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BPLB2014-1038.. w Iw 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