BPLB2016-008878-495 CALLE TAMPICO _
LA QUINTA, CALIFORNIA 92253
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number:
BPLB2016-0088
•Property Address:
54685 AVENIDA CARRANZA
APN:
•774274020
Application Description:
FARROW /ABANDON SEPTIC -CONNECT TO SEWER
Property Zoning:
is issued. My workers' compensation insurance carrier and policy number are:
Application Valuation:
$3,500.00
Applicant:
I certify that in the performance of the work for which this permit is issued, I
EDWARD 1 STRZELCZYK '
shall not employ any person in any manner so as to become subject to the workers'
P 0 BOX 7114
compensation laws of California, and agree that, if I should become subject to the
LA QUINTA, CA 92248-7114
workers' compensation provisions of Section 3700 of t -Lab shall forthwith
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760).777-7153
Date: 6/15/2016
Owner:
STEPHEN FARROW
o �J
S
z c—
Contractor: m E� z
EDWARD J STRZELCZYK � t�
PO BOX 7114 � Cn
LA QUINTA, CA 92248-711'.4
CD r
(760)578-0201 D cn
Llc. No.: 439904
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter I I hereby affirm under penalty of perjury one of the following declarations:
9 (commencing with Section 7000) of Division 3 of the Business and Professions Code,
I have and will maintain a certificate of consent to self -insure for workers'
and my License is in full force and effect.
comp tion, as provided for by Section 3700 of the Labor Code, for the performance
License Class- B C10 C29 License No.: 43990
of . for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by.
Date: �5/! Contractor
ction 3700 of the Labor Code, for the performance of the work for which this permit
v Ci
is issued. My workers' compensation insurance carrier and policy number are:
OWN ER-BUILDE ATION ECLAR
Carrier: _ Policy Number: _
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State
I certify that in the performance of the work for which this permit is issued, I
License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
shall not employ any person in any manner so as to become subject to the workers'
city or county that requires a permit to construct, alter, improve, demolish, or repair
compensation laws of California, and agree that, if I should become subject to the
any structure, prior to its issuance, also requires the applicant for the permit to file a
workers' compensation provisions of Section 3700 of t -Lab shall forthwith
signed statement that he or she is licensed pursuant to the provisions of the
comply with those provisions.
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
Date: /J'�i Applicant:
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
WARNING: FAILURE TO SECURE WORKERS' OMPENSATION COVERAGE IS UNLAWFUL,
($500).:
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
(_) 1, as owner of the property, or my employees with wages as their sole
ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
compensation, will do the work, and the structure is not intended or offered for sale.
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
(Sec. 7044, Business and Professions Code: The Contractors' State License Law does not
INTEREST, AND ATTORNEY'S FEES.
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
APPLICANT ACKNOWLEDGEMENT
are not intended or offered for sale. If; however, the building or improvement is sold
IMPORTANT: Application is hereby made to the Building Official for a permit subject to
within one year of completion, the owner -builder will have the burden of proving that
the conditions and restrictions set forth on this application.
he or she did not build or improve for the purpose of sale.).
1. Each person upon whose behalf this application is made, each person at whose
(_) 1, as owner of the property, am exclusively contracting with licensed contractors
request and for whose benefit work is performed under or pursuant to any permit
to construct the project. (Sec. 7044, Business and Professions Code: The Contractors'
issued as a result of this application , the owner, and the applicant, each agrees to, and
State License Law does not apply to an owner of property who builds or improves
shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and
thereon, and who contracts for the projects with a contractor(s) licensed pursuant to
employees for any act or omission related to the work being performed under or
the Contractors' State License Law.).
following issuance of this permit.
(� I am exempt under Sec. B.&P.C. for this reason
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.
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
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 ent Pon the
above-mentioned property for inspection purposes.
Date �� 6 Signature (Applicant or Agent):
r -+
FINANCIAL INFORMATION
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 for BUILDING 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
BUILDING SEWER
101-0000-42401
0
$12.09
$0.00
PAID BY
METHOD
RECEIPT#
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
BUILDING SEWER PC
101-0000-42600
0
$12.09
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid for PLUMBING FEES: $24.18 $0.00
TOTALS:00
Description: FARROW / ABANDON SEPTIC -CONNECT TO SEWER
CONDITIONS
Type: PLUMBING Subtype:
Status: APPROVED
Applied: 6/15/2016 SKH
Approved: 6/15/2016 SKH
Parcel No: 774274020 Site Address: 54685 AVENIDA CARRANZA LA QUINTA,CA 92253
Subdivision: SANTA CARMELITA AT VALE LA QUINTA Block: 308
Lot: 9
Issued:
UNIT 28
ADDRESSI
CITY
Lot Sq Ft: 0 Building Sq Ft: 0
Zoning:
Finaled:
Valuation: $3,500.00 Occupancy Type:
Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0
No. Unites: 0
CA
Details: ABANDON SEPTIC/CONNECT TO SEWER. 2013 CALIFORNIA BUILDING CODES.
CHRONOLOGY
CONDITIONS
CONTACTS
NAME TYPE NAME
ADDRESSI
CITY
STATE
ZIP
PHONE
FAX
EMAIL
APPLICANT EDWARD J STRZELCZYK
P 0 BOX 7114
LA QUINTA
CA
92248-
7114
CONTRACTOR EDWARD J STRZELCZYK
P O BOX 7114
LA QUINTA
CA
92248-
7114
OWNER STEPHEN FARROW
1716 N DECATUR BLV
APT 4
LAS VEGAS
NV
92253
FINANCIA! INFfIKIVIATION
Printed: Wednesday, June 15, 2016 9:22:25 AM 1 of 2 C
MEYSYSTElv1S
DESCRIPTION
ACCOUNT -
QTY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID BY
CLTD
BY
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$0.00
Total Paid for BUILDING STANDARDS ADMINISTRATION
$1.00 $0.00
BSA:
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
Total Paid for PERMIT ISSUANCE: $91.85 $0.00
BUILDING SEWER
101-0000-42401
0
$12.09
$0.00
BUILDING SEWER PC
101-0000-42600
0
$12.09
$0.00
Total Paid for PLUMBING FEES: $24.18 $0.00
TOTALS: $117,03 00
BOND INFORMATION
Printed: Wednesday, June 15, 2016 9:22:25 AM 2 of 2 J
SYSTEiNS
COACHELLA VALLEY WATER DISTRICT
P.O. BOX 1058, COACHELLA, CALIFORNIA 92236 (760) 398-2651
INVOICE Date: 5/19/2016
SUBJECT: SANTA CARMELITA, 54685 AVENIDA CARRANZA, LA QUINTA, LOT 9, LID 691212
THE REAL.ESTATE CO.'INC. Project:
c/o CARLOS A. PENA Project Date:
44100 JEFFERSON ST. STE C-304
Amount Due:
INDIO, CA 92201 GEO:
Planner:
TO INSURE PROPER CREDIT, PLEASE RETURN THIS PORTION WITH
REMITTANCE AND INCLUDE THE PROJECT ON YOUR CHECK
16-7204
5/19/2016
.$4,851.00
06-06-13-1
SARA LOPEZ
SUBJECT:SANTA CARMELITA, 54685 AVENIDA CARRANZA, LA.QUINTA, LOT 9, LID 691212
COACHELLA VALLEY WATER DISTRICT
P.O. BOX 1058, COACHELLA, CALIFORNIA 92236 (760) 398-2651 Page1
Bin #
City of LQ Quin to
Building &' Safety Division
78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: 5Y-6005-
Owner's Name: p,vVGw
A. P. Number: d
Address: G /V S �� •� j
Legal Description:
City, ST, Zip: y/Co
'l t
/
Contractor:Tele
S T yZ G 1 c
P h one:
Project Description.
Address: - 0,
City, ST, Zip: `�. �v�:�„� s %L`�
Q►, t VBG
ele h one•
TP s -o z 0
s •
v ar•c.,j
State Lic. # : 39 o
City Lie. #;
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
Con structi n Type: e-Occ c
u
Y P Occupancy:
P Y:
State Li
c. te Ltc. #
Pr oJe ct tYPa (circle e 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
:Y
Submittal
Req'dRecd
T
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cates.
Reviewed, ready for corrections
Plan Check Deposit
Truss-Calcs.
Called Contact Person
Plan Check Balance
Title 24 Cales.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2nd Review, ready for correctionstissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN ROUSE:-
'^! 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