13-0850 (PLBG)1
4 XP Qum&
P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
FITFINAIN4CEID)EPT. ate: 7/10/13
Application Number: 13-00000850 Owner:PropertyAddress: 53125 AVENIDA JUAREZ JOHN NELSONAPN: 774-032-012-4 -000000- 53125 AVENIDAApplication description: PLUMBING LA QUINTA, CAProperty Zoning: COVE RESIDENTIAL (760)000-0000
Application valuation: 6200
Contractor:
Applicant: Architect or Engineer: HAMMER PUMPING INC
P.O. BOX 2448
CATHEDRAL CITY, CA 92235
(760) 321-7448
IVA Lic. No.: 661018
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -'
f LI E SED RA OR'S DECLARATION
I hereby affirm under penalty,!of perjury tha I a under rovisions of Chapter 9 (commencing with
Section 70I.,
1 of Division 3?of the Busine s an P fession C e, and my License is in full force and effect.
Licensed la2C42 C3,6 Lic 661018
Date/ � G J Co tract'
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 ($5001.:
1 _ I 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.).
(_ 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.).
1 _) I am exempt under Sec. , B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
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
issued.
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 NATIONAL UNION Poli y Number 910606
I certify that, in the performance of the ork for which this ermit is issued, I shall not employ any
person in any ner so beco a subject t e work ' is laws of California,
and agree t t, if I should be me bject to the kers' co pensation provisions of Section
•-+ 3700 of
Labor FCode, 1 11 f hwith comply with provisions.
" ei d Ap 'can% 'r
WARNI G: F ILURE TO SECU ERS' 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 ermit, or cess tion of work for 180 days will subject
permit to cancellation.
I certify that 1 have read this application anLnedproperty
he above i formatio is cor I agree to comply with all
city and co my dinances and state laws rilding con ructio , and hereby ori representatives
of this cou ty t eiinter upon the above-menfor ' ec ' purposes.
DatJ Signature (Applicant o
Application Number . . . . . 13-00000850
Permit ... . PLUMBING 2013
Additional desc . .
Permit Fee . . . . 11.92 Plan Check Fee
.00
Issue Date . . . . Valuation . . .
. 0
Expiration Date .. 1/06/14
Qty Unit Charge Per
Extension
1.00 11.9200 EA PLBG BUILDING SEWER
11.92
----------------------------------------------------------------------------
Special Notes and Comments
SEPTIC ABANDONMENT/CONNECT TO SEWER.
2010 CALIFORNIA BUILDING CODES.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
PERMIT ISSUANCE M/P/E
90.57
` PLAN CHECK, PLUMBING
11.92
Fee summary Charged Paid Credited
---------------------------------------------------------
Due
Perm it Fee Total 11.92 .00 .00
11.92'
Plan Check Total .00 .00 .00
.00
Other Fee Total 103.49 .00 .00
103.49
Grand Total 115.41• .00 .00
115.41
LQPERMIT .�
Bin #
Qty of La Quint'a
-Building &r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-70.12
Building Permit Application and Tracking Sheet
Permit #
Project Address: Alt
Owner's Name:
A. P. Number:
Address: 5>1 1 LfS
Legal Description:
Contractor: TU Vv\ Ia e.,, Tf4 C
City, ST, zip: Lk Q JI rtl A
Telephone:
Address: Vog>,,y, z-4gi
Project Description: 1
City, ST, Zip: CP0Y1Et&A1(_ CcTq
Telephone: 16
State Lic. #
City Lic.
Arch., Engr., Designer:
Address:
City., ST, Zip:
XX
Telephone: .... ............
State Lic. #:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Reqld
RWd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit
Truss CaIcs.
Called Contact Person
Plan Check Balance.
Tide 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
3rd 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
Jul 10 13 09:12a Daniel Callister
760-771-9876 p.1
COACHELLA VALLEY WATER DISTRICT
10 P.O. BOX 1058, COACHELLA, CALIFoRNiA 92236 (760) 398-2651
INVOICE Date: 71512013
SUBJECT: SANTA CARMELITA, 53125 AVENUDA JUAREZ. LA QUINTA, LID 686498, "SCC FEE ONLY"
JOHN NELSON Project: 13-4680
Project Date: 71512013
Amount Due: $4,851.00
GEO: 06-06-12-0
Planner: SANDRA VILLALOBOS
TO INSURE PROPER CREDIT. PLEASE RETURN THIS PORTION WITH
REMITTANCE AND INCLUDE THE PROJECT ON YOUR CHECK
1.001FF SCC -COLLECTION
1.00 FJ 1SCC-TREATMENT
COACKW VALLEY WATER DISTRICT
*** CUSTOMER RECEIPT *:Is
Oper: WON Type: OC Drawer: 1
Date: 7/U/13 22 Receipt no: 18584
Descriti n *Quantity A*ount
213
PZ ® PLANNING 3 ENGINEERING
1.18 $4851.98
Trans number: 2729965
53125 AMIDA JUAREZ SCC
SCC FEE LID9686498
RCVD.FROM JOHN NELSON
PHN
Tender.detail S4b51.8a
IT POINT OF SAL 4851.88
Total ten $
dered $4851.88
Total paysent
Trans date: 7YU113 Tice: 13:26:42
*TRUE CONSERVATION USE WATER WISELY*
X:
(768) 398-2651
$2,415.001
$2,415.00
$2,436.00
$2,436.00
$4,851.00
,REZ, LA QUINTA, LID 686498, "SCC FEE ONLY"
—.eLLA VALLEY WATER DISTRICT
_. -U58, COACHELLA, CALIFORNIA 92236 (760) 398-2651
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