12-0998 (PLBG)c&t!t 4
P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 8/29/12
Application Number: 12-00000998 Owner:
Property Address: 52190 AVENIDA DIAZ RICHARD MORGAN
APN: 773-212-004-19 -000000-
Property Zoning: COVE RESIDENTIAL
Application valuation: 2700
Contractor: p
Applicant: Architect or Engineer: EGGAN, RICK EDWARD D
73680 HIGHWAY 111, S 123 AUG 29 2012
PALM DESERT, CA 9226,
/Pt(760)404-6325
�
CE Oril1ltt,TA
LiC. No.: 950244 CIV of pE
FINAN
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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 Professionals Code, and my License is in full force and effect.
License Class: C42 sLicense No.: 950244
Date: 'Z Contractor:
OWNER LDER 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 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 sale3.
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 _ 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
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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 EXEMPT Policy Number EXEMPT
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
p3700 of the Labor Code 1 shat forthwith comply with those provisions.
WARNING: FAILURE TO SECURE WORKERS' COMPE S TION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,0001. 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 Ouinta, 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 county to enter upon the above-mentioned property for insp tion purposes.
G
Date: �L nature (Applicant or Agent):
Application Number . . . . 12-00000998
Permit
PLUMBING SEWER
Additional desc .
Permit Fee
30.00
Plan Check Fee
.00
Issue Date
Valuation . . .
. 2700
Expiration Date
2/25/13
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
COACHELLA VALLEY WATER DISTRICT
f P.O. BOX 1058, COACHELLA, CALIFORNIA 92236 (760) 398-2651
INVOICE Date: 6/29/2012
SUBJECT: 52190 AVENIDA DIAZ, LA QUINTA, LID 682976, "SCC FEE ONLY"
BANK OF AMERICA
Project:
C/o ANNE SALERN_O_
Project Date:
52190 AVENIDA DIAZ
Amount Due:
LA QUINTA, CA 92253
GEO:
Planner:
TO INSURE PROPER CREDIT, PLEASE RETURN THIS PORTION WITH
REMITTANCE AND INCLUDE THE PROJECT ON YOUR CHECK
12-3928
6/29/2012
$4,231.00
06-06-12-2
SANDRA VILLALOBOS
1.00 SCC -COLLECTION 1 $1,836.001 $1,836.00
1.00 SCC -TREATMENT $2.395.00 $2.395.00
$4;231:00
PAI®
4f a31-00 V# a,776
AUG 2-9 2012
COACHELLA VALLEY
WATER DISTRICT
SUBJECT:52190 AVENIDA DIAZ, LA QUINTA, LID 682976, "SCC FEE ONLY'
COACHELLA VALLEY WATER DISTRICT
P.O. BOX 1058, COACHELLA, CALIFORNIA 92236 (760) 398-2651 Pagel
sirs.#
Qty Of La QUlhta
Bullft 8E Safety Dil+lsion
P.O. Box 1504,78-495 Calle Tampico
La.Whta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Perintt #�j�
Project Address: j Z l�r
Owner's Name:.
A. P. Number.
Address: ,�
Legal Description:
City, ST, Zip:
Contactor. S 6 �' ��iy
Telephone:
Address: 700 � � �
ProjectDescripaon:
City, ST, Zip:
Telephone: 760 L DLt 37-5'
"City
State Lia #: j D L Lir-' #;
Arch., FW., Designs-
Address:
City, ST, Zip.
Telephone: ElmConstruction Type:. Occupancy:
State Lia #: Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: Sq. Ft.: # Stories: —Tunits:
Telephone # of Contact Person: Esdmatod Value of Project: Z 0�)
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Reed
TRACMG PERMfI' FEES -
Plan Sets
Plan Check submitted Item Amonat
S"cturai Cafes.
Reviewed, ready for corrections Plan Check Deposit, .
Truss Calcs.
Called Contact Person Plan Check Balance
Title 24 Calcs.
Plana picked up Construction
Flood plain plan
Pians resubmitted mechanical
Grading plan
Z`! Review, ready for correctiousfrssue Electrical
Subeontactor List
Called Contact Person Plumbing
Grant Deed
Plans picked up S.M.L
H.O.A Approval
Plans resubmitttd Grading
IIV HOUSE:-
s'` Review; ready for eorrectionsilssac Developer Impact Fee
Planning Approval
Called Contact Person A,I.P.P.
Pub. Wks. Appr
Date of permit issue
School Bees
Total Permit Fees
S ANDGPUMPING SERVICE INVOICE # 4 7 9 1
73-680 Hwy I 11, Suite 123 - Palm Desert, CA 92260
Cell (760) 766-5074 * (760) 404-6325
Date: _3 0 _)Z
Bill To:
Ph#:
A-2 0 "Y) I Vt eA
Pump & Dump Fee per 1000 gal (Grease Trap)
Address:,�'
Mechanic:
Hrs:
"OF_ A
_C
jSg:�a
City:
Helper:
Job NaVe—annolatiom
Description of Work:
r
0!5
Amt. Pum Tank OSeepagePit OCesspool OGreaseTrap 00ther
0 System is Failing i(1�0 System Passed Inspection 0 Excessive Sludge 0 Roots
Quantity
Description of Work or Material Used
Price
Amount
Pump & Dump Fee per 1000 gal (Grease Trap)
Pump & Dump Fee per 1000 gal (Septic Tank)
Locating,& Opening Fee (per hour)
High Pressure Water Jet (First Hour)
High Pressure �ater Jet (Addtional Hour)
Labor per hour
Rooter Mainline
Rooter Lateral
Rooter On -premise
0 After Hours 0 Sat. Charge 0 Sun. Charge
Fuel Surcharge
ThankYou
Total
r-dlL� Dy. U %,,! IUUFff U 0M 1U.
Date Next Serv*ice Due