Loading...
BRES2016-0171411111i l� aK�I1�(�(/ VOICE (760) 777-7125 78-495 CALLE TAMPICO D FAX (760) 777-7011' LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING -PERMIT Date: .6/17/2016 Application Number: BRES2016-0171 Owner: Property Address:. 54700 AVENIDA VALLEJO STEPHEN FARROW APN: 774282010 1716 N DECATUR BLV APT 4 Application Description: FARROW /SEPTIC ABANDONMENT WITH MINOR REMODEL LAS VEGAS, NV 92253 Property Zoning: Application Valuation: $3,500.00 Applicant:. Contractor: EDWARD J STRZELCZYK PJ n EDWARD J STRZELCZYK PO BOX 7114 (�=�� _ P0BOX 7114 LA QUINTA, CA'9224&7114 '` '4""` LA QUINTA, CA -92248-7114 UN 1 7.2016 _ (760)578-0201 CITYOFIAOUINTA LIc. No.: 439904 COMMUNITY DEVELOPMENT DEPARTMENT 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: B. C10, C29 License No.: 439904 Date: �` Contractor: OWNER -BUILDER D RATION 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).: 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 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:_ Policy Number: _ I certify that in the performance of the work for which this permit is issued, l 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 of the Labor Code, I shall forthwith comply with those rovisions. Date: 6 Applicant: - WARNING: FAIL RE TO SECURE WORKERS' MPENSATION 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 ent r upon the above-mentioned property for inspection purposes. Date: !JenSignature (Applicant or Age FINANCIAL INFORMATION a _ DESCRIPTION;, s; ° ACCOUNT . a'w ;QTY AMOUNT'" rt PAID sK PAID DATE" - BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00 -" �; x ;: _ ;�� .:.' ..' _.` <!: PAID'BY x- -` +`` METHOD ��RECEIPT # {....` , CHECK # t.CLTD BY Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 $0.00 °DESCRIPTION `_. ; �,�x w., 71 , "."ACCOUNT ..r QTY;" AMOUNT ., ' = ,'PAID '• ` PAID DATE" DEVICES, FIRST 20 101-0000-42403 0 $24.17 $0.00 := PAID BY_ METHODT�`'' ' RECEIPT# CHECK# LTD BY DESCRIPTION:'' r _, ACCOUNTw'LLQTY:-, AMOUNT ">' °PAID* �': +P,AID DATE: DEVICES, FIRST 20 PC ` . 101-0000-42600 0 $24:17 $0.00 PAID BY' : METHOD,, • ;'RECEIPT # s� Vie' {CHECK # a rCLTD BY Total Paid for ELECTRICAL: $48.34 $0.00 R DESCRIPTION+ x" ACCOUNT ' ';QTY °` AMOUNT: ; "PAID ,. ,PAID DATE PERMIT ISSUANCE 101-0000-42404 0 $91.85 $0.00 PAID �,�BY s _- :> METHOD ! `: :•:. , RECEIPT # . CHECK # BY. Total Paid for PERMIT ISSUANCE: $91.85 $0.00 r DESCRIPTION ';` 'r•'ACCOUNT, Er AMOUNT PAID PA ID DATE BUILDING SEWER 101-0000-42401. 0 $12.09 _ $0.00 IPAID BY } ? METHOD RECEIPT # CHECK # CCTD BY. r DESCRIPTION '. =ACCOUNT E.-:. TYr AMOUNT,`-� PAID.PAID DATE BUILDING SEWER PC 101-0000-02600 0 $12.09 $0.00 METHOD , RECEIPT # CHECK #ACL"TD BY Total Paid for PLUMBING FEES: $24.18 $0.00 ' DESCRIPTION' " _ ; . - ,ACCOUNT {? QTY AMOUNT r PAID , r PAID DATE SMI - RESIDENTIAL 101-0000-20308 0 $0.50 $0.00 'PAID BY F ' ` + _. F. `:M ` METHOD RECEIPT # , : CHECK # CLTD BY a. Total Paid for STRONG MOTION INSTRUMENTATION SMI: $0.50 $0.00 5 TOTALS:00 Description: FARROW / SEPTIC ABANDONMENT WITH MINOR REMODEL IAL Subtype: REMODEL Status: APPROVED Type: BUILDING, RESIDENTIAL Applied: 6/17/2016 RSE Approved: 6/17/2016 AOR Parcel No: 774282010 Site Address: 54700 AVENIDA VALLEJO LA QUINTA,CA 92253 Subdivision: SANTA CARMELITA-AT VALE LA QUINTA' Block: 305 Lot: 15 Issued: UNIT 28 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 Details: SEPTIC ABANDONMENT/SEWER HOOKUP WITH ADDITION OF ELECTRICAL OUTLET AT FRONT OF DWELLING AND INSTALLATION OF CONCRETE FLATWORK. 2013 CALIFORNIA BUILDING CODES. FINANCIAL "INFORMATION Printed: Friday, June 17, 2016 4:07:18 PM 1 of 2 C§?wsYSTFm­S' DESCRIPTION = ACCOUNT QTY .'AMOUNT x PAID'-, ` v PAID DATE s RECEIPT.# hCHECK #� METHOD PAID BY BY' BSAS SB1473 FEE 101-0000-20306 0 $1.00'' = $0.00 Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 $0.00 DEVICES, FIRST 20 101-0000-42403 0- $24.17 $0.00 DEVICES, FIRST 20 PC 101-0000-42600 0 $24.17 $0.00 Total Paid for ELECTRICAL: $48.34 $0.00 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 SMI - RESIDENTIAL 101-0000-20308 0 $O.SO $0.00 Total Paid foe STRONG MOTION INSTRUMENTATION SMI: $O.SO $0.00 TOTALS:• •0 INSPECTIONS . �-PARENT PROJECTS"" Printed: Friday, June 17, 2016 4:07:18 PM 2 of 2 cB?w-sy'sTcms fh .. ' Bin # City of La Quinta Building & Safety Division 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # 1,ift: DIV Project Address: ,��' ®77 ���; `� '� Owner's Name: A. P. Number: Address: Legal Description: City, ST, Zip: Contractor: S' !� L L T ele h on c: P Address: o . ................... Project Description: City, ST, Zip: Telephone e. s !j �o � oLv State Lic. # : City Lic. Arch., Engr., Designer: Address: City., ST, Zip: T p one: > an tru ' T C s ctt n o e: anc Y Occupancy: P Y: State Lic. # Project hPa (circle one):' New A d' Alter n Repair r De mo Name of Contact Person: Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: 7-3e N Estimated Value of Project: �SD� APPLICANT: DO NOT WRITE BELOW THIS LINE N Submittal Req'd Rec'd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Cates. Called Contact Person Plan Check Balance Title 24 Cates. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2"" Review, ready for corrections/issue Electrical SubconOctor 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 rt COACHELLA VALLEY WATER DISTRICT ' P.O. BOX 1058, COACHELLA, CALIFORNIA 92236 060) 398-2651 INVOICE Date: 5/19/2016 SUBJECT: SANTA CARMELITA, 54700 AVENIDA VALLEJO, LA QUINTA, LOT 15, LID 691344 THE. REAL ESTATE CO. INC. Project: 1 16-7206 c/o CARLOS A...PENA Project Date: 5/19/2016 44100 JEFFERSON ST. STE. C-304 Amount Due: $4,851.00 INDIO, CA 92201 GE 0: 06-06-13-1 Planner: SARA LOPEZ TO INSURE PROPER CREDIT, PLEASE RETURN THIS PORTION WITH REMITTANCE AND INCLUDE THE PROJECT ON YOUR CHECK SUBJECT: SANTA CARMELITA, 54700 AVENIDA VALLEJO, LA QUINTA, LOT 15, LID 691344 COACHELLA VALLEY WATER DISTRICT P.O. BOX 1058, COACHELLA, CALIFORNIA 92236 (760) 398-2651 Pagel