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BPLB2015-009578-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application Description Property Zoning: Application Valuation: BPLB2015-0095 53770 AVENIDA MENDOZA 774173002 GEIGER PETER SEPTIC $2,300.00 Applicant: MIRANDA'S SEPTIC SERVICES 33749 WHISPERING PALMS TRIAL CATHEDRAL CITY, CA 92234 COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT 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: C42 License No.: 1002066 Date:—F^/g—fir Contractor: '00.0.4/ / 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 Divisio 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 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 Name: - Lender's Address: VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 8/12/2015 Owner: PETER GEIGER 53770 AVENIDA MENDOZA LA QUINTA, CA 92253 Contractor: MIRANDA'S SEPTIC SERVICES 33749 WHISPERING PALMS TRIAL CATHEDRAL CITY, CA 92234 (760)404-8806 Llc. No.: 1002066 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. fvy 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: D �i 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 ($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: 1/.y" /7 Signature (Applicant or Agent))_ 52 �� FINANCIAL 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 forPERM1T 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 c 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 forPLUMBING FEES: $24.18 $0.00 TOTALS:00 Description: GEIGER PETER SEPTIC ABANDONMENT SEWER HOOKUP Type: PLUMBING Subtype: Status: UNDER REVIEW Applied: 8/12/2015 PIU Approved: Parcel No: 774173002 Site Address: 53770 AVENIDA MENDOZA LA QUINTA,CA 92253 Subdivision: SANTA CARMELITA VALE LA QUINTA Block: 249 Lot: 23 Issued: UNIT 23 Lot Scl Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $2,300.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 ADDRESSI Details: SEWER HOOKUP SEPTIC ABANDONMENT PER 2013CALIFORNIA BUILDING CODES. ADDITIONAL SITES CHRONOLOGY CONDITIONS CONTACTS NAME TYPE NAME ADDRESSI CITY STATE ZIP PHONE FAX EMAIL APPLICANT MIRANDA'S SEPTIC SERVICES 33749 WHISPERING PALMS TRIAL CATHEDRAL CITY CA 92234 (760)391-3139 CONTRACTOR MIRANDA'S SEPTIC SERVICES 33749 WHISPERING PALMS TRIAL CATHEDRAL CITY CA 92234 (760)391-3139 OWNER PETER GEIGER 53770 AVENIDA MENDOZA LA QUINTA CA 92253 (760)391-3139 Printed: Wednesday, August 12, 2015 9:44:44 AM 1 of 2 srszrnns DESCRIPTION . ........ . ACCOUNT .......... . .. QTY .......... 11 ... ...... .. AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY CLTD. BY BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00 Total Paid forBUILDING STANDARDS ADMINISTRATION $1.00 $0.00 BSA: PERMIT ISSUANCE 101-0000-42404 0 $91.85 $0.00 Total Paid for PERMIT 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 forPLUMBING FEES: $24.18 $0.00 TOTALS:• 00 INSPECTIONS SEQID INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED DATE DATE RESULT REMARKS NOTES' PLUMBING FINAL" BLD BOND INFORMATION Printed: Wednesday, August 12, 2015 9:44:44 AM 2 of 2 SYSTEMS Bin # City of La Quinta Building 81• 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: '57A--70 A V, Owner's Name: pl� A. P. Number: Address: 37 V, e .' Legal Description: City, ST, Zip: , Contractor: Telephone: e: - 9/ - 3 9 Address:yq Project Description: City, ST, zip: 2` crf G/�`9�� 3 �—rCGvG12 Telephone: D FOP L g G Y State Lic. # : p City Lic. #; Arch., Engr., Designer: Address: City., ST, Zip: Telephone: one: '? ............................... Construction s on T e: c Y• YP Occupancy: P State Lic. #- Project e o ct tYP circle one): New Add'n A J � Alter Repair Demo Name of Contact Person: Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: Estimated Value of Project: ®a� APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rcc'd 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 Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 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 corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees " Total Permit Fees Geiger h'`f 7605653609 P.1 COACHELLA VALLEY WATER DISTRICT P.O. BOX 1059, COACHELLA, CALIFORNIA 92236 (760) 398_2651 INVOICE Date: 7/27/2015 SUBJECT: SANTA CARMELITA, 53770 AVENIDA MENDOZA, LA QUINTA, LID 689408, "SCC FEE ONLY" PETER GEIGER Project: 80614 APPLE COURT 15-6486 Project Date: 7/22/2015 IMO, CA 92201 Amount Due: $4;851.00 GEO: 06-06-12-4 Planner: SANDRA VILLALOBOS TO INSURE PROPER CREDIT. PLEASE RETURN THIS PORTION WITH _REMITTANCE AND INCLUDE THE PROJECT ON YOUR CHECK 1.00 FF SCC -COLLECTION 1.OD FJ SCC -TREATMENT $2,415.00 $2,436.00 PAID $ `�, 8'5-1.00 /- ----- �474a o/ Development Services Department JUL 27 2015 �Y- Coachella Valley Water District 75-515 HDv)ey Lane East Palm D®sert, CA 92211 .767o _3q1 3f3 y. P�257P- 71" /--7- 5-3 -72� A L./'�- M 1tiAo 4 �-A SUBJECT: SANTA CARMELITA. 53770 AVENIDA MENDOZA. LA QUINTA, LID 689408. "SCC FEE ONLY" • 'r COACHELLA VALLEY WATER ISTRICT P.O. BOX 1058. COACHELLA, CALIFORNIAD922 6 (760).398-2651 $2,415.00 $2,436;00>, . $4,851.00 Page 1