permit is issued'. My workers"compensation
OM4ER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that Ilam exempQroni.the Contractor's State License Law for the
following reason (Sec. 7031.5, Business and Professions.Codei Any city or county .that requires a permit to
construct, alter,improve, demolish, or repair, any structure,p'rior to its issuance, also requires the applicant for the
permit to file a signed'staternant that he or she is licensed pursuant to the provisions of the Contractor's State
License iaw (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 J$500);:1 _ 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 ofproperty 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 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 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(sl licensed
pursuant to the Contractors' State License Law.).
(_) I am exempt under Sec. _ , B.&P.C..for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
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
. insurance carrier and policy number are: '
Carrier BARRET BUS SRVC Policy Number ' 2246
I certify that, in the performance of the.work for.which this permit is issued, -1 shall not employ any '
person in any,mannerso as to become subjeofto theworkers' compensation laws of.California,
and agree that, )f I. should become subject to the workers' compensation provisions -of Section
/ 37700 of the Labor Code, I shall forthwith comply.wiith'h'those provisions.'
Date:. Applicant: &0 �U%l L0 ,(174. .
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO MMINAL•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'duinta, 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 thiscountyto enter upon the above-mentioned property for inspection purposes.
^
Date: C ill /2 Signature (Applicant or Agentl:, 0 /60 �/ f/
Application Number . . . . . 12-00001037
Permit . .
. PLUMBING SEWER
Additional desc .
.
Permit Fee . . .
. 30.00
Plan Check Fee
.00
Issue Date . . .
.
Valuation . . .
. 2500
Expiration Date .
. 3/10/13
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 15.0000
EA PLB BUILDING SEWER
15.00
----------------------------------------------------------------------------
Special Notes and
Comments
SEPTIC ABANDONMENT
/ SEWER CONNECTION
----------------------------------------------
Other Fees . . .
-----------------------------
. . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary
-----------------
Charged Paid
--------------------
Credited
--------------------
Due
Permit Fee Total
30.00
.00 .00
30.00
Plan Check Total
.00
.00 .00
.00
Other Fee Total
1.00
.00 .00
1.00
Grand Total
31.00
.00 .00
31.00
LQPERMIT
,NATER COACHELLA VALLEY WATER DISTRICT
x P.O. BOX 105`8, COACHELLA;,CALIFORNIA 92236 (760) 398-2651
��S;i Fid
INVOICE Date: 9/7/2012:
SUBJECT: SCC ONLY- 521.40 AVENIDA ORBREGON ,LA QUINTA, LID 683080
Project: 12-4077
WONG, VINCENT 9/7/2012
74468 PEPPERGRASS Project Date:
Amount Due: $4,231.00
PALM DESERT, CA 92260. �GEO: 06-06-12-2
Planner: CAROL PFANNKUCHE
TO INSURE PROPER CREDIT, PLEASE RETURN THIS PORTION WITH
REMITTANCE AND INCLUDE THE PROJECT ON YOUR CHECK__-_-
SUBJECT: SCC ONLY -52140 AVENIDA ORBREGON ,LA QUINTA, LID 683080
:COAtHELLA VALLEY WATER DISTRICT
P.O. BOX 1058,,COACHELLA, CALIFORNIA 92236 (760) 398-2651
Page 1
BIn.#
City Qf U- Quishta
Buffding 8t Safety; Division
P.O. Box 1504,-78-495-Calle Tampico
14.Quinta, CA 92253, •(760) 777-70.12
Bu!ldin . P
g ermit Application and Tt# ng Sheet
Pemnit #
Project Address:
Owner's Name:.
A. P. Number.
Address:
Legal Description:
City, ST, Zip: 14
/
Contractor. A M5 Uncle! ij/1aC �p
Telephone:
Address: 3 , Qp3
Project Description:
City. ST, Zip:<WAFT2AA C 4-Y - 2,
Telephone:
State Lic. # : City
Arch., Engr., Designer
Address:
City., ST. Zip:
Telephone:
State Lia #:
`. Construc ion,Type:.. Occupancy:
:.';Project type (circle one): 'Now Add'n Alter Repair Demo
Sq. Ft.:#Stories: # Unity:
Name of Contact Person:
Telephone # of Contact Person:
'Estimated Valise of Project;
APPLICANT: DO NOT WRITE'BELOW THISUNE .
N
Submittal
Req'd
Reed
TRACMG
PERMIT FEES
PlnmSeb
Plan Cheek submitted
Item Amount
Structural Cates
Reviewed, ready for corrections
Play Check Deposit. .
Truss Coles.
Called Contact Person
Plan Check Balancs.
Title 24 Calc3
Plans picked up
Construction
Flood Plato plan
Plans resubmitted.
Mecharilcal
Grading plan
V Review, ready for corrections/issue
Electrical
Subeoutactor List
Called ContactPerson
Plumbing
Grant Deed
Plans picked up
SALL
H.O.A. Approval
Plans resubmitted
Grading
IN ROUSE:-
''"Review; ready for eorreetions2ssae
Developer Impact Fee
Planning Approval.
Called Contact Person
A.I.P.P.
Pub. Wks. Appr - . '
Date of permit Issue
School Fees
Total Permit Fees