PLBG (12-0669)54295 Avenida Madero
12-0669
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
12-00000669 ,
Property Address:
54295 AVENIDA MADERO
APN:
774-231-018-3 -000000-
Application description:
PLUMBING
Property Zoning:
COVE RESIDENTIAL
Application valuation:
4500
Applicant: Architect or Engineer:
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LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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: C21 C42 LicenseNo.: /44822%18(0 ,
Date,y' / Contractor: / f/,tea 6
' 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 ($500).:
I _) 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 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 improvesthereon, and who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
I _ ) 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
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/15/12
Owner:
PETERS KEVAN O
54295 AVENIDA MADERO
LA- QUINTA, CA 92253
Q -----v
Contractor:
( { I- - 2012 i
ALMS UNDERGROUND CONST,
INC 1
38703 VISTA DRIVE'
I Cip(€3F,Ji
CATHEDRAL CITY, CA 92234
? aAQUINTA
..
(760)324-1911
Lic. No.: 482180
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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.
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 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, 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 I should become subject to the workers' compensation provisions of Section
370000 of the Labor Code, I shall forthwith comply with
those
%provisions.
DateIq,/ L.Applicant:
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 1$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 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.
--Y-- C q V rt 1 e
Date-h D gnature (Applicant or Agent): `. `Cl/
14%,
Application Number . . . . 12-00000669
Permit
PLUMBING SEWER
Additional desc .
Permit Fee
30.00
Plan Check Fee
00
Issue Date . . .
.
Valuation
4500
Expiration Date
12/12/12
Qty Unit Charge Per
Extension
BASE FEE
30.00
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Special Notes and
Comments
Abandon Septic Tank
-------------------------------------------------------------7--------------
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
I' AT' 4 COACHELLA VALLEY WATER DISTRICT
a7fit P.O. BOX 1058, COACHELLA, CALIFORNIA 92236 (760) 398-2651
INVOICE Date: 6/15/2012
SUBJECT: 54295 AVENIDA MADERO; LA QUINTA, LID 690280, "SCC FEE ONLY"
KEVAN PETERS
54295 AVENIDA MADERO
LAQUINTA, CA 92253
1.00 SCC -COLLECTION
1.00 SCC -TREATMENT
Project:
Project Date:
Amount Due:
GEO:
Planner:
TO INSURE PROPER CREDIT, PLEASE RETURN THIS PORTION WITH
REMITTANCE AND INCLUDE THE PROJECT ON YOUR CHECK
--------------------------------------------------------------
--------------------------------
ko ,
JUN 1 52 2.-k
a3
Amoun
I= is
12-3806
5/25/2012
$4,231.00
06-06-13-2
SANDRA VILLALOBOS
$1,836.00
$2,395.00
$4,231.00
SUBJECT:54295 AVENIDA MADERO, LA QUINTA, LID 690280, "SCC FEE ONLY"
COACHELLA VALLEY WATER DISTRICT
P.O. BOX 1058, COACHELLA, CALIFORNIA 92236 (760) 398-2651 Pagel
BIn. #
City.Of ? Qutnta
BEAft at Safety Division
P.O. Box 1504,'76-49S Calle Tampico
1a.Quhlta, CA 92253 -:(760) 777-7012
Building Permit Appllcadon and Tracking Sheet.
Pejt #
Project Address:'
Owner's Name:.
S
A. P. Number.
Address:
Legal Description:
City, ST, Zap. l
Contractor.
\
Telephone:
Description:
Address: 38 dProject
City, ST, Zip: -
Telephone:
State Lia # :
AL n `
'
City Lie. #;
\
Arch, EW., Designer
Address:
City., ST, Zip:
Telephone:
Construction Type: , Ocxupancy:
Project type (circle one): New Add'n Alter Repair
Sq. Ft.: # Stories: # Univ:
Demo
State Lic. #:
Name of Contact Person:
Telephone # of Contact Person:
Estimated Value of ;Project
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Reed
TRACKING
PERMiTFEES
Plan Sets -
Pian Check submitted
Item.
Amount
Strgetnrai CkIcs
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Calci.
Called Contact Person
Plan Check Balance.
'Nile 24 Calci.
Plans picked up
Construction
Flood plain plan
Plans resubmitted..
Mechanical
Giading plan
2'i Review, ready for correctionskssue
Electrical
Sabeontaetor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
ML .
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
''d Review; ready for cormcdonsAssue
Developer Impact Fee
Planning Approval
Called Contact Person
AXP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees