12-1365 (PLBG)- 1
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 12-00001365
Property Address: 51310 CALLE JACUMBA
APN: 770-166-004_-21 .-000000-
Application description: PLUMBING
Property Zoning: MEDIUM DENSITY RES
Application valuation: 3800
Ta�144-Qumm
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
VICTORIA BRILZ
51310 CALLE JACUMBA
LA QUINTA, CA 92253
Contractor:
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
r�
N
Date: 11/19/12
I''
NOV 19 2012
Applicant: Architect or Engineer: ALMS UNDERGROUND CONST, INC.
38703 VISTA DRIVE CITY
QF 4QOINTA
CATHEDRAL CITY, CA 92234 FINANCE DEPT•___--
(760)324-1911
Lic. No.: 482180
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that 1 am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
cense Class: C21 C4 License No.: 482180 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
/.11
— is
1sue.d.
Date: ��—� Contractor: t_� 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
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 1, 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.). _
(_ 1 I am exempt under Sec. , B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
1 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
insurance carrier and policy number are:
Carrier BARRET BUS SRVC Policy Number 2246
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 of the Labor Code,
Irshall forthwith comply with those provisions.
bate: -�y-1 Applicant: l -
WARNING: FA LURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND r
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 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 ap ,.cation and state that the above information is correct. I agree to comply with all
city a county ordinances d state laws relating to building construction, and hereby authorize representatives
oft county to
enter u n the above-mentioned property for inspe ion purposes.
ate: (— /' ignature (Applicant or Agent):
Application Number .
. . . . 12-00001365
Permit . . ..
PLUMBING SEWER
Additional desc .
Permit Fee
30.00
Plan Check Fee
.00
Issue Date . . . .
Valuation
3800
Expiration Date
5/18/13
Qty Unit Charge
Per
Extension
BASE FEE
30.00
--------------------------------------------------------------------------=--
Special Notes and Comments
SEPTIC ABANDON, SEWER
CONNECT. 2010
CODES.
----------------------------------------------------------------------------
Other Fees . . . . .
. BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid
-------------------------------------
Credited
--------------------
Due
Permit Fee Total
30:00
00 .00
30.00
Plan Check Total
.00
.00 .00
.00
Other Fee Total
1.00
.00 .00
1.00
Grand Total
31.00
.00 .00
31.00
LQPERMIT
�Np'T COACHELLA VALLEY WATER DISTRICT
P.O. BOX 1058, COACHELLA, CALIFORNIA 92236 (760) 398-2651
INVOICE Date: 10/24/2012
SUBJECT: 51310 CALLE JACUMBA, LA QUINTA, LID 677538, "SCC FEE ONLY"
VICTORIA BRILL Project: 12-4174
51310 CALLE JACUMBA Project Date: 10/23/2012
Amount Due: $4,231.00
LA QUINTA, CA 92253 - GEO: 06-07-06-3
Planner: SANDRA VILLALOBOS
' TO INSURE PROPER CREDIT, PLEASE RETURN THIS PORTION WITH
REMITTANCE AND INCLUDE THE PROJECT ON YOUR CHECK
1.00 SCC-COLLECTION$1,836.00 $1,836.O..
1.00 SCC -TREATMENT $2 395.00 $2,395.00
PAID $4,231.00
31 00 V#a7.f
NOV 02 2012
COACHELLA VALLEY
WATER DISTRICT
SUBJECT:51310 CALLE JACUMBA, LA QUINTA, LID 677538, "SCC FEE ONLY"
COACHELLA VALLEY WATER
P.O. BOX 1058, COACHELLA, CALIFORNIA D92236C(760) 398-2651
Page 1
Bin.#
City/ Of* La Quinta
Bu11&1ng 8z Safety Division
P.O. Box 1504, 78-49S Calle Tampico
14.Quinta, CA 92253 - (760) 777-7012
Building Permit -Application' and Tracking Sheet
Perinit #
\
Project Address:
Owner's Name:. �C 40V, ck
A. P. Number.
Address: 3 1 C-1 C U. W\- `J C-t
Legal Description:
Ci ST11
City, , Zip: P L� ,-, Qv ., a^ �
Contractor. V1/L✓
Telephone:
Address: 31&-3-63
Project Description: 'S C-S).)VtY\-CC�.; G�
City, ST, Zip:
Telephone
CityLic. 1,
State Lic. # :
Arch., Engr., Designer.
Address:
City., ST, Zip:
Telephone:
r
State Lic. #: -m;wre� »sit ,r
Name of Contact Person: l�C G✓ Z c-, c,
Construction T.ype:.,vet, Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.:
# Stories:
#Units
Telephone # of Contact Person: V-601
Estimated Value of Project: 3 �[
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Rcq'd
' Rec'd
TRACIMG
PERMIT FEES
Plan Sets
Plan Check submitted
Item Amount
Structural Cities.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss C21cs.
Called Contact Person
Pian Check Balance.
Title 24 Calci.
Pians picked up
Construction
Flood plain plan
Pians resubmitted.'.
Mechanical
Grading plan
2•` Review, ready for correctionsfissue
Electrical
Subcoutactor last
Called Contact Person
Plumbing
Grant Deed
Plans picked up
SAML
ILO.A. Approval
Plans resubmitted
Grading
W HOUSE:-
''d Revlew, 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