14-0141 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:,
14-00000141
Property Address:
54625 AVENIDA RAMIREZ
APN:
774-275-018-6 -000000-
Application description:
PLUMBING
Property Zoning:
COVE RESIDENTIAL
Application valuation:
2450
Applicant:
I hereby affirm underpenalty of perjury that I
Section 7 00) of Division 3 of t e Business
License f� CJ42 C36���P\V
�atP'$ I 1 Cnntf,'IR.TM'
'F -41Y_4
BUILDING & SAFETY DEPARTMENT'
BUILDING PERMIT
Owner:
PATRICIA MATHIS
P O BOX 254
LA QUINTA, CA 92253
VOICE (760) 777-7012
D - X (740 X77-7011
CTI S (76 7-7153
i
FEB 12- Ml e: 12/14
CITY OF w QUINTA
_# FINANCE DEPT.
Contractor:
Architect or Engineer: HAMMER PUMPING INC
P.O. BOX 2448
CATHEDRAL CITY, CA 92235
(760)321-7448
LiC. No.: 661018
----
------------------------------------------------------------- - - - - -=
TOR' DECLARATION
under p 'ions of Chapter 9 (commencing with
,.Is
Code a y License is in full force and effect.
OWNER -BUILDER -DgC LARATI O
'I hereby affirm under penalty o erjury that.l am exempt from tfie Contrac or 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 fora permitsubjects 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 novintended 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 herselfthrough his orher-own employees, provided that the
improvements are not intended or offered for sale. If, however, the building or- improvement is sold within
one year oCcompletion, the owner-builder'will have the burden"of proving that he or she did not build or
improve' for:the purposeof sale.).
(_ 1 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:
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
save and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
Code, for the performance of the work for which t s permit. is issued. My workers' compensation
insurance carrier and policy number are:
I certify that,-ierformance of he orkfor ich is permit lsissued, .l shalfnoi employ any
person m ymanner sous to beco esub' t to [h 'workers'.c mpensation laws of California,
4FAIL
grefe that,if 1 should. becom uble, tothe wor 'comp nsation provisions of Section
0 # the Labor Code I ha h' tfi comply with.tho r visions.
Date: -WARNI : URE TOSECUREWORKERS' COMPENSATION COVERAGE IS UNLA FUL, 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 o ission 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 a void if work isnot commenced
within 180 days from date of issua permit, or ces tion of 180 days will subject
permit to cancellation.
I certify thaO have read this application an state thatthe a ve infor tion is cor I agre to comply with all
city .and co my rdinances and state law relating to buildi constr ion, and hereby a ri representatives
of 'h is
ty t enter upon the above-menur
above-mentioned pro rt f r in ction pposes.
Da
Lig Joh!i L L Signature (Applica t or Ag,
�
Application Number . . . . . 14-00000141
Permit . . . . . . PLUMBING 2013
Additional desc . .
Permit Fee . . . . 11.92 Plan Check Fee .
Issue Date . . . . Valuation
Expiration Date . . 8/11/14
Qty Unit Charge Per
Extension
1.00 11.9200 EA PLBG SEPTIC SYSTEM
11.92
----------------------------------------------------------------------------
Special Notes and Comments
PLUMBING - ABANDON SEPTIC TANK,
CONNECT
TO SEWER. 2013 CALIFORNIA BUILDING
CODES.
----------------------------------------------------------------------------
Other Fees . . . . . . . . .
BLDG STDS ADMIN
(SB1473)
1.00
PERMIT ISSUANCE
M/P/E
90.57
PLAN CHECK, PLUMBING
4.77
Fee summary Charged
----------
Paid Credited
------------------------------
Due
-----------------
Permit Fee Total 11.92
.00
.00
11.92
Plan Check Total .00
.00
.00
.00
Other Fee Total 96.34
.00
.00
96.34
Grand Total 108.26
.00
.00
108.26
LQPERMIT
Din #
-Gr, of La i�Q urn to f
Building 8r Safety Division
P:O Box 1504, 78 495 C I&Tampico
La Qu(nta, CA 92253 (760) 777-70.12'
Building Permit Applcat►on'and Tracking Sheet
Permit #
ii
4"- l �'�
Project Address: 5 ZSR.
nn i 2 c
Owner's Name . P
A. P. Number:
Address"�6� Z �(
Legal Description: r '
City, ST, Zip .L f 4 v C -A ct 2 -L. Y /
Contractor:
oc• "
Tele hone:.
Address: ' D k Z L-[. 1-k...• ' .
P`ro�ect Description: `:� t L
City, ST, Zip:. ,..,
C,�-rh.CUl--�IJELI(.d.
Telephone:—?
::::%:i::°.::::::<:.>.::>:;:<:>;:>s::•r,:.:>:>::.>.»;
. f
State Mc. #:
CrtyLrc
Arch., Engr., Designer.
Address:
City., ST, Zip:
Telephone:
P
<:'•.»_:•:,.;.,:::::;.:::::;>;:.::.::::;. ;. ;>;;::;:.;;:.:
:' : •:h•.::::::::.::.::•:::•.:...
` 'Construction Type:: Occupancy:
State Lic. #:
'Project type (circle one),j,New Add'n Alter Repair Demo
'Name of Contact Person:
. Sq:. Ft.:
# Stories:
# Units:
Telephone #,of Contact Person:.
Estimated Value of•Project
APPLICANT: MNOTWRITE,BELOWWTHIS LINE
H
Submittal
Req'd
Reed
?TRACKING
7 PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Revieived, ready o corrections
'Plan Check Deposit
Truss Calcs.
Called'ContactPerson
<
Plan Check Balance,
Title 24 Calcs.Plans
picked up .. `,. -
Constcuctiop
Flood plain plan
4
Plans resubmitted
'Me'chanical
Grading plan
2od Review, ready for corrections/issue
Eleetrical
Subcontactor List .
"Called otitact•Person
Plumbing
Grant Deed
Plan's picked,up '
S.M.1.,
H.O.A. Approval
Y.
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
Stenhanie Khatami
From: randy knowles <randyk@hammerpumping.com>
Sent: Wednesday, February 12, 2014 8:52 AM
To: Stephanie Khatami
Subject: Re: [Scan] 2014-02-12 08:18:40
■
1.00 FF SCC -COLLECTION
, '
$2,415.00
r GOACHELLA•VALLEY WATER DISTRICT
+N ER
4�gTRs P.O:
BoX 1058, COACHELLA, CALIFORNIA 92236 (760) 398-2651
INVOICE Date: 2/10/2014
SUBJECT: SANTA CARMELITA, 54625 AVENIDA RAMIREZ, LA CIUINTA, LID 691264, "SCC: FEE ONLY"
PATRICIA MATHIS
Project: 14-5223
PO BOX 254Protect
Date: 2/10/2014
Amount Due: $4,851.00
LA QUINTA, CA 92241
GEO: ' 06 06 i3-1 ti
Planner: SANDRA VILLALQBOS
TO INSURE PROPER CREDIT, PLEA$E RETURN TMS, PORTION WITH
REMI TANCFANDANCLUDETMEPROJECTONYOUR'CHECK 'I
FEB' 10 2013
■
1.00 FF SCC -COLLECTION
$2,415.00
$2,415.00
1.00? FS SCC -TREATMENT
$2,436.00
$2,.436.00
$4,851.00
FEB' 10 2013
COACHELLA VALLEY
.. WATER DISTRICT.
,
' ... �..
:4 • - y
... i, a
Y.
SUBJECT. SANTA CARME .LTA, 54625 A+IENIDA RAMIREZr LA OUiNTA CIO B4i' e" •crrr rxF nnuav-
r
t
J f •".
4
r' COACHELLA VALLEY WATERI. DXSTRICT`
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