BPLB2017-0016n
78-495 CALLE TAMPICO D
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BPLB2017-0016
Property Address: 54283 AVENIDA RUBIO
APN: 774234037
Application Description: ABANDON SEPTIC/CONNECTTO SEWER
Property Zoning:
Application Valuation: $6,000.00
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
Date:3L? ia- X017 contractor: R 121,
OWNER BUILDER DEC TION
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).:
( ) 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 Contractors' State License Law does not
apply to an owner of property who builds or improves thereon, and who does the work
himselfor 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.).
( 11, 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 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 Na
Lender's Add
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Owner: 1— :5 CL -
SMITH
SMITH MARILYN JANE RICHA Cq ti
1613 E RUSTIC CREEK TER Z O
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EDMOND, OK 92253 Q U 6A
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Contractor: n
ALMS UNDERGROUND CONSTRUCTION INC
38703 VISTA DRIVE
CATHEDRAL CITY, CA 92234
(760)324-1911
Llc. 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'
compensati , as provided for by Section 3700 of the Labor Code, for the performance -
of thewpA.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'
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.
Qate:30,Tu.2017 Applicant:
l��,-.,�R,_ye"�
WARNING: FAILURE TO SECURE WORKERS' COMPEN T N 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 c' to enter upon the
above-mentioned property for inspection purposes.
Date: �p�n �Of 7 Signature (Applicant or Agent):
Applicant:
ALMS UNDERGROUND CONSTRUCTION INC
38703 VISTA DRIVE
CATHEDRAL CITY, CA 92234
Date: 1/30/2017
Owner:
SMITH MARILYN JANE RICHARDSO
1613 E RUSTIC CREEK TER
EDMOND, OK 92253
Contractor:
ALMS UNDERGROUND CONSTRUCTION INC
38703 VISTA DRIVE
CATHEDRAL CITY, CA 92234
(760)324-1911
t LIC. No.: 482180
---------------------------------------------------------------------------------------------
Detail: ABANDON SEPTIC/CONNECTTO SEWER. 2016 CALIFORNIA BUILDING CODES.
Application Number:
BPLB2017-0016
Property Address:
54283 AVENIDA RUBIO
APN;
774234037
Application Description:
ABANDON SEPTIC/CONNECT TO SEWER
Property Zoning:
Application Valuation:
$6,000.00
Applicant:
ALMS UNDERGROUND CONSTRUCTION INC
38703 VISTA DRIVE
CATHEDRAL CITY, CA 92234
Date: 1/30/2017
Owner:
SMITH MARILYN JANE RICHARDSO
1613 E RUSTIC CREEK TER
EDMOND, OK 92253
Contractor:
ALMS UNDERGROUND CONSTRUCTION INC
38703 VISTA DRIVE
CATHEDRAL CITY, CA 92234
(760)324-1911
t LIC. No.: 482180
---------------------------------------------------------------------------------------------
Detail: ABANDON SEPTIC/CONNECTTO SEWER. 2016 CALIFORNIA BUILDING CODES.
DESCRIPTION
ACCOUNT CITY
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
QTY
AMOUNT
BUILDING SEWER
101-0000-42401
0
$25.33
DESCRIPTION
ACCOUNT
QTY
AMOUNT
BUILDING SEWER PC
101-0000-42600
0
$17.73
Total Paid for PLUMBING FEES: $43.06
Bin #
Permit #{
W/b -7
Project Address: -5- / Z $ 3 A
City of b QUinta
Building a Safety Division
78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-701,2
Building Permit Application and Tracking Sheet
ve- , u b) O Owncr's Name: e n . % c4-&, Jso Vt,-
A. P. Number'-
Address: 5 2 $ 3 ve a
Legal Description:
City, ST, Zip: L
Contractor: " h
5 .0 der•
rau>1� Consl
Telephone:
z: <' < <>:<:;
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Address: 3'S 3 S
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Project Description: Seer Gonnee_-E-i ori,
City' ST, Zip: C9it^ec{ra C�`F 9223y
Telephone:
Ph o . �
7 6 a 3 2 Y•/
State Lic. # : L/ 8 2/ SU
City Lic. #.: 76 9
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
e.
Construction Type: Oecu Y:
TY Occupancy:
P
a
St to Lic. # •
Project type (circlew
one): � Ne A dd,n Alter Repair. r Demo.
Name of Contact Person: u
�m 5
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: 7�0 , S 78 / S� v
Estimated Value of Project: 4 iia
APPLICANT: DO NOT. WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'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 correctionsfissue
Electrical .
SubcontaetorList
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
II.O.A. Approval '
Plans resubmitted
Grading
IN ROUSE:-
Jrd 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