13-0170 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: — 13 00000170
Property Address:
.51556 AVENIDA HERRERA
APN:
773-133-003-22 -000000-
Application description:
PLUMBING
Property Zoning:
COVE RESIDENTIAL
Application valuation:
500
Applicant:
"`&t!t-44Q"
Architect or gineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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 8u ' ass and Professionals Code, and my License is in full force and effect.
Licensee Class: A B C36 License No.: 520825
Date.`".- 3 ,;1j- 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).:
(_ 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 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. , 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:
LQPERD1IT
Owner:
ZUNIGA ESPERANZA
51530 AVENIDA HERRERA
LA QUINTA, CA 92253
(
Contractor:
JC CONSTRUCTION COMPANY
84821 CALLE ZAMORA
COACHELLA, CA 92236
(760)835-0653
Lic. No.: 520825
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 2/13/13
D �
FEB 14 2013
CtTy OF 1. QUINTA
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
3700 of the Labor I shall forthwith comply with t�rovisions.Datq`{ .l Applicant:
WARNING: FAILURE TO SECURE RKERS' COMPENSATION COVEAND 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, indemnity 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 building construction, and hereby authorize representatives
of this county to enter upon the above-mentioned property for inspection purposes.
Date3'(;�4Signature (Applicant or Agen G�'
Application Number
. . . . . 13-00000170-
3-00000170Permit
Permit. .,.
PLUMBING SEWER
Additional desc .
Permit Fee . . . .
30.00 Plan Check Fee
.00
Issue Date . . . .
Valuation . . .
. 500
Expiration Date
8/12/13
Qty Unit Charge Per
Extension
BASE FEE
30.00
---------------------------------------------- ------------------------------
Special Notes and Comments
SEPTIC ABANDONMENT
/SEWER HOOK UP 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
r,
Cit}r of" La Quir�ta
8ugftBE Safety on
P.O. Box (SO4,76-495 Cai[e Tampko
La Quirt;, CA 92253 -{760) 777-7012
Building Pem* -AppRadon"and Tracking Sheet
Perinit
�1
Project .Addtesr6 j —SS 6 rW ti, 1 " �! e�11 z'1
Owner's Names. £S - roy u z UNC b »
A. P. Number.
Address:
Leo DescrWorr
city. U, zip: t OL d44,,,VT-tJq 7- -Zs 3
C0111ractor cJ-1, C.
Address: qt - q Z(- Csik . d!C.fi
Project .
..
Ciry. ST, rip: i (� ' ► 7 2236"
State Lia d : City Lir @:
Arck. Eng, Dedpe
Address:
Caty. ST. 24:
Tyner
State Lie. S:
construction Type:. Ooatpanoy
Project type (aide one): New Add'; Alia Repair Demo
Sq. Ft.: # Stories: tl Unity
Name of Coma Person:
Tdephoae i of Canted Pj ;son Estimatad Value of Project;
APPLICANT: DO NOT WRITE BELOW THIS UNE
9
Submittal
Pam Sed
RcWd
Reed
TSG PERMETFm-
Plau"Ckeek submitted Iarm' Amount
Sbvd=d Orad.
Reviewed, ready for corrections Plan Chock Deponit•
Truss Gera.Called
contact Peron Plan ChedrAd,
lade 24 Gra.
Plain pidted up Construction;
Flood t� pDn
Yuan resubmitted:. Mecbaaical
hr 'adhg p�
2" Review, ready for correotiourrrsme Eleediral
Submatnelor list
Called Contact Pawn Flnu n "
Grant Decd
Plans pkked up S.HJL
H.OA. Apprwal
Pleas roabmitled Gad g
1N HO E.,
''+ Review; ready for correctioosame Dcvdoper Impact Fee
Planning Approval
Caged Contact Person
Pull. Wb. Appr
Date otpermit Issue
School Fees
Total Permit Fees
FA
COACHELLA VALLEY WATER DISTRICT
P.O. BOx 1058, COACHELLA, CALIFORNIA 922.36 (760) 398-2651
INVOICE Date: 1/22/2013
SUBJECT: SANTA CARMELITA, 51556 AVENIDA HERRERA, LA QUINTA, LID 681596, "SCC FEE ONLY"
ESPERANZA ZUNIGA . ' Project:
51530 AVENIDA HERRERA 'Project Date:
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
12-4223
11/16/2012
$4,231.00
.06-06-01-41
SANDRA VILLALOBOS
SUBJECT:SANTA CARMELITAr51556 AVENIDA HERRERA, LA QUINTA, LID 681596, 'SCC FEE ONLY"
COACHELLA VALLEY WATER DISTRICT
P.O. BOX 1058, COACHELLA, CALIFORNIA 92236 (760) 398-2651 page/
I