BPLB2017-001878-495 ' VOICE (760) 777-7125
CALLE TAMPICO C` D
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011DESIGN & DEVELOPMENT DEPARTMENT
INSPECTIONS (760) 777-7153
BUILDING.PERMIT .
Date: 2/1/2017
Application Number: BPLB2017-0018 Owner: k
Property Address: 52825 AVENIDA VALLEJO SUSAN FOSTER
APN: 773323017 5137 AMALFI WY
Application Description: FOSTER RESIDENCE / SEWEROONWNCT OXNARD, CA 93035
Property Zoning:
Application Valuation: .$3,000.00
N31
Applicant: �A Contractor:
SEWER & SEPTIC PROS INC LAEWER & SEPTIC PROS INC
16315 AVEN DA RAMADA C\\N �F aU1 (ZDEP%AjM�ty 16315 VEN DA RAMADA
DESERT HOT SPRINGS, CA 92240E�-CpC�E� DESERT HOT SPRINGS, CA 92240
DESIGN PND D�
(760)329-7600
Llc. No.: 986954
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 License No.: 986954
Date: 2 — ( — f Contractor:
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.). .
(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.).
(_) 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:.
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: ACE AMERICAN INSURANCE COMPANY Policy Number: RWCC48828553
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 o?Section 7 3 � Code, l shall forthwith
comply with those provisions.
2Date: r/—/:7Appli .
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 Agen
Date: 2/1/2017
Application Number: BPLB2017-0018 Owner:
Property Address: 52825 AVENIDA VALLEJO SUSAN FOSTER
APN:. 773323017 5137 AMALFI WY
Application Description: FOSTER, RESIDENCE / SEWER CONNECT OXNARD, CA 93035
Property Zoning:
Application Valuation: $3,000.00.
Applicant: Contractor:
SEWER & SEPTIC PROS INC SEWER & SEPTIC PROS INC
16315 AVENIDA RAMADA 16315 AVENIDA RAMADA
DESERT HOT SPRINGS, CA 92240 DESERT HOT SPRINGS, CA 92240
(760)329-7600
Llc. No.: 986954
Detail: ABANDON SEPTIC AND CONNECT TO SEWER. PER 2016 CALIFORNIA BUILDING CODE
DESCRIPTION
FINANCIAL •• •
ACCOUNT CITY
AMOUNT
BSAS SB1473 FEE
101-0000-20306 0
$1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA:
$1.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT.
PERMIT ISSUANCE
101-0000-42404
0
$96.27
Total Paid for PERMIT ISSUANCE:
$96.27
DESCRIPTION
ACCOUNT
QTY
AMOUNT
BUILDING SEWER
101-0000-42401
0
$25.33
DESCRIPTION
ACCOUNT
CITY
AMOUNT
BUILDING SEWER PC
101-0000-42600
0
$17.73
Total Paid for PLUMBING.FEES:
$43.06
s1,}ATie
,Q COACHELLA VALLEY MATER DISTRICT
d�SrR�G P.4. BOX 1058, COACHELLA, CALIFORNIA 92236 (760) 398-2651
INVOICE Date: 112412017
SUBJECT. SANTA CARMELITA, 52825 AVENIDA VALLEJO, LA QUINTA. LOT 4, Lill 685322, "SCC FEE ONLY"
SAN FOSTER Project: 17-7758
37 AMALFI WAY Project Date: 112412017
Amount Due, $4,851.00
{HARD, CA 93035 GEO: 06-06-12-1
Planner: SANDRA VILLALOBOS
TO INSURE PROPER CREDIT, PLEASE RETURN THIS PORTION WITH
REMITTANCE AND INCLUDE THE Pt20JECT ON YOUR CHECK
$2,415.00
52>436.L'0
$4,851.00
00 C /c,
PAID $
Development S -prices DepaMnenE
JAN 2 4.2017
Coachella ualiey water Dis id
75=516 Hovleyi..aae East
Palm hart, CA 92211
• Bin f>f
Qt y of La Quinta
Building &r Safety Division
Permit ## 78-495 Calle Tampico.
La Quinta, CA 92253 - (760) 777-701,2 '
Building Permit Application and Tracking Sheet
Project Address: A V e' hOwner's Name: c
A. P. Number:
Address: LA--'
Legal Description:
City, ST, Zip:. y VV G v d C
Contractor: r •�
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T ele h ne:
P 0 '2 6 11
Address: T 6 3 f S• V tT n 4
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Project Description: 2
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City, ST, Zip: S e �, ►-10r
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Tlelte one:
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G 3 Z '1' 600
State Lic. # : 1 g 61 S I
City Lic. #..
Arch.,`Engr., .Designer:
Address:
City, ST, Zip:
Telephone:
P one:
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Construction T Occu ane
YPe: P Y
.State ,. Lic.
Pro' a 'n
ect circle one • New Add Alt
e 'Repair., Demo
J tYP � )•. P 0
Name of Contact Person:
LJ S C �� C� cir c
Sq. Ft.:
#Stories:.
#Units:
Telephone # of Contact Person: ,:7-6 0
3 O v
Estimated Value of Project: 3 d o o
APPLICANT: DO NOT WRITE BELOW THIS LINE
t✓ ,
Submittal
Req.. ,
Rcc'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for. corrections
Plan Check Deposit
Truss Cafes.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted .
Mechanical
Grading plan
2" Revicw, ready for corrections/issue
Electrical .
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
H.O.A. Approval
Plans resubmitted
Grading
IN ROUSE:-
Jrd Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. APPr
Date of permit issue
sC11061 Fecs,
Total Permit Fees