BPLB2016-003278-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application Description:
Property Zoning:
Application Valuation:
Applicant:
IRMA L DIAZ
54105 AVENIDA VELASCO
LA QUINTA, CA 92253
Tit�t 4 4 Q"
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
BPLB2016-0032
54105 AVENIDA VELASCO
774214018
IRMA DIAZ / SEPTIC TO SEWER
$7,500.00
2 V
Q
CITY(. rAA
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 Class: License No.: _
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
($5 ).:
I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure isnot 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
h or she did not build or improve for the purpose of sale.).
I, as owner of the property, am exclusively contracting with licensed contractors
o 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
t��oo ntractors' State License La
I am exempt under Se B.&P.C. for this reason
Date: Ow '
'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
Lender's Add
47
VOICE (760).777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 2/12/2016
Owner:
IRMA L DIAZ
54105 AVENIDA VELASCO
LA QUINTA, CA 92253
Contractor:
Llc. No.:
WORKER'S COMPENSATION DECLARATION
I her a irm under penalty of perjury one of the following declarations:
WI 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 th o for which this permit is issued.
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. orkers' compensa n s nce carrier and polity number are:
Carri Polity Numb
certify that in the performance of the work for which this permit is issued, I
shat 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 f -the Labor Code, 1 shall forthwith
comply with those provisions.
Date: Applica
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 building
construction, and hereby authorize representatives of:this city to enter upon th
above-mentioned/property for inspection purposes.
Date: l l Signature (Applicant or Age
FINANCIAL • {•
DESCRIPTION. ACCOUNT` : QTY AMOUNT-:: PAID PAID DATE
BSAS SB1473 FEE 101-0000-20306 0 $1.00 $1.00 2/12/16
PAID BY METHOD...RECEIPT # CHECK# CLTD. BY
IRMA L DIAZ CHECK R12878 1066 RSE
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 $1.00
DESCRIPTION
ACCOUNT
QTY >
.. AMOUNT
PAID
PAID DATE
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$91.85
2/12/16
PAID BY
METHOD
•;RECEIPT #
CHECK #
CLTD BY
IRMA L DIAZ
CHECK
R12878
1066
RSE
Total Paid for PERMIT ISSUANCE: $91.85 $91.85
DESCRIPTION
.ACCOUNT,'
QTY''
'"AMOUNT°:.
PAID-"-
PAID DATE
SEPTIC SYSTEM
.101-0000-42401
•0
$12.09
$12.09
2/12/16
PAID BY
METHOD `:
RECEIPT # : -
CHECK #
CLTD BY
IRMA L DIAZ
CHECK
R12878
1066
RSE
DESCRIPTION
ACCOUNTQTY
:
AMOUNT
PAID
PAID DATE
SEPTIC SYSTEM PC
101-0000-42600
0
$4.83
$4.83
2/12/16
PAID BY
METHOD
RECEIPT #
.CHECK #
CLTD BY
IRMA L DIAZ
CHECK
R12878
1066
RSE
Total Paid for PLUMBING FEES: $16.92 $16.92
TOTALS:•• 0•
Description: IRMA DIAZ / SEPTIC TO SEWER
CONDITIONS
NAME TYPE NAME
Type: PLUMBING Subtype:
Status: UNDER REVIEW
Applied: 2/12/2016 RSE
Approved:
Parcel No: 774214018 Site Address: 54105 AVENIDA VELASCO LA QUINTA,CA 92253
Subdivision: SANTA CARMELITA VALE LA QUINTA Block: 282
Lot: 6
Issued:
UNIT 26
LA QUINTA
CA
Lot Scl Ft: 0 Building Scl Ft: 0
Zoning:
Finaled:
Valuation: $7,500.00 Occupancy Type:
Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0
No. Unites: 0
(760)564-2139
Details: SEPTIC TO SEWER SEPTIC ABANDONTMENT. 2013 CALIFORNIA BUILDING CODE.
CHRONOLOGY
CONDITIONS
NAME TYPE NAME
ADDRESSl
CONTACTS
CITY
STATE
ZIP
PHONEFAX
EMAIL
APPLICANT IRMA L DIAZ
54105 AVENIDA "
VELASCO
LA QUINTA
CA
92253.
(760)564-2139
Total Paid for BUILDING STANDARDS ADMINISTRATION
OWNER IRMA L DIAZ
54105 AVENIDA
VELASCO
LA QUINTA
CA
92253
(760)564-2139
Printed: Friday, February 12, 2016 8:54:31 AM 1 of 2 "
SYS Tr: ti1S
FINANCIAL
INFORMATION
DESCRIPTION ACCOUNT. QTY
AMOUNT
PAID
PAID DATE RECEIPT # CHECK # METHOD PAID BY [CLTI)
BY''
BSAS SB1473 FEE 101-0000-20306 0
$1.00
$1.00
2/12/16 R12878 1066 CHECK IRMA L DIAZ RSE
Total Paid for BUILDING STANDARDS ADMINISTRATION
$1.00
$1.00
BSA:
Printed: Friday, February 12, 2016 8:54:31 AM 1 of 2 "
SYS Tr: ti1S
DESCRIPTION
ACCOUNT.
QTY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID BY
CLTD'
BY
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$91.85
2/12/16
R12878
1066
CHECK
IRMA L DIAZ
RSE
Total Paid for PERMIT ISSUANCE: $91.85 $91.85
SEPTIC SYSTEM
101-0000-42401
0
.$12.09
$12.09
2/12/16
R12878
1066
CHECK
IRMA L DIAZ
RSE
SEPTIC SYSTEM PC
101-0000-42600
0
$4.83-
$4.83
2/12/16
R12878
1066
CHECK
IRMA L DIAZ
RSE
Total Paid for PLUMBING FEES: $16.92 $16.92
• •• 0• .77
INSPECTIONS
Printed.: Friday, February 12, 2016 8:54:31 AM 2 of 2 or
srsiEnns