BPLB2016-012078-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA.92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BPLB2016-0120
Property Address: 53445 AVENIDA MENDOZA
APN: 774092022
Application Description: GERTSMAN RESIDENCE / SEWER HOOK UP
Property Zoning:
Application Valuation: $3,900.00
Applicant:
ALMS UNDERGROUND CONSTRUCTION INC
38703 VISTA DRIVE
CATHEDRAL CITY, CA 92234
LICENSED CONTRACTOR'S DECLARATION
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 Professions Code,
and my License is in full force and effect.
License Class: C21, C42 License No.: 482180
M
Date: / Q " Contractor:��ra^r
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 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
Lender's Address:
VOICE (760) 777-7125
�fAX (760) 777-7011
FAX (760)
777-7153
Owner: c / 0 -3,,
PHIL GERTSMAN tS
481 W 23RD AVE 0'.
VANCOUVER
VANCOUVER BC CANADA �515`HS'�92253
Contractor:
ALMS UNDERGROUND CONSTRUCTION INC
38703 VISTA DRIVE
CATHEDRAL CITY, CA 92234
(760)324-1911.
LIC. No.: 482180
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: ACE AMERICAN INSURANCE COMPANY Policy Number: RWCC48821078
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'
compensationlaws of California, and agree that, if 1 should become subject to the
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with those provisions.
Date: _—Z6 ^ -'Applicant:)���_lC(J Y1
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 ($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.
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 city to enter upon the
above-mentioned property for inspection purposes.
Date: 0 " � °` Signature (Applicant or Agent, '-1� �p1 / off (:FM,
Date: 10/10/2016
Application Number:
BPLB2016-0120
Owner:
Property Address:
53445 AVENIDA MENDOZA
PHIL GERTSMAN
APN:
774092022
481 W 23RD AVE
Application Description:
GERTSMAN RESIDENCE/ SEWER .HOOK UP
VANCOUVER BC CANADA V5Y, H5 92253
Property Zoning:
Application Valuation:
$3,900.00
Applicant:
Contractor:
ALMS UNDERGROUND CONSTRUCTION INC
ALMS UNDERGROUND CONSTRUCTION INC
38703 VISTA DRIVE
38703 VISTA DRIVE
CATHEDRAL CITY, CA 92234
CATHEDRAL CITY, CA 92234
c '
'(760)324-1911
Llc. No.: 482180
Detail: SEWER HOOK UP. PER 2013 CALIFORNIA BUILDING CODE
DESCRIPTION
ACCOUNT I CITY I AMOUNT
BSAS SB1473 FEE 101-0000-20306, 0 $1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PERMIT ISSUANCE
101-0000-42404
0
$96.27
Total Paid for PERMIT ISSUANCE: $96.27
DESCRIPTION
ACCOUNT
CITY
AMOUNT
BUILDING SEWER
101-0000-42401
0
$12.67
DESCRIPTION
ACCOUNT
QTY
AMOUNT
BUILDING SEWER PC
101-0000-42600
0
$12.67
Total Paid for PLUMBING FEES: $25.34
COACHELLA VALLEY WATER'DI:STRICT
P.O. -BOX'1058,' COACHELLA, CALIFORNIA 92236`, (760) 3-98- 2651
INVOICE Date: 8/26/201.6' '
SUBJECT: SA. NTACARMELITA;'53445 AVENIDA MENDOZ_ A, LA•QUINTA,.LOT XX, LID:687806- t -
PHIL GERTSMAN, Project: - - 46435,2'
48.1 W`23RD AVENUE: • Project Date: "' /28/2016'
. 4
Amount'D.ue: .. .._ . $4,851":00.,..
VANCOIJVER,.BC, CN` V5Y•2H5 GEQ: 06-0&12=4
-79&- --3-7781 P%lanner: SDR" VILLALOBOS.
NO
e.
T6*N 'kE'PROPER CREDIT °RLEASE RETURN THIS:PORTION: WITH '
REMITTANCE AND'INCLUDE THE PROJECT ON'YOUR CHECK '
�zUrnts`� CL): �-�`�"•�;��-'�:�•fi��+fee`rType Descriptions k��°�',� ��Fi'�- °Charge Amount_ r_�,Tota1�A o nt���
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PAID
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PAID
•- DevelopmeritServlces Department.. _ _ � _ ' , • • '� ',
`�t38+Ch�ll�'V�fiey�UUBt�t' District _•�� f • 1 . � •
75-515 HQVley Len@:E88t
palm: desert; CA.92211.
• .. •. P� _•' 1 �� •" •• < � 1 1,
SUBJECT;SANTA CARMELITA, 53445 AVENIDA MENDOZA, LA QUINTA, LOT XX, LID 687806 `
COA.CHELLA:VALL;EYWATER DISTRICT
P. -O. 'BOX 105.8, COACHELLA, CALIFORNIA 92236,(760) 398-265-1
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--76-7), 0
Bill it
Permit Pm
�N7
Project Address:
i
Qty of La Qui eta
Building 8z- Safety Division
78-495 Calle Tapico
La Quinta, CA 92253 - (760) 777-70 h2.
Buiiding Permit Appiicatidn and Tracking Sheet
Icr's 1,1. 11 S ..
A. P. Number:
Address:
Legal Description:
City, ST, Zip:,, I
Contractor:
S
TelP hon one•
• Address: '
Project Description:
City- ST, Zip:
O 1C l/l
Telephone: -
State Lic. # :
City Lic. #;
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
--.-�•--:<�-'���= �:�<�-��
Construction Type: Occupancy:
YP P Y:
State ; -
to Lic. #
Project type one), New Add'n Alter Repair. Demo
0
ame of Contact Person:
Sq. Ft-:
#Stories:
#Units:
Telephone # of Contact Person:stimated
Value of Project:
APPLICANT- DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rcc'd
TRACKING .
PERMIT FEES
Plan Sets
n Cheek submitted
[RevicNvcd,
Item
Amount
Structural Calcs.
ready for corrections
Plan Check Deposit
Truss C21c5.
Called Contact Person
Plan Check Balance.
Title 24 Calcs.
Plans picked up
Construction '
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Revicw, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant. Deed
Plans picked up
II.O.A. Approval
Plans resubmitted
Grading
IN ROUSE:-
'"' Reyicw, ready for correctionsrassue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I-P.P.
Pub. Wks. Appr
Date of permit issue
School Fecs•
Total Pcrmit Fccs