11-1262 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 11-0006,262 `.
Property Address: 51365 AVENIDA HERRERA
APN: 773-084-018-6 -000000-
Application description: PLUMBING
Property Zoning: COVE RESIDENTIAL
Application valuation: 2500
c&`!t440"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
DAVID SULLINS
PO BOX 3143
CLEAR LAKE, CA 95422' M
I
Contractor:
Applicant: Architect or Engineer: SO CAL & ASSOCIATES
P.O. BOX 955
YUCCA VALLEY, CA 922
(760)369-4104
Lic. No.: 793482
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7,000) of Division 3 of the Business and Professionals Code nd my Liceose_is m full force and effect.
License aes: oA B C8 C36 iceite`fTi `7e33 8
e -OWNER -BUILDER DECLARATION
I hereby affirm und�pa 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 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.).
1 _ 1 1, 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
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: A
Lender's Address: •
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/22/11
If0Mt
I
(
,nV r' 2 2011 s
TYOF UA fcUiNTA
11 ^t•: +.
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 EVEREST NATL Policy Number 760007142111
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,
[,1 and agree that, if I should become subject to the workers' compensation provisions of Section
tell 37,00 of the abor Code,l —
WARNING: FAI RE 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 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.
certify that I have read this application and state that the above' _- a ree to comply with all
city and county- ordinances and state laws relatin - _ - g construction, and hereby authorize -res ntatives
of this Bounty, to eater upon Ahe above ed property for inspection purposes
Application Number . . . . . 11-00001262
Permit . .
. PLUMBING SEWER
Additional desc .
Permit Fee . . .
. 30.00
Plan Check Fee
.00
Issue Date . . .
.
Valuation . . .
. 2500
Expiration Date
5/20/12.
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
Bin #
City of ra QUinta . .
Building u Safety. Division ,.
P.O. Box 1504; 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Z �p
�l
Project Address: 5'
Owner'7Name:
A. P. Number:
Addres
Legal Description:
City, ST, Zip:
Contractor:-
fs#
Telephone: r a
Project Description:
Address:
City, ST, Zip:
Telephone:
State Lic. # : 3 8 Z City Lic. #:
Arch., Engr..'Designer:'
Address:
City, ST, Zip.
Telephone:
'\, \RC1•'.',
S}.yrfwi:>:'•.C..:'iiii:+l.!r;::::.Kii$^J:9iYh hpro'ect
Construction Type: Occupancy:
State Lic. #:
t)/pp circle one): New Add'n Alter Repair Demo
Sq. FL: # Stories: # Units:
Name of Contact Person:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Recd
TRACMG
PERMIT FEES,
Plan Sets
Plan Check submitted
Item Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
T'itic 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2T'! Review, ready for corrections/issue
Electrical -
Subeontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
Review, ready for correctionslissuc
Developer Impact Fee
Planning Approval
Called Contact Person
A:I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
JV
Total Permit Fees
A.5_A.P.
PUMP/NG
Lic #C42 855 851
OU 340- 100 / " "1-owu-43f4- / 400
FAX 760 328-6607
P.O. Box 2318 - Cathedral City, CA 92235
CUSTOMER'S ORDER NO.
DAT RD
ORDER TAKEN BY
DATE PROMISED ❑ A.M.
❑ P.M.
BILL TOO
PHONE
ADDRESS
Pumping Fee/per-1000 gal.
MECH N
CITY
HELPER
JOB NAME AND LOCATION
❑ DAY WORK
DESCRIPTION OF WORK � /
❑ CONTRACT
❑ EXTRA
QUANT
DESC PTION OF MATERIAL USEV
PRICE
AMOUNT
Gallons
Pumping Fee/per-1000 gal.
Dumping Fee per 1000 gal.
Out of Area Fee
Locating / Opening Fee (per hour)
Size System:
A SERVICE CHARGE OF $20 WILL BE DUE ON ALL RETURNED CHECKS.
18% PER YEAR WILL BE CHARGED ON PAST DUE
ACCOUNTS OVER 30
TOTAL
MATERIALS
TOTAL
L OR
WAIVER: Not responsible for sec
damage, chipped cont m or drivewa a
SIGNATUREE COMPLETED
TAX
TOTAL
p, COACHELLA VALLEY WATER DISTRICT
°QjSR� P.O. BOX 1058, COACHELLA, CALIFORNIA 92236 (760) 398-2651
INVOICE Date: 11/22/2011
SUBJECT: 51365 AVENIDA HERRERA, LA QUINTA, SANTA CARMELITA, "SCC FEE ONLY"
DAVID SULLINS Project:
PO BOX 3143
Project Date:
Amount Due:
CLEARLAKE, CA 95422 GEO:
Planner:
TO INSURE PROPER CREDIT, PLEASE RETURN THIS PORTION WITH
REMITTANCE AND INCLUDE THE PROJECT ON YOUR CHECK
11-3252
.11/15/2011
$4,231.00
06-06-01-4
SANDRA VILLALOBOS
1.00 SCC -COLLECTION $1,836.001 $1,836.00 .
1.00 SCC -TREATMENT _ $2,395.001 $2,395.00
$4,231.00
NOV 2 2 2011 CK,rf 1033
BY:lb I -p-
SUBJECT:
SUBJECT: 51365 AVENIDA HERRERA, LA QUINTA, SANTA CARMELITA, "SCC FEE ONLY"
COACHELLA VALLEY WATER DISTRICT
P.O. BOX 1058, COACHELLA, CALIFORNIA 92236 (760) 398-2651 Pagel