BPLB2014-103352945 Avenida Martinez
BPLB2014-1033
LICENSED CONTRACTOR'S DECLARATION.
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing with Section 70001 of Division 3 of the Business and Professions Code,
and my License is in full force and effect.
License Class: License No.: :LIC -0108088
y/ Date: —Contractor: /1—
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, 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 improves
thereon, 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: )C
Lender's Address:
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: _ Policy Number: _
_ 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 3700 of the Labor Code, I shall forthwith
comply with those provisions.
;,Date:Applicant:
WARNING: FAILURE TO SECURE WORKERS' COM PENSATIO C VERAGE 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 Building Official 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.
(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 city to enter upon the above-
mentioned property for inspection purposes.
Date: % i / Signature (Applicant or Agent): —
C0
VOICE (760) 777-7125
78-495 CALLE TAMPICO
D
FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253
COMMUNITY DEVELOPMENT DEPARTMENT
INSPECTIONS
(760) 777-7153
BUILDING PERMIT
Date: 11/4/2014
Application Number:
BPLB2014-1033
Owner:
Property Address:
52945 AVENIDA MARTINEZ
CYNTHIA SJOQUIST
APN:
773331024
524 MINNEAPOLIS AVE
Application Description:
SEWER CONNECTION SEPTIC ABANDONMENT
GLADSTONE, MI 92253
Property Zoning:
Application Valuation:
$1,800.00
Applicant:
Contractor:
EGGAN, RICK EDWARD
D
EGGAN, RICK EDWARD
OUTSIDE CITY LIMITS
OUTSIDE CITY LIMITS
LA QUINTA, CA 92253
NOV 2014
LA QUINTA, CA 92253
CITY OF
(760)404-6330
LA QUINTA
COMMUNITY DEVELOPMENT DEPARTMENT
LIC. No.: :LIC -0108088
---------------------------------------------------------------------------------------------
%P
LICENSED CONTRACTOR'S DECLARATION.
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing with Section 70001 of Division 3 of the Business and Professions Code,
and my License is in full force and effect.
License Class: License No.: :LIC -0108088
y/ Date: —Contractor: /1—
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, 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 improves
thereon, 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: )C
Lender's Address:
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: _ Policy Number: _
_ 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 3700 of the Labor Code, I shall forthwith
comply with those provisions.
;,Date:Applicant:
WARNING: FAILURE TO SECURE WORKERS' COM PENSATIO C VERAGE 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 Building Official 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.
(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 city to enter upon the above-
mentioned property for inspection purposes.
Date: % i / Signature (Applicant or Agent): —
FINANCIAL INFORMATION
DESCRIPTION,' ACCOUNT
QTY AMOUNT PAID, PAID DATE
BSAS SB1473 FEE 101-0000-20306
0 $1.00 $0.00
PAID BY METHOD
RECEIPT # CHECK # CLTD BY
Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $1.00 $0.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT •
PAID
PAID DATE
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid for PERMIT ISSUANCE: $91.85 $0.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
BUILDING SEWER
101-0000-42401
0
$12.09
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID', "
PAID DATE
BUILDING SEWER PC
101-0000-42600
0
$12.09
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid for PLUMBING FEES: $24.18 $0.00
TOTALS:00
Bin .#
Crtjr Of LQ QI1fllia
Building a Safety Division
P.O. Box 1504,78-495 Calle Tampico
La.Quinta, CA 92253 - (760) 777-7012
Building Permit' Application and Tracking Sheet
Permit #.
Project Address:
Owner's Name: .
.
A. P. Number.
Address: `3"Z n +.0 L L1 S ✓L
Legal Description:
City, ST, Zip: '
Contractor.
Telephone:
"E ' .
Address:7 b fo ')
Project Description:
City, ST, Zip:
Telephone:7( ,o 0
State Lic. # : q D Z -Li 9
Arch, Engr., Designer.
Address:
City, ST, Zip:
Telephone:
P a
State Lic. #:
Construction Type:. Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. FL: #Stories: #Units:
Name of Contact Person:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WHITE BELOW THIS LINE
9
Submittal
Req'd
Reed
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted.Item
Amount
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Calcs.
Called Contact Person
Plan Check Balance
Tide 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2'd Review, ready for correctionsfissue
Electrical
Subcoutactor Ust
Called Contact Person
Plumbing
Grant Deed
Plans picked up
SALL
H.O.A. Approval
Plans resubmitted
Grading
IN I'IOUSE:-
3'd Review', ready for correctionsfissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr '
Date of permit issue
School Fees
Total Permit Fees
z
COACHELLA VALLEY WATER DISTRICT P.O. BOX 1058, COACHELLA, CALIFORNIA 92236 (760) 398-2651
INVOICE Dates 10113/2014
SUBJECT: SCC ONLY 52945 AVENIDA MARTINEZ LA QUINTA. UD 685518
CYNTHIA B SJOQUIST Project: 14-5874
524 MINNEAPOLIS AVE Project Date: 10/9/2014
Amount Due: $4,851.00
GLADSTONE, MI 498371821 GEO: 06-06-12-1
Planner: CAROL PFANNKUCHE
To wsuRE PROPER CREW, PLEASE RETURN THtS PORnoN wt7H
REMI I TANCE AND INCLUDE THE PROJECT ON YOUR CHECK
$4,851.00
,
CYNTHIA S SAMIST 2` Z7 5043
524 MINNEAPOLIS'AVE 74.14519112512
laza s a 49837-1821 ' 6es2sa3toe
''ee -- ate
Pay m the OC2a ✓ "' f D
er of $ 1100 ✓ ` 1
Ord
F walbr poe"NA
w
For s (F
1:09110145SI: 9992543 &0911' 05 3
&X,A s oy3
SUBJECT:scc ONLY 52945 AVENIDA MARTINEZ, LA QUINTA, UD 685518
COACHELLA VALLEY WATER DISTRICT'
P.O. BOX 1058, COACHELLA, CALIFORNIA 92236:(760) 398-2651 . Page 1
Description: SEWER CONNECTION SEPTIC ABANDONMENT
CHRONOLOGY
Type: PLUMBING Subtype:
Status: SUBMITTED
Applied: 11/4/2014 PJU
Approved:
Parcel No: 773331024 Site Address: 52945 AVENIDA MARTINEZ LA QUINTA,CA 92253
Subdivision: SANTA CARMELITA VALE LA QUINTA Block: 145
Lot: 11
Issued:
UNIT 15
Lot Sq Ft: 0 Building Sq Ft: 0
Zoning:
Finaled:
Valuation: $1,800.00 Occupancy Type:
Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0
No. Unites: 0
NAME
Details: SEWER CFONNECTION SEPTIC ABANDONMENT PER 2013 CALIFORNIA PLUMBING CODES.
CITY
Printed: Tuesday, November 04,20144:01:10 PM 1 of 2
- N?WSYS TEMS
CHRONOLOGY
CONDITIONS
CONTACTS
NAME TYPE
NAME
ADDRESSI
CITY
STATE
ZIP
PHONE
FAX EMAIL
APPLICANT
EGGAN, RICK EDWARD
OUTSIDE CITY LIMITS
LA QUINTA
CA
92253
CONTRACTOR
EGGAN, RICK EDWARD
OUTSIDE CITY LIMITS
LA QUINTA
CA
92253
OWNER
CYNTHIA SJOQUIST
524 MINNEAPOLIS AVE
GLADSTONE
MI
92253
Printed: Tuesday, November 04,20144:01:10 PM 1 of 2
- N?WSYS TEMS
DESCRIPTION .
ACCOUNT r
QTY
AMOUNT
_ PAID
PAID DATE
RECEIPT #
CHECK #
~ METHOD
PAID BY
CLTD
BY
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
Total Paid forPERMIT ISSUANCE: $91.85 $0.00
BUILDING SEWER
101-0000-42401
0
$12.09
$0.00
BUILDING SEWER PC
101-0000-42600
0
$12.09
$0.00
Total Paid for PLUMBING FEES: $24.18 $0.00
TOTALS:• 00
INSPECTIONS
SEQID' INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED
DATE DATE
RESULT REMARKS NOTES
PLUMBING FINAL"
ATTACH M E NTS
Printed: Tuesday, November 04, 2014 4:01:10 PM 2 of 2
RWYSTEMS