12-1067 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
12-00001067
Property Address:
54065 AVENIDA CARRANZA
APN:
774-204-014-4 -000000-
Application description:
PLUMBING
Property Zoning:
COVE RESIDENTIAL
Application valuation:
3000
Annlirant-
Architect or Engineer:
FMU
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
------------------------------------------------------------------------------------------=- - - - - - —
Owner:
MYERS BETTE L
54065 AVENIDA CARRANZA
LA QUINTA, CA 92253
Contractor:' D
ALMS UNDERGROUND CONST,
38703 VISTA DRIVE
CATHEDRAL CITY, CA 92234
(760)3_24-1911
Lic. No.: 482180
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/18/12
_p a
0
SEP g 2012
OF LA QUU4TA
CITY nGPT.
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 Professionals Code, and my License is in full force and effect.
License Class: C21 C42 License No.: 482180
/bate: �' ontractor: �^r rr) ('FI �ij ij 1c -l!7'
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 (5500).:
(_) 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 contractorls) licensed
pursuant to the Contractors' State License Law.).
(_ 1 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: D
LQPERMIT
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 BARRET BUS SRVC Policy Number 2246
1 certify that, in the performance of the work for which this permit is issued, 1 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 bor Code, I shall forthwith comply with those provisions.
Date: llfticant: (,% %140/ /7' J
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 Director of Building and Safety 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 county to enter upon the above-mentioned property for inspection purposes. .
21
Date: T-11?Si ature (Applicant or Agent): L Y'� r) �O CU
r% (b ,
Application Number . . . . . 12-00001067
Permit . .
. PLUMBING SEWER
Additional desc .
Permit Fee . . .
. 30.00
Plan Check Fee
.00
Issue Date . . .
.
Valuation . . .
. 3000
Expiration Date .
. 3/17/13
Qty Unit Charge Per
Extension
BASE FEE
30.00
----------------------------------------------------------------------------
Special Notes and
Comments
SEPTIC ABANDON, SEWER CONNECT. 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
LQPERMIT
760-568-1789
03:23:01 p.m. 08-29-2012 212
�►'�' #;:COACHELLA VALLEY WATER DISTRICT
O& : P.O. BOX 1058, COACHELLA, CALIFORNIA 92236 (760) 398-2651
INVOICE Date: 812912012
SUBJECT: 54065 AVENIDA CARRANZA, LA QUINTA, LID 689846, 'SCC FEE ONLY'
BETTE L MYERS Project: 12-4045
PO BOX 5759 Project Date: 8129/2012
Amount Due: $4,231.00
LA QUINTA, CA. 92253 GEO: 06-06-13-1
Planner: SANDRA VILLALOBOS
TO INSURE PROPER CREDIT, PLEASE RETURN THIS PORTION WITH
REMITTANCE AND INCLUDE THE PROJECT ON YOUR CHECK
SUBJECT: 54065 AVENIDA CARRANZA, LA QUINTA, LID 689846, 'SCC FEE ONLY"
COACHELLA VALLEY WATER DISTRICT
P.O. BOX 1058, COACHELLA, CALIFORNIA 92236 (760) 398-2651 Pagel
J(
tsin P
City of La Quinta
Building 8r 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 Addressis9406s_ C'MA A A 2ZA
wrier's Name:
A. P. Number:
Address:
Legal Description:
City, ST, Zip: 1A Auz'&Z4 /--1 i VZZ-9 3
Contractor: U12df-er(2)Y19un4( CoYM,-�
Arelephone:
Address: -3 V ?o3 V CSTA 0),
Project Description:
City, ST, Zip: (JM(RA 2-
Telephone:
7 6 -...
.......
C4
State Lic. # : LIM go
City Lic.
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
..............
...... ...
. . ....
Construction Type: Occupancy:
State Lic. #:
r0i
P e type (circle one): New Add'n Alter Repair Demo
� Name of Contact Person:M
yous A) '�
Sq. Ft.:
# Stories:
T Units:
k Telephone h of Contact Person:
12"Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
Submittal
Rcq'd
Rcc'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
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 correctionslissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
SAI.I.
II.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
www.hammerpumping.com
760/360-7448 7601321-7448 FAX 760/324-6434
Customer Name
0,4 C-,
Address
City L �_
Ph#
Additional Service-❑RequiredMRecommended
P.O. BOX 2448 - Cathedral City, CA 92235-2448 - LIC# 661018 JOB INVOICE
[I;OATII: TIME IN: TIME OUT: TECHNICIAN 111 TECHNICIAN b2 HELPER(S)
q'1 /� /-Z % c ,E' Torr'<_ jRDERED BY: I P.O. N I START DATE; I END DATE:
JOB LOCATION
s I v y cool r eta n e- o
SERVICE
BACK UP
❑CONTRACT
MAINTENANCE
❑ REPAIR
.Wl MAINTENANCE
❑ ESTIMATE
CONSTRUCTION
COMMENTS
❑ Leach System Failing ❑ Roots ❑ Excessive sludge/grease
SERVICES COMPLETED