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BPLB2015-01090 Fi 78-495 CALLE TAMPICO f V � � LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT Application Number: BPLB2015-0109 Owner.-- Property Address: 54595 AVENIDA HERRERA ALLA TITENSKY APN: 774282016 54595 AVENIDA FERRERA Application Description: TITENSKY RESIDENCE / SEWER CONNECT LA QUINTA, CA 9253 Property Zoning: Application Valuation: $1,800.00 Applicant: Contractor: MIRANDA'S SEPTIC SERVICES MIRANDA'S SEPTIC SERVICES 33749 WHISPERING PALMS TRIAL / \ OUT OF CITY LIMITS CATHEDRAL CITY, CA 92234 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.::LIC-7630400_ D /�a7 ^ �rj Contractor: C/�i-2.Ze.-o,'7 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, 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.). ( I 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 Lender's Address: Llc. No.: :LIC -763C40 (760) 777-7125 (760)777-7011 (760) 777-7153 9/25/2015 WORKER'S COMPENSArzON DECLARATION I hereby affirm under penalty of perjury one ollthe following declarations: I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 370C 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 Che 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. 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 owne-, 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 tl-Ae 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 i3suance of such permit, or cessation of work for 180 days will subject permit to cancell3tion. 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 representalves of this city to enter upon the above-mentioned property for inspection purpDses. 011 Signat trer(Applicant--x Agent): i FINANCIAL INFORMATION nDESCRIPTION N:_ a ,ACCOUNT fQTY !; AMOUNT °PAID PAID DATE BSAS SB1473 FEE 101-0000-20306 0 $1.00 $1.00 9/25/15 ;` w '-, PAID:BY,, r r' -`' -' '_ METHOD r'i "--' -RECEIPT#,' CHECK # CLTDBY_; MIRANDA'S SEPTIC SERVICES DEBIT R9512 BPLB2015-0109 MFA Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 $1.00 '• DESCRIPTION `� ` .` ;' * "' ACCOUNT f 'SQTY AMOUNT'S = PAID r PAID DATE PERMIT ISSUANCE 101-0000-42404 0 $91.85 $91.85 9/25/15 PAID BY a ' ' ; ' 'r METHOD :` "r , : ., _, .RECEIPT #', I CHECK # CLTD BY-. MIRANDA'S SEPTIC SERVICES DEBIT R9512 BPLB2015-0109 MFA Total Paid for PERMIT ISSUANCE: $91.85 $91.85 DESCRIPTION } . P ACCOUNTat: QTY AIVI 0. -NT '. ;PAID �, ", PAID.DATE BUILDING SEWER 101-0000-42401 0 $12.09 $12.09 9/25/15 }PAID BY = < METHOD ;RECEIPT # CHECK # CLTD BY" MIRANDA'S SEPTIC SERVICES DEBIT R9512 BPLB2015-0109 MFA DESCRIPTION g ACCOUNT ° ' t SQTY : p 4' . AMOUNTS, ' f PAID " PAID DATE BUILDING SEWER PC 101-0000-42600 0 $12.09 $12.09 9/25/15 ' PAIDBY °' 4; a. METHOD _° ° t 'RECEIPT,#° �, CHECK # rF' CLTD BY MIRANDA'S SEPTIC SERVICES DEBIT R9512 BPLB2015-0109 MFA Total Paid for PLUMBING FEES: $24.18 $24.18 Permit Details PERMIT NUMBER City of La Quinta BPL -B 01&:010 n Description: TITENSKY RESIDENCE / SEWER CONNECT NAME.TYPE ; Type: PLUMBING Subtype: Status: ISSUED Applied: 9/25/2015 MFA Approved: 9/25/2015 MFA Parcel No: 774282016 Site Address: 54595 AVENIDA HERRERA LA QUINTA,CA 92253 Subdivision: SANTA CARMELITA AT VALE LA QUINTA Block: 305 Lot: 5 Issued: 9/25/2015 MFA UNIT 28 CONTACTS, CITY STATE ZIP Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $1,800.00 Occupancy Type: Construction Type: Expired: 3/23/2016 MFA No. Buildings: 0 No. Stories: 0 No. Unites: 0 CONTRACTOR Details: SEWER CONNECTION PER 2013 CALIFORNIA BUILDING CODES OUT OF CITY LIMITS __j APPneu W APProveu Approved to Issued - .. CONDITIONS NAME.TYPE ; PHONE FAX EMAIL NAME ADDRESS1 CONTACTS, CITY STATE ZIP APPLICANT MIRANDA'S SEPTIC SERVICES 33749 WHISPERING PALMS TRIAL CATHEDRAL CA CITY 92234 CONTRACTOR MIRANDA'S SEPTIC SERVICES OUT OF CITY LIMITS OWNER ALLA TITENSKY 94999 AV!NIDA HERRERA LA QUINTA CA 91[S3 FINANCIAL INFORMATION Printed: Friday, September 25, 2015 4:33:37 PM 1 of 2 e SYS'fEAAS DESCRIPTION • .' `, > ACCOUNT �, QTY ",tAMOUNT PAID PAID DATE RECEIPT# CHECK # METHOD PAID BY CLTD ..-, S BSAS SB1473 FEE 101-0000-20306 0 $1.00 $1.00 9/25/15 R9512 BPLB2015- DEBIT MIRANDA'S SEPTIC MFA 0109 SERVICES Total Paid for BUILDING STANDARDS ADMINISTRATION $1.00 $1.00 BSA: PERMIT ISSUANCE 101-0000-424040 $91.85 $91.85 9/25/15 R9512 BPLB2015- DEBIT MIRANDA'S SEPTIC MFA 0109 SERVICES Total Paid for PERMIT ISSUANCE: $91.85 $91.85 BUILDING SEWER 101-0000-42401 0 $12.09 $12.09 9/25/15 R9512 BPLB2015- DEBIT MIRANDA'S SEPTIC MFA' 0109 SERVICES BUILDING SEWER PC 101-0000-42600 0 $12.09 $12.09 9/25/15 R9512 BPLB2015- DEBIT MIRANDA'S SEPTIC MFA 0109 SERVICES Total Paid for PLUMBING FEES: $24.18 $24.18 ..., PARENT OR 01 ECTS BOND INFBRMATIOW ., . :: • Printed: Friday, September 25, 2015 4:33:37 PM 2 of 2 sys7cMs MINA Bin # City of La Quinta Building 87- Safety Division Permit #{ 78-495 Calle Tampico ' La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking ShEet Project Address:,EYefFn, ` ��t. �I%OOwner's Name: A. P. Number: Address: Legal Description: City, ST, Zip: It Con ract r o. B.n L one: Telephone: ele P Address: Project Description: City, ST, Zip: Telephone: State Lic. # : City Lic. #.. Arch., Engr., Designer: Address: City, ST, Zip: Telephone: M. Construction Type: Occupancy: : State to Lic: #: Project type (circle one): New Add'n Ater Repair Demo Name of Contact Person: ` o Sq. Ft.: # Stories: # Units: o Telephone # of Contact Person: p -- y0 !'Q p 0 stimated Value of Project: ez-> APPLICANT: DO NOT WRITE BELOW THIS LINE N Submittal Req'd Rcc'd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Depo=it Truss Cates. Called Contact Person Plan Check Balance Title 24 Cales. Plans picked up Construction Flood plain plan . Plans resubmitted Mechanical Grading plan 2nd Review, ready for corrections/issue Electrical Subcdntactor.List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN I-IOUSE:- '•' 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 16, COACHELLA VALLEY WATER DISTRICT P.O. 80X 1058, COACHELLA, CALIFORNIA 92236 (760) 398-2651 INVOICE Date: 9/18/2015 SUBJECT: SANTA CARMELITA, 54595 AVENIDA HERRERA, LA QUINTA, LID 691350, 'SCC FEE ONLY" TITENSKY, ALLA Project: 15-6625 1728 ADDISON RD Project Date: 9/16/2015 Amount Due: $4,851.00 PLS VRDS PNSL, CA 90274 GEO: 06-06-13-1 Planner: SARA LOPEZ TO INSURE PROPER CREDIT, PLEASE RETURN THIS PORTION WITH REMITTANCE AND INCLUDE THE PROJECT ON YOUR CHECK 1.00 FF SCC -COLLECTION $2,415.00 $2,415.00 1.00 FJ SCC -TREATMENT '$2,436.00 $2,436.00 $4,851.00 PAID$ ��7�' � C>�37 {� Development Services Department t Lk SEP 1'8* 2015. l� Coachella Valley Water District 75-515 Hovley Lane East Palm Desert, CA 92211 SUBJECT: SANTA CARMELITA, 54595 AVENIDA HERRERA, LA QUINTA, LID 691350, -SCC FEE ONLY" COACHELLA VALLEY WATER DISTRICT P.O. BOX 1058,.COACHELLA. CALIFORNIA 92236 (760) 398-2651 Page 1 r,