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BPLB2015-0033P-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 T-;tr o& rw4umrw COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT Application Number: BPLB2015-0033 Property Address: 52920 AVENIDA NAVARRO APN: 773335010 Application Description: CALLENS/ABANDON SEPTIC/CONNECT TO SEWER Property Zoning: Application Valuation: $2,500.00 Applicant: BALLINGER DEVELOPMENTS c -n N P O BOX 542 YUCCA VALLEY, CA 92286 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: B. C42, C53 License No.: 832890 D� V3/�r Contractor-ri L/ OWNER -BUILD R DECTION 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. Q. Lender's'Name: Lender's Address: VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 (760)831-5086 Llc. No.: 832890 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 ,A rk for which this permit is issued. (vim _ 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 the Labor ode, I shall forthwith comply with those provisions. Date 36 2 %S 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 here by;authorize representatives of this city to enter n above . mentioned property for inspection purposes. DaZ)4930V Signature (Applicant or Ageht)� \l Date: 3/2/2015 Owner: RENE CALLENS 83433 STAGECOACH RD INDIO, CA 92203 tr) c -n N 9 "' 4 s LL Contractor: oc ICE o BALLINGER DEVELOPMENTS a v� P O BOX 542 \ YUCCA VALLEY, CA 92286 rr �1 , (760)831-5086 Llc. No.: 832890 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 ,A rk for which this permit is issued. (vim _ 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 the Labor ode, I shall forthwith comply with those provisions. Date 36 2 %S 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 here by;authorize representatives of this city to enter n above . mentioned property for inspection purposes. DaZ)4930V Signature (Applicant or Ageht)� \l 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 forPERMIT 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. • 00 Permit IDO iI PERMIT NUMBER; ,r City of La Quints BPLB2tJ15-x033 Description: CALLENS/ABANDON SEPTIC/CONNECT TO SEWER NAME TYPE NAME Type: PLUMBING Subtype: Status: APPROVED Applied: 3/2/2015 SKH Approved: 3/2/2015 SKH Parcel No: 773335010 Site Address: 52920 AVENIDA NAVARROLA QUINTA,CA 92253 Subdivision: SANTA CARMELITA VALE LA QUINTA Block: 149 Lot: 17 Issued: UNIT 15 BALLINGER DEVELOPMENTS P O BOX 542 Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $2,500.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 P O BOX 542 Details:' PLUMBING - ABANDON SEPTIC/CONNECT TO SEWER. 2013 CALIFORNIA BUILDING CODES. CA Process Summary Iff Printed: Monday, March 02, 2015 8:55:03 AM 1 of 2.R SYSTEM S NAME TYPE NAME ADDRESS1 CITY STATE . ZIP PHONE FAX EMAIL APPLICANT BALLINGER DEVELOPMENTS P O BOX 542 YUCCA VALLEY CA 92286 (760)455-2455 CONTRACTOR BALLINGER DEVELOPMENTS P O BOX 542 YUCCA VALLEY CA 92286 (760)455-2455 101-0000-20306 0 OWNER RENE CALLENS 83433 STAGECOACHD INDIO CA 92203 (760)455-2455 Total Paid forBUILDING STANDARDS ADMINISTRATION Printed: Monday, March 02, 2015 8:55:03 AM 1 of 2.R SYSTEM S Comm DESCRIPTION ACCOUNT QTY 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: Printed: Monday, March 02, 2015 8:55:03 AM 1 of 2.R SYSTEM S Permit Det►al'�S P■ER'MIT NUMBER � fM City of la Quinta BPLB2Q►15�C10+33 DESCRIPTION ACCOUNT QTY AMOUNT PAID, PAID DATE RECEIPT # CHECK # METHOD PAID BY CLTD BY 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 for PLUMBING FEES: $24.18 $0.00 o FREMARKSRETURNEDREVIEW TYPE REVIEWER SENT DATE DUE DATE DATE STATUSNOTES Printed: Monday, March 02, 2015 8:55:03 AM 2 of 2 ((�,7 ��j`'p'��/] �.�,-7" T t_:f SYSTEMS SE ID INSPECTION TYPE INSPECTOR . SCHEDULED DATE ' 'COMPLETED DATE RESULT REMARKS NOTES PLUMBING FINAL" o FREMARKSRETURNEDREVIEW TYPE REVIEWER SENT DATE DUE DATE DATE STATUSNOTES Printed: Monday, March 02, 2015 8:55:03 AM 2 of 2 ((�,7 ��j`'p'��/] �.�,-7" T t_:f SYSTEMS '1.W ,11 r52A15:00 FACOASHELLA VALLEY WATER DISTRICT $2415.00 oiSTRtQ P.C. BOX 1058. .COACHELLA, CALIFORNIA92236 (260) ;398-2651 INYOICE Date: 2/23/2015, S4,85i';00' SUBJECT: SCC (N1LY,52.020 AVENIDA NAYARRd.;LA QUINTA. LID 085704 CALLENS REALTY LLC Project: 83433:STAGECOACH RD: 15;8136 Project Date: 2/2312015 INDIO. CA 92203 Ameunt Due: .54;85L0� GEO: 6"6.12-1'. Planner. SARKLOPEZ ' TUI\SU,FE,PROPER LRE01 is PLEtiRE?DHNTIi:S PJFT?Oti HFH REMR iAVCE AND IkC1uDE.TiF Ppp�ECTck: TOUR C�(.i.: '1.W ,11 r52A15:00 P SCC -COLLECTION $2415.00 1_:00 F:1 MC-TREATPAENT - _ - $2,436.00 52 .43 .00 S4,85i';00' Oeve'.09i?'xis16£�+icesflape.^.men: 3 2©15 Cddcbelia valieywat6r District. TSSi5; M.rvIatJ Lana Set% Dart+OCSe�. i•A�� SUBJECT SCC ONLY- S2A20AvE?AD'A'NAVARRO. LADUINTA. LID COACHELLA VALLEY WATER DISTRICT 'P -.o_ BOX 1058. COACHELIA,- CALIFO"IA.92236 (760).398-2651 Page. t I City of La QuInta Building & Safety Divcdon P.O Box 1504,78-495 Calle Tampico La CA 92253 -{760) 777-7012 Building Permit Application and Tracking. Sheet : pennh ProjectAdd=. 52920 Avenida Navarro ownet'sName:. Rene Callens A. P.xrmbet 773-33-5010 Adds: 83-433 Stagecoach Rd Legal Description: La Quinta Cave- City, ST, Zip: Indio- 6a 92203' contractor. Ballinger Developments Telephone: 760,-455-2455 Project Description: Pump septic tic tank and seepage Address: PO Box 542 city, ST Zig:. Yucca Valley, Ca 92286 pit and fill with sand, connect to city sewer . Telephone: 760-831-5086: ter al State Lic. # : 832890 City Lic A. Arch, Bag., Designer: N/A Address: City, ST, zip: N/A Telephone: N/A State Lic. #: MA Construction Type-, Oc�upancy: Vacant Project type (circle one): New Add'n . C� Repair Demo Name of Contaq.Person: Robert Ballinger sq. Ft: 1286 # Stories: 1 #Unit: Telephone # of Contact Person: _ Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE Sabmttpl Req'd 'Reed TRACMG PERMIT FEES PJpa Scis Piaa Check submitted. Ilan Amomrt filvctmalM Reviewed, ready for corrections Plan CdcckDeposit. . Tn,m C21cs. Called Contact Person Pias t3eek Salanee Titie24 Cales Pians picked up canstrnetlon Flood plain plan . Plans resubmitted.' , Mechmiical Giading plan Z'! Review, ready for correWonslissue Electrical Subeo=taetor List Called Contact Person Plumbing ' Grant Deed Plans picked up S M.I H.O.A. Approval Plans resubmitted Grading IPI HOUSE:- kd Re-vLew, ready for eorreetions/issaeDeveloper Impact Fee Planning Approval. Called Contact Person A".P. Pub. Wks. APpr Date of perm It issue Scirool.Fees - - Total Permit Fees 9 ..... .. .... . . ........ . . ........ I�I,�T_1 AN : 9� •` 7:.?x-..33 - c� o "To 7 7t/ Li . F iJ vu.1 LoC4?-1 CITY OF LA QUINTA BUILDING & SAFETY DEPT. APPROVED FOR CONSTRUCTION DA a�13Y U ,P o Sjp L f<<< Z/° A&.S c� I Na"T . PW