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PLBG (13-0465)P.O. BOX 1504 78-495 CALLE TAMPICO LA OUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application description: Property Zoning: Application valuation: Applicant: cu. VOICE (760) 777-7012 FAX (760) 777-7011 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760)777-7153 BUILDING PERMIT 13-00000465 - Owner: 51592 AVENIDA NAVARRO SANTIAGO CONRAD 773-145-026-21'-000000= PLUMBING +. COVE RESIDENTIAL 2000 51592 AVENIDA NAVARRO LA QUINTA, CA 92253 Contractor: Architect or Engineer: - - - NYPD ' VERANDA L INDIO INDIO, CA 92201 7 (760)296-0990 Lic. No.: 61055 LXLX U APR 15 2013 Date:'- 4/15/13 t CITY OF LA QUINTA 1 - FINANCE DEPT -------------------------------------------------- --------.----------------------------------------— LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations: ' Section 7000) of Division 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: 13-C36 icense N .: 610554 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is. t/rr 0 issued. Date: Contractor: - 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 OWNER -BUILDER DECLARATION insurance carrier and policy number are: I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the - Carrier EXEMPT - Policy Number EXEMPT . following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires -a permit to _ I certify that, in the performance of the work for which this permit is issued, I shall not employ any - construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner so as to become subject to the workers' compensation laws of California, permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I should become subje te-th rkers' compensation provisions of Section License Law (Chapter 9 (commencing with Section 7000) of Div70 ision 3 of the Business and Professions Code) or 0 of the Labor C I sh 11 fort t comply wit e p that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by /•7 any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: Date: Applicant: (_ 1 1, 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 WARN NG: FAILURE TO SECURE WORKERSCOMPENSATION COVERAGE IS UNLAWFUL, AND SHALL Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND and who does the work himself or herself through his or her own employees, provided that the DOLLARS ($100,000).* IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. 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.). - APPLICANT ACKNOWLEDGEMENT _ (_ 11, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the . 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application. property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed 1 . Each person upon whose behalf this application is made, each person at whose request and for _ - - pursuant to the Contractors' State License Law.)- whose benefit work is performed under or pursuant to any permit issued as a result of this application, (_) I am exempt under Sec. , B.&P.C. for this reason the owner, and the applicant, each agrees to, and shall defend, indemnity 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. - Date: Owner: 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 . CONSTRUCTION LENDING AGENCY . permit to cancellation. I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify that I have read this application and state that the above information is correct. I agree to comply with. all • -., work for which this permit is issued (Sec. 3097, Civ- C.)- city and county ordinances and state laws relating to buildin myyons' action, a�herebyauthorize representatives of this cou ty t enter upon the above-mentioned prope f 'Lection pu Lender's Name: "Date: i^ Signature (Applicant or Agen . - Lender's Address: LQPERMIT -, . LQPERMIT Application Number . . . . . 13-00000465 Permit . . . PLUMBING SEWER Additional desc . Permit Fee . . . . 30.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 2000 Expiration Date 10/12/13 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 HOOK UP 2010 CODES. -------------------------------------------------- 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 r Bin.# oty..of LA Quinta Bullding a Safety Division P.O. Box 1504,78-495 Calle Tamploo 1.a.Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # ProjectAdd[ess: ^•�f'� rv,6 0wna'sName:.006(Y.(& 4 A. P. Number. Address:�m Legal Description: City, ST, Zip: S/ Contactor. Telephone:-� Address: d Project Description: ��` City, ST, Zip 4C(� e S E-- r; Telephone: 7th- l( O 210 State Lie. #: 0�DJ` 7 City Li(-*#; c Arch., Engr., Designer. Address: City., ST, Zip: Telephone: Construction Type: , Occupancy: Project type (circle one): New Add'n Alter Repair Demo Ft; # Stories: # Unity: State Lic. #: Name of Contact Person: ��' kSq, Telephone # of Contact Person: 76o G C 96 Estimated Value of Project . 6�50 APPLICANT: DO NOT WRITE BELOW THIS UNE N Submittal Req'd Rec'd TRACMG PERMITFEES Plan Sets Plan Check submitted Item Amount Structural Cales. Reviewed, ready for corrections Plan Check Deposit. . Truss Cales, Called Contact Person Plan Check Balance Title 24 Calci. Plans picked up Construction Flood plain plan Pians resubmitted, . Mechanical Giading plan 2' Review, ready for correctionskssue Electrical Subcoutactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- ''d Review; ready for correetionsrissue_ Developer Impact Fee Planning Approval Called Contact Person A.LP.Y. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees . y Avd. No vaeeo Sm 1. T�nee ' COACHELLA VALLEY WATER DISTRICT P.O. BOX 1058, COACHELLA, CALIFORNIA 92236 (760) 398-2651 �JFg; INVOICE Date: 4/3/2013 . SUBJECT: SCC ONLY - 51592 AVENIDA NAVARRO, LA QUINTA, LID 681916 SANTIAGO CONRAD & RUTH Project: 51592 AVENIDA NAVARRO 13-4497 Project Date: 4/3/2013 LA QUINTA, CA 92253 Amount Due: $4,851.00 GEO: 06-06-01-0 Planner: CAROL PFANNKUCHE TO INSURE PROPER CREDIT. PLEASE RETURN THIS PORTION WITH REMITTANCE AND INCLUDE THE PROJECT ON YOUR CHECK 1.00 SCC -COLLECTION $2,415.00 , 1.00 SCC -TREATMENT $2,415.00 $2,436.00 $2,436.00 $4,851.00 $ dp Ca gasb APR 0-5 201 COAGrrcis. irf,LLE' CONRAD SANTIAGO RUTH SANTIAGO 8350 W8123/3222 �� ( jL Ls� .✓ / 07 O �SHFa4K.�� Date xx / ollars a "" v ��6 ,�X Altura C11011UY10%. 1.808.803.7228 wwwztturdou.com i / For - SUB.rct: 1: at -s- UNLY - 51592 AVENIDA NAVARRO, LA QUINTA, LID 681916 COACHELLA VALLEY WATER P.O. BOX 1058, COACHELLA, CALIFORNIA 92236 (760) 398-2651 Page 1