BPLB2015-007478-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T4'4t 4•�wRu;.rw
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number:
BPLB2015-0074
Property Address:
52520 AVENIDA JUAREZ
APN:
773281002
Application Description:
VELEZ/ABANDON SEPTIC AND CONNECTTO SEWER
Property Zoning:
QUINTA, CA 92253
Application Valuation:
$7,400.00
Applicant:
PERRIS VALLEY SERVICE PLUMBING
49652 WAYNE STREET
INDIO, CA 92201
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing with Section 70001 of Division 3 of the Business and Professions Code,
and my License is in full force and effect.
License Class: _ License No.: 477854 2
Date:(, Contractor/ 1 J
v
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
($500).:
(1 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. C.).
Lender's
Lender's Address:
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
MARY VELEZ52520
AVENIDAJUAREZLA
QUINTA, CA 92253
L10-1
Contractor:
PERRIS VALLEY SERVICE PLUM
49652 WAYNE STREET
INDIO, CA 92201
(760)485-9436
Llc. No.: 477854
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
Sectio 700 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 of the Labor Code, I shall forthwith
comply with those provisions: /
Date: 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 hereby authorize representatives of this city to enter upon the above-
mentioned property for inspection purposes.
Date: Signature (Applicant or Age t . 1
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 for PERMIT ISSUANCE: $91.85 $0.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
SEPTIC SYSTEM
101-0000-42401
0
$12.09
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
SEPTIC SYSTEM PC
101-0000-42600
0
$4.83
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid for PLUMBING FEES: $16.92 $0.00
TOTALS:09 00
Description: VELEZ/ABANDON SEPTIC AND CONNECT TO SEWER
Type: PLUMBING . Subtype:
Status: UNDER REVIEW
Applied: 5/26/2015 SKH
Approved:
Parcel No: 773281002 Site Address: 52520 AVENIDA JUAREZ LA QUINTA,CA 92253
Subdivision: SANTA CARMELITA VALE LA QUINTA Block: 166
Lot: 22
Issued:
UNIT 17
Lot Sq Ft: 0 Building Sq Ft: 0
Zoning:
Finaled:
Valuation: $7,400.00 Occupancy Type:
Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0
No. Unites: 0
Details: ABANDON SEPTIC AND CONNECT TO SEWER. 2013 CALIFORNIA BUILDING CODES.
ADDITIONAL SITES
CHRONOLOGY
DESCRIPTION I ACCOUNT I QTY I AMOUNT
PAID I PAID DATE I RECEIPT # I CHECK # I METHOD
BSAS SB1473 FEE 1 101-0000-20306 1 0 $1.00 $0.00
Total Paid forBUILDING STANDARDS ADMINISTRATION
$1.00 $0.00
BSA:
PAID BY I CLTD
BY
Printed: Tuesday, May 26, 2015 8:54:13 AM 1 of 2
CRSY57EMS
of - _ �Fo i,, `s f ^ +� 0 • • • •
OF'I1'� -
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID BY
CLTD
BY
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
BLD
Total Paid forPERMIT ISSUANCE: $91.85 $0.00
SEPTIC SYSTEM
101-0000-42401
0
$12.09
$0.00
SEPTIC SYSTEM PC
101-0000-42600
0
$4.83
$0.00
Total Paid for PLUMBING FEES: $16.92 $0.00
! c 5.cit �: k -Y �i y+.. � �� •:. , : ' ., ..'.' '. s
... 'v�w6';i:Y�,..e:'Ly�tx`3::•.�t°5�'.����iY�.B�L��di�h.n .-fc`��'. �rsssiF . .. T' _ _ .s: �� .�.. �.�^' iQ s�.�.� ti .t '�:.
. � . ,-b=. e -.?t. t;:.. . v.. _.� - ,.. r.::z..: t - � - - aR -s: •'rix;�. rr..a,�N rr't +n!n : Lx��tt!a:� k. .{ e -,'yE'-.-rs�,.�� �,..
� BONDINFORMATIONWON OHM W-
(: .3r
ATTAC'HM N 5
Printed: Tuesday, May 26, 2015 8:54:13 AM 2 of 2
(COV V srsreMs
x
U_
SEQID INSPECTION TYPE
INSPECTOR SCHEDULED COMPLETED
RESULT
REMARKS
NOTES
DATE DATE
PLUMBING FINAL"
BLD
. � . ,-b=. e -.?t. t;:.. . v.. _.� - ,.. r.::z..: t - � - - aR -s: •'rix;�. rr..a,�N rr't +n!n : Lx��tt!a:� k. .{ e -,'yE'-.-rs�,.�� �,..
� BONDINFORMATIONWON OHM W-
(: .3r
ATTAC'HM N 5
Printed: Tuesday, May 26, 2015 8:54:13 AM 2 of 2
(COV V srsreMs
lain #
City of La Quinta
Building 8l: Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012.
Building Permit Application and Tracking Sheet
Permit #
3��r��'olS�o
Project Address: sas Av eN t, ps
Owner's Name:. (V` 1�•� L` C Z
A. P. Number:
Address: a S.1O,
Legal Description:
City, ST, Zip: CA.
Contractor: 1
P 4 � L y
Telephone:
Address: 6 i3 C'0-'rC' V-,\ Q�-o
Project Description:\
•2 4 " C' V -
City, ST, Zip: 1 b a.'���
Gib r VIAew?t a CovAV\C- It
Telephone
ePhon e
.................
State Lic. # :
City Lie. #;
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:.
Con tr ucti n TY Pe• Occupancy:
R • � L I
�i
Lic.#
DStato
Project type (circle one): New Add'emon
]ter Repair
Ft.: i L Q # Stories: S L #Units:
Name of Contact Person:Sq.
Telephone # of Contact Person:
Estimated Value of Project::3 L O to
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Ree'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 Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2°" Review, ready for corrections/issue
Electrical
Subeontactor List
Called Contact Person
Plumbing.
Grant Deed
Plans picked up
S.M.I.
H.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
COACHELLA VALLEY WATER DISTRICT
QrS Rte P.O. BOX 1058, COACHELLA, CALIFORNIA 92236 (760) 398-2651
INVOICE Date: 4/21/2015
SUBJECT: SANTA CARMELITA, 52520 AVENIDA JUAREZ, LA QUINTA, LOT 22, LID 684276, "SCC FEE ONLY"
MARY C. VELEZ
52520 AVENIDA JUAREZ
LA QUINTA, CA 92253
Project:
Project Date:
Amount Due:
GEO:
Planner:
TO INSURE PROPER CREDIT, PLEASE RETURN THIS PORTION WITH
REMITTANCE AND INCLUDE THE PROJECT ON YOUR CHECK
15-6292
4/16/2015
$4,851.00
06-06-12-2
SANDRA VILLALOBOS
1.00 FF SCC -COLLECTION $2,415.001$2,415.00
1.00 FJ SCC -TREATMENT $2,436.001 $2,436.00
$4,851.00
PAID $
Develop,_ ��L
ent Services Department
MAY IS 2015
Coachella Valley Water District,
75-515 Hovley Lane East
Palm Desert, CA 92211
SUBJECT:SANTA CARMELITA, 52520 AVENIDA JUAREZ, LA QUINTA, LOT 22, LID 684276, "SCC FEE ONLY"
COACHELLA VALLEY WATER DISTRICT
P.O. BOX 1058, COACHELLA, CALIFORNIA 92236 (760) 398-2651
Pagel
4
I
fi
INVOICE #
0
; o
'ke City of La Quinta INV -225
78-495 Calle Tampico
a
La Quinta,CA 92253 Date Due: 6/25/2015
�
PERRIS VALLEY SERVICE PLUMBING
83613 SACRAMENTO STREET -
Invoice Date: 5/26/2015
Record # Record Type Fee Group Fee Description'
Quantity Amount .
LIC -762813 CONTRACTOR C, ANNUALLY 0
$50.00
SB -1186 STATE FEE 0 $1.00
$51.00
Invoice Total: $51.00
f
Please send your payment to this address:
Printed: Tuesday, May 26, 2015 8:53 AM 1 of 1
CRw
SYSTEMS
ATTENTION CONTRACTOR
1 declare that the following items comprise a complete business license application packet for a
new or renewal license for the City of La Quinta and are attached:
A. Business License Application Form
B. Check made payable to the City of La Quinta
Contractor Business License Fees:
A or B License Classification $100.00 per year. or $50.00 semi-annual
C License Classification. $ 50.00 per .year -or $25.00 semi-annual
SB -1186 State Fee $ 1.00
The submittal of a complete application packet will assist in the licensing process. Please return
this .form with the information packet. Failure to include alf of the above may delay the
application process.
NOTE: If your business is not being run from a commercial location and you live in -the City of La
Quinta, you will be required to obtain a Home Occupation Permit Approval prior to the submittal
of your license paperwork.
Thank you for your interest.
Date: Applicant: - -
On';Septembe� 19,.-201.2 .Governor.Brown sigried into law S:B-1186 which ;adds a state fee of.:51 on any applicant fora
local businessiicense,permit,'orrenewal: The purpose:".--' comply wifh construction relked.accessibility requirements-
for:businesses in'order.fo .facilitate :compliance with' federal:and stale:disability law; as specified.