14-0925 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 14-00000925
Property Address: 51673 AVENIDA VELASCO
APN: 773-133-020-9 . -000000-
Application description: PLUMBING
Property Zoning: - COVE RESIDENTIAL
Application valuation: 5500
Applicant:
eZd�
--------------
I hereby a firm under penalty of perjury thatCI
Section 7 00) of Division 3 o",the Business a
License C ss: C42 36 1
�- Date: Z ` ontractor: q
•4 4 "
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Architect or Engineer:
JTRACTOR'S DECLARATION
under provisi Ins of Chapter 9 (commencing with
mals ode, an my License is in full force and effect.
License No . .1018
1 1 / r OWNER -BUILDER DECLARATION
I hereby r penalty of p affirm under rjutwt at I/am exempt from the Contractor's State License Law for the
following reason (Sec. 7031.5, Business an 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).:
(_) 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 contractors) licensed
pursuant to the Contractors' State License Law.).
1 _ 1 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
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/24/14
Owner:
JOE ANDRADE/TOM CHALBERG
51673 AVE VELASCO
LA QUINTA, CA 92253
D
Contractor: v1lA` 5 a
HAMMER PUMPING INC Vltl G �1�j�
P.O. BOX 2448
CATHEDRAL CITY, CA 922 5 CYPyOFIAQUINrq '
(760) 321-7448!tcc_ ppb.
Lic. No..: 661018
------------------------- ---------------------
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 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 Policy um ber--930606.
_ I certify that, in the.performa%�ce of the opk for which thi§ permit is issued, I shall not employ any
Peron in any manner so asko beco a su�jecx�o -thew rkers' compensation laws of California,
an agreerthat, if I should becom subject to the worke s' compensation provisions of Section
3 00 o/fllrthe Labor Cod ,'� ha orthwith comply wiy tsions.
Date: � C' I Appl'ca) nt: t.
WARNING: FA LURE TO RE 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 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 theCity
of LaQuinta, its officers, agents and employees for any act or omissio a at -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 or not co menced
within 180 days from date of issuance of uch p it, or cessation of ork f i da swill subject
permit to cancellation. /
I certify that I have read this application and state that the above n ormation is orrect. 1 gree t co y with all
city and co my or mantes and state laws relating to building o ruction,nd hereby aut oriz represen tives
of this cou ty to ter Pon the above-mentioned prope y r ins ectio fSurposes.
Date: Sinature (Applicant or Znt):
! \
Application Number . . . . . 14-00000925
Permit . . . PLUMBING 2013
' Additional desc .
.� Permit Fee- 11.92 - Plan Check Fee
.00
Issue Date . . . . Valuation
0
Expiration Date .12/21/14
Qty Unit Charge Per
Extension
1.00 11:9200 EA PLBG BUILDING SEWER
11.92
-------------------------------=-------------------------------
Special Notes and Comments
-------------
" SEPTIC ABANDONMENT SEWER HOOK UP 2013
PLUMBING 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 r
Other Fee Total _ 96.34 .00 .00
96.34
Grand Total 108.26 .00 .00
108.26
Bin #
Permit #
Project Address:
City of La - Quin ta
-Building &r Safety Division
P.O. B - ox 1504, 78-495 Calle Tampico.
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking- Sheet
L_ S 6 C) Owner's NamcJ�2
A. P. Number:
Address:
L A5
Legal Description:
City, ST, Zip:
Contractor: JkOA �L) MAO,
r -%Telephone:
...... . . . . . .
.. ........
4
Address:
Project Description: S Z:RL
City, ST, Zip: L_
tS, 0 �c._—" I <)
Telephone: -7 q
State Lic.
City Lie. C.
Arch., Engr., Designer.
Address:
City., ST, Zip:
Telephone:
Construction Type: Occupancy:
StatLic. #:
e
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
Req'd
Rcc1d
TRACKING
PERMIT FEES.
Plan Sets
Plan Check submitted
Item
Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Check Deposit
Truss C21cs.
Called Contact Pcrsim
Plan Check Balance
Title 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:-
3" 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
IM
1
C JG C4 6 � �.
F\
F (• ..� ; � ,^ .bis • • `• + y •• Y.• .: ' Y .' y ,!
,
j ,WATER• ^; COACHELLA VALLEY WATER' DISTRICT "
K
`O�grR�
P-0: BOX 1058,,COACHELLA, CALIFORNIA 92236 (76.0) 398=2651
i - INVOICE . •: Date: 5/20/2014 ` y
SUBJECT: SANTA CARMELITA, 51673 AVENIDA VELASCO; LA QUINTA, LID 681630, 'SCC FEE ONLY."
JOE ANDRADE ,' < Project: 14-0512 ;
do TOM CHALBERG Project Dater .
PO BOX 4357, .. . r. Y
i' ` �" . ,. 5/20/2014,
AmountDue:$4,851.00
BOISE, ID, 83711:". _' •GEO• 06-06-01-4''
Planner. _ SANDRA VILLALOBOS
TO INSURE PROPER CREDIT, PLEASE RETURN THIS PORTION WITH a
REMITTANCE AND INCLUDE THE PROJECT ON YOUR CHECK 4
SUBJECT:SANTA CARMELITA, 51673 AVENIDA VELASCO, LA QUINTA, LID 681630, "SCC FEE ONLY_ ° . ' • '� ,
COACHELLA`.VALLEY'WATER-DISTRICT ' s
P.0.:4BOX 1058; COACH ELLA;"CALIFORNIA 92236•(760),398-2651. "- -
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