BPLB2016-0106z
78-495 CALLE TAMPICO C 0 D
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BPLB2016-0106
Property Address: 51840 AVENIDA VALLEJO
APN: 773172004 . SEPr1C.
Application Description: ERICKANGEL/ SEWER -ABANDON
Property Zoning:
Application Valuation: $3;200.00
Applicant: ilwl
SEWER& SEPTIC PROS INC AUG 2 4206
16315 AVENIDA RAMADA
DESERT HOT SPRINGS, CA 92240 fLA
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing with Section 7000) of Division 3 of the Business.and Professions Code,
and my License is in full force and effect.
License Class: C42 `L License No.: 986954 '
Date: - ` V Contractof.5 ►vJ
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).:
(_) 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 riot 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
Date:. 8/24/2016
Owner:
DALE" BURNETT
92253
Contractor:
SEWER & SEPTIC PROS INC
16315 AVENIDA RAMADA
DESERT HOT SPRINGS, CA 92240
(760)329-7600
Llc. No.: 986954
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
o"the for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by
Sec ion 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: STATE COMPENSATION INSURANCE FUND Policy Number: 9076014
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 ofthe L r Code, I shall forthwith
comply with those provisions.
Date:` 1' Applicant:
WARNING: FAILURE TO SECURE WORKERS' PENSATION COVERA E IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIIAL 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 th
above-mentioned property for inspection purposes.
Date: - 2� f - l Signature (Applicant or Agent
DESCRIPTION' r,
ACCOUNT QTY
AMOUNT
BSAS SB1473 FEE-
101-0000-20306 0
$1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA:-
$1.00
DESCRIPTION'
ACCOUNT
QTY
AMOUNT
PERMIT ISSUANCE
101-0000-42404
0
$91.85
Total Paid for PERMIT ISSUANCE:
$91.85.
*
DESCRIPTION
ACCOUNT
QTY
AMOUNT
'
BUILDING SEWER
101-0000-42401
0
$12.09
DESCRIPTION
ACCOUNT
QTY
AMOUNT
BUILDING SEWER PC
101-0000-42600
0
'
$12.09
Total Paid for PLUMBING'FE8'.
$24.18
TOTALS:
f
ti
Bin #
C y of La Q uIn td
Building 9 Safety Division
78-495 Calle- Tampico
La Quinta, CA 92253 - (760) 777-7012
01 Building. Permit Application and Tracking Sheet
Permit #
;Lo 161
Project Address: FI
Owner's Name:
A. P. Number:
Address:
Legal Description:
City, ST, -Zip:
Contractor: '
1
Telephone:
Address: ) ( 3
Project Description: x
City, ST, Zip:nl_�Oli tf► Lri
ele h ne
TP0
s uJ
� C.t> r4 N C
State Lic. # :
City Lie. #;
k-, b N Vo N
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
Con tructi
s on Type: ccu
Occupancy:
P P Y:
a
St to Lic. #
Project tYPa circle ne • 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
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount, -'-
Structural Calcs. .
Revicived, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Bce
Title 24 Calcs.
Plans picked up
slruction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review,.ready for correcli issue
Electrical
Subcontactor List
Called Contact -Pe r
Plumbing
Grant Deed
Plans pi up
S.M.I.
H.O.A. Approval
ans resubmitted
Grading
IN ROUSE:-
'"' Review, ready for correctionstiissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. App!,_
Date of permit issue
School cs,
Total Permit Fees
s.i� Y � Ji�l.:�.:..Y_.a..,�3•.-*Ga .Fr- • � r • • �•' �I•_ �•� +F � x'_. ;I' ��/.�_
1.00 FF . SCC-COLLECTIO
$2,415.M $2,415.00
.N'
•' 1.00 FJ SCC -TREATMENT ' -
$2 436.00 $2,436 nn
` r
$4,851.00
4
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• �� Coachei'1 . Vatley'Water Districti,
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75-515'Hovley Lene East r•
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- , ; • ''. Palm Desert; CA 9<?11 ''�, � ��.
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•
• COACHELLA VALLEY, WATER, DISTRICT '
P, 0.
BOX
1058, • C_ OACHELLA, CALIFORNIA ;92236
i
(760) 398-2651 ;
•+ ��Y r',. ,.
AUG 242016
Date:,8/9/2016.
�,�, , Y=
OF, LA OUINTA,
.INVOICE
�. .•
NITY DEVELOPMENT
COMMU ;
SUBJECT: -TRACT SANTA CARMELITA, 51840'AVENIDA VALLEJO,'LA 06INTA, LID 682404 "SCC ONLY" �=
DALE J. BURNETT F
,. Project
16-7390
51-840 AVENIDA VALLEJO
Project Date`.
. ►,
4, . Amount Due:
- ' $4;851:00
., LA QUINTA; CA. 92253
�
� GEO:
-
-.06-06-01-4-
}
.
Planner:
SARA LOPEZ {
TO INSURE PROPER CREDIT, PLEASE RETURN THIS PORTION WITH
REMITTANCE 'AND INCLUDE.THE PROJECT ON YOUR CHECK
s.i� Y � Ji�l.:�.:..Y_.a..,�3•.-*Ga .Fr- • � r • • �•' �I•_ �•� +F � x'_. ;I' ��/.�_
1.00 FF . SCC-COLLECTIO
$2,415.M $2,415.00
.N'
•' 1.00 FJ SCC -TREATMENT ' -
$2 436.00 $2,436 nn
` r
$4,851.00
4
S S
;PAID $
w `D evelopmeni,Service..DepaRmen
AUG_:10.2016
• �� Coachei'1 . Vatley'Water Districti,
+
4 ,
75-515'Hovley Lene East r•
•s
- , ; • ''. Palm Desert; CA 9<?11 ''�, � ��.
• • � ' ' , .�,
_•
Y -..
. AECEIV ED ,
•+ ��Y r',. ,.
AUG 242016
OF, LA OUINTA,
NITY DEVELOPMENT
COMMU ;
SUBJECT:TFtACT SANTA CARMELITA; 51840 AVENIDA VALLEJO, LA QUINTA;'LID 682404 "SGC ONLY"
• COACHELLA VALLEY WATER DISTRICT 'i• '
.'' ,P.O BOX 1058.,. COACHELLA, CALIFORNIA 922W(760)'398,-2651'-,
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