10-0335 (PLBG)4 P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 10-00000335 Owner:
Property Address: -53685 AVENIDA DIAZ MCQUILLEN GILBERT A
APN: 774-111-020-8 -000000- 2862 ALONDRA WAY
Application description: PLUMBING PALM SPRINGS, CA 92264
Property Zoning: COVE RESIDENTIAL D
Application valuation: 3000
Contractor:
Applicant: ) Architect or Engineer: ALMS UNDERGROUND CON
��/�\'��/' ^ 38703 VISTA DRIVE
CATHEDRAL CITY, CA 2234
(760)324-1911
Lic. No.: 482180
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 C21 C42 License No.: 482180
Date: Contractor:
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).:
(_) 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 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. , 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 Address:
LQPERM[T
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/19/10
INCApR � 9 zona/gi�
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
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 NATIONAL UNION Policy Number 4880390
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, I shall forthwith comply with those provisions.
Date: `1/ / "1 Applicant:
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 1$100,000). IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
conditions and restrictions set.forth on this application.
1 . Each person upon whose behalf this application is made, each person at whose request and for
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Quinta, its officers, agents and employee$ 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
�j�for inspection purposes.
Date: Signature (Applicant or Agent): V
Application Number . . . 10-00000335
Permit . . . PLUMBING SEWER
Additional desc .
Permit Fee . . . . 30.00
Plan Check Fee
.00
Issue Date . . . .
Valuation . . .
. 3000
Expiration Date 10/16/10
Qty Unit Charge Per
Extension
BASE FEE
30.00
---------------------------------------- -----------------------------------
Special Notes and Comments
SEWER HOOK-UP / SEPTIC ABANDONMENT
-------------------------------------------------------- -------------------
_.__ _-- - --- ------ - --.-- ------ ----- -"--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
P.O.. BOX 1058, COACHELLA, CALIFORNIA 92236 (760) 398-2651
INVOICE Date: 4/19/2010
SUBJECT: 53685 AVENIDA DIAZ, LA QUINTA 606123,280
GILBERT MCQUILLEN
2862 ALONDRA WY
PALM SPRINGS, CA 92264 ,
Project:
10-2268
Project Date:
4/19/2010
Amount Due:
$3,995.00
GEO:
06-06-12-3
Planner:
REBECCA MILWARD
TO INSURE PROPER CREDIT, PLEASE RETURN THIS PORTION WITH
REMITTANCE AND INCLUDE THE PROJECT ON YOUR CHECK
1.00 SCC -COLLECTION $1,658.00 $1,658.00
1.00 SCC -TREATMENT $2,337.00 $2,337.00
$3,995.00
PAIP _� d
APR, 2010
COACHELLA VNO EV
WATER DISTRI."
7
SUBJECT: 53685 AVENIDA DIAZ, LA QUINTA 606123,280
COACHELLA VALLEY WATER DISTRICT
P.O. BOX.1058, COACHELLA, CALIFORNIA 92236 (760) 398-2651 Pagel
Bin #
0ty Of La Quinta
Building 8L Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
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Project Address: J $ S (� v i A
Owner's Name: 'T
t. A— 1
A. P. Number: �
Address:
Legal Description:
City, ST, Zip: Gl'V\1 g ,2cl
Contractor:
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Address: 31 703 V , 51, y � � �
Telephone: ; �,% `'•5��1? f'>„ ' ':
Project Description:
City, ST, Zip:
Tele hon
P � U (
:;
...:'t.::;•,';2�•�.�j'%3i�w;r.i:, {�r.:.f� 1*'.•':oxy:y
State Lic. #
City Lie. #:
Arch., Engr., Designer:
Address:
City., ST, Zip: �p
Telephone: z::>� •. �ti . .<.:
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State Lic. #:w .,-'
•�:� w,�a,.
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: COW- a r
Sq. Ft.:
# Stories: # Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Plan Sets
Req'd
Recd
TRACKING
Plan Check submitted
PERMIT FEES
Item Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
god Review, ready for correctionstissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Pians resubmitted
Grading
IN HOUSE:-
'`' Review, ready for correctionsrssue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
------------------
Total Permit Fees
7
[h—f
.qVFt4A � JOB INVOICE
_JR
LIC #661018
POST OFFICE BOX 2448
CATHEDRAL CITY, CA 92235-2448
(760) 360-7448 • (760) 321-7448
Time -in
Date
Time-out
Ordered by
Bill To 1 as M�
Cust. Order #
Address _
Ph. #
City
c
Mechanic
Job Name and Locatlan
Helper
Description of Work
Amnt. Pumped Gal ❑Septic Tank ❑ Seepage Pit ❑ Cesspool ❑ Grease Trap ❑ Other
❑ System is Failing ❑ System Passes Inspection ❑ Excessive Sludge ❑ Roots
Quantity
Description of Work or Material Used
Price
Amount
Pump & Dump Fee per 1000 gal
Locating & Opening Fes(per hour
Septic Inspection
Out of Area Fee
Fuel Surcharge
Snake Line ❑ Roof
Video Pipe Inspection Camera list hour
Additional hours
High Pressure Water Jet
Additional Hours
'
Labor per hour
'
❑ After Hours ❑ Sat. Charge ❑ Sun. Charge
A service charge of $20 will be due on all returned checks Total
18% per year will be charged on past due accounts over 30 days
Paid By
Check # ❑ MasterCard/ Visa
Card #
Signature
❑ Billing
Exp. Date I 1
Next Service Due
On
Date