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Applicant:
TRI - STAR CONTRACTING II INC
15 - 501 LITTLE MORONGO ROAD
DESERT HOT SPRINGS, CA 92240
p. Q A
NOV 2 Q 2014
CITY OF LA QUINTA
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 CImss: An License No.:
Date: 909195
�/ Contract /
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 Divisio
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 ) 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.).
(_) 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 riot 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. BAP.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 Addre:
Contractor:
TRI - STAR CONTRACTING II INC
15 - 501 LITTLE MORONGO ROAD
DESERT HOT SPRINGS, CA 92240
(760)251-5454
Llc. No.: 909195
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, I
shall not employ any person in any manner so as to become subject to the workArs'
compensation laws of California, and agree that, if I should beco m ubject t h
workers' compensation provisions of Section 37 of the Labor C e, I shat ort with
comply with those provisions.
01
Date: �1 7/11P
/ Aoolicant
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 bui ling
construction, and hereby authorize representatives of this city to nter upon th ove•
mentioned property for inspection purposes.
Date: Signature (Applicant or Agent).
J
4 4i�Il��/
VOICE (760) 777-7125
78-495 CALLE TAMPICO
FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253
COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 11/20/2014
Application Number:
BPLB2014-1038
Owner:
Property Address:
52980 AVENIDA DIAZ
JOHN YOKNIS
APN:
773312012
52980 AVENIDA DIAZ
Application Description:
SEWER CONNECTION SEPTIC
ABANDONMENT
LA QUINTA, CA 92253
Property Zoning:
Application Valuation:
$3,250.00
Applicant:
TRI - STAR CONTRACTING II INC
15 - 501 LITTLE MORONGO ROAD
DESERT HOT SPRINGS, CA 92240
p. Q A
NOV 2 Q 2014
CITY OF LA QUINTA
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 CImss: An License No.:
Date: 909195
�/ Contract /
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 Divisio
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 ) 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.).
(_) 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 riot 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. BAP.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 Addre:
Contractor:
TRI - STAR CONTRACTING II INC
15 - 501 LITTLE MORONGO ROAD
DESERT HOT SPRINGS, CA 92240
(760)251-5454
Llc. No.: 909195
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, I
shall not employ any person in any manner so as to become subject to the workArs'
compensation laws of California, and agree that, if I should beco m ubject t h
workers' compensation provisions of Section 37 of the Labor C e, I shat ort with
comply with those provisions.
01
Date: �1 7/11P
/ Aoolicant
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 bui ling
construction, and hereby authorize representatives of this city to nter upon th ove•
mentioned property for inspection purposes.
Date: Signature (Applicant or Agent).
J
FINANCIAL INFORMATION
DESCRIPTION 'ACCOUNT
QTY AMOUNT PAID PAID DATE
BSAS SB1473 FEE 101-0000-20306
0 $1.00 $0.00
PAID BY METHOD
RECEIPT # CHECK # CLTD BY
Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $1.00 $0.00
DESCRIPTION
ACCOUNT
QTY
'AMOUNT
PAID
PAID DATE
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid for PERMIT ISSUANCE: $91.85 $0.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
BUILDING SEWER
101-0000-42401
0
$12.09
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
BUILDING SEWER PC
101-0000-42600
0
$12.09
$0.00
PAID BY
METHOD
- RECEIPT #
CHECK #
CLTD BY
Total Paid for PLUMBING FEES: $24.18 $0.00
• • ••
Description: SEWER CONNECTION SEPTIC ABANDONMENT
NAME TYPE
NAME'
Type: PLUMBING Subtype:
Status: SUBMITTED
Applied: 11/20/2014 PJU
Approved:
Parcel No: 773312012 Site Address: 52980 AVENIDA DIAZ LA QUINTA,CA 92253
Subdivision: SANTA CARMELITA VALE LA QUINTA Block: 170
Lot: 15
Issued:
UNIT 17
TRI - STAR CONTRACTING II INC
15 - 501 LITTLE
MORONGO ROAD
Lot Sq Ft: 0 Building Sq Ft: 0
Zoning:
Finaled:
Valuation: $3,250.00 Occupancy Type:
Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0
No. Unites: 0
15 - 501 LITTLE
MORONGO ROAD
Details: SEPTIC ABANDONMENT SEWER HOOK UP 2013 PLUMBING CODES.
CA
CONDITIONS
CONTACTS
NAME TYPE
NAME'
ADDRESSS
CITY
STATE
ZIP; '
PHONE
FAX
'EMAIL
APPLICANT
TRI - STAR CONTRACTING II INC
15 - 501 LITTLE
MORONGO ROAD
DESERT HOT
SPRINGS
CA
92240
(
FINANCIAL INFORMATION
Printed: Thursday, November 20, 2014 10:21:12 AM 1 of 2 CROW SYSTEMS Ms
b>
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID BY
CLTD
BY
BSAS SB1473 FEE
1 101-0000-20306
0
$1.00
$0.00
Total Paid forBUILDING STANDARDS ADMINISTRATION $1.00 $0.00
BSA:
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
Total Paid forPERMIT 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
TOTALS:••
INSPECTIONS
SEQID INSPECTION TYPE INSPECTOR SCHEDULED
DATE
COMPLETED
DATE
RESULT REMARKS NOTES
PLUMBING FINAL"
PARENT PROJECTS
REVIEWS
REVIEW TYPE REVIEWER SENT DATE DUE DATE RETURNED STATUS -F- REMARKS NOTES
DATE
Printed: Thursday, November 20, 2014 10:21:12 AM 2 of 2 CRWsrsrEMS
A
Bin # City of La Quinta
Building sl: Safety Division
Permit # P.O. Box 1504, 78-495 Calle Tampico .
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Project Address: Owner's Name: d `co
A. P. Number:
Address:
Legal Description:
City, ST, Zip: L A e Q
Contractor: 1 S r
Telephone: —
'%> s>''•> rsky<`:x•:::;:>.:c::;:;,:j.
Address: SpJ �.�•�
Project Description:
City, ST, Zip:
r
Telephone. (�� _S_
���2 (�
State Lic. # : J J
City Lie. #;
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
State Lic. #:
Name of Contact Person:
Sq. Ft.: # Stories:
# Units:
Telephone #,of Contact Person:
Estimated Value of Pro ect: v
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rce'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cala.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Decd
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN IiOUSE:-
'rd 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
COACHELLA VALLEY WATER DISTRICT
P.O. BOX 1058, COACHELLA, CALIFORNIA 92236 (760) 398-2651
INVOICE Date: 6/13/2014
SUBJECT: SANTA CARMELITA, 52980 AVENIDA DIAZ, LA QUINTA, LID 685054, "SCC FEE ONLY"
JOHN YOKNIS Project: 14-5569
52980 AVENIDA DIAZ Project Date: 6/17/2014
Amount Due: $4,851.00
LA QUINTA, CA 92253 GEO: 06-06-12-2
Planner: SANDRA VILLALOBOS
TO INSURE PROPER CREDIT, PLEASE RETURN THIS PORTION WITH
REMITTANCE AND INCLUDE THE PROJECT ON YOUR CHECK
TREATMENT
1
$4,851.00
PAI® - O 0
Development Services Depararnent
NOV 13`20%
Coachella Valley Water pievict O 02 S,10 3
75-515 Hovley Lane East
Palm Desert, CA 92211 /i K # 3/ / (0 q 0
SUBJECT:SANTA CARMELITA, 52980 AVENIDA DIAZ, LA QUINTA, LID 685054, "SCC FEE ONLY"
COACHELLA VALLEY WATER DISTRICT
P.O. BOX 1058, COACHELLA, CALIFORNIA 92236 (760) 398-2651 Pagel