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BPLB2017-0030LICENSED 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 Busi ss a , essions Code, and my License is in full force and effect' License Cl s*CQ 067 Licens o.: 66101 Date: (� I T Con racto 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, 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 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: WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate :)f consent to self -insure for workers' ompe tion, as provided for by Section 3700 & the Labor Code, for the performance of th rk for which this permit is issued. `! I have and will maintain workers' conpensation insurance, as required by ion 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: ACE AMERICAN INSURANCE COMPANY Policy Number: RWCC48818456 I certify that in the performance of the work for wh' h this permit is issued, I shall not employ any person in any manner so come bjectnjeci rkers' compensation laws of California, and agree/� at: if I sh uld comethe workers' compensation provisions of Sectibn 37)0 of e L c Codrthwith D u 7 Applica WARNING: FAILURE TO SECURE WORK ERS—COIVJPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINR1 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 aind 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 performe J 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 applicafion becomes null and void if work is not commenced within 180 days from date of iswance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and stat=_ that the above infor ation is correct. 1 agree to comply with all city and county ordinances an laws r latin to building construction, and hereby authorize representati-es his city, a er h above -menti ned operty for inspection purpo(Agen � l Da�0�Signature (Applicant o t VOICE (760) 777-7125 78-495 CALLE TAMPICO . D FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT INSPECTIO - BUILDING PERMIT . 2 M,,/2 ��'{ Application Number: BPLB2017-0030 `eh Owner: r�r� o Property Address: 77685 CALLE MADRID KENNETH WOODBURN APN: 774251013 752 KINGFISHER CT p G Application Description: WOODBURN / ABANDON SEPTIC/CONNECT TO SEWER CORONA, CA 92253 M C. o Property Zoning: a Application Valuation: $7,880.00 m Applicant: Contractor: HAMMER PLUMBING AND PUMPING INC HAMMER PLUMBI qG AND PUMPING INC P O BOX 2448 r P O BOX 2448 CATHEDRAL CITY, CA 92235 CATHEDRAL CITY, CA 92235 (760)360-7448 Llc. No:: 661018 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 Busi ss a , essions Code, and my License is in full force and effect' License Cl s*CQ 067 Licens o.: 66101 Date: (� I T Con racto 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, 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 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: WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate :)f consent to self -insure for workers' ompe tion, as provided for by Section 3700 & the Labor Code, for the performance of th rk for which this permit is issued. `! I have and will maintain workers' conpensation insurance, as required by ion 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: ACE AMERICAN INSURANCE COMPANY Policy Number: RWCC48818456 I certify that in the performance of the work for wh' h this permit is issued, I shall not employ any person in any manner so come bjectnjeci rkers' compensation laws of California, and agree/� at: if I sh uld comethe workers' compensation provisions of Sectibn 37)0 of e L c Codrthwith D u 7 Applica WARNING: FAILURE TO SECURE WORK ERS—COIVJPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINR1 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 aind 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 performe J 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 applicafion becomes null and void if work is not commenced within 180 days from date of iswance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and stat=_ that the above infor ation is correct. 1 agree to comply with all city and county ordinances an laws r latin to building construction, and hereby authorize representati-es his city, a er h above -menti ned operty for inspection purpo(Agen � l Da�0�Signature (Applicant o t Dater , 2/10/2017 Application Number: BPLB2017-0030 Owner:. Property Address: 77685 CALLE MADRID KENNETH WOODEURN APN: 774251013 752 KINGFISHER CT Application Description: WOODBURN / ABANDON SEPTIC/CONNECT TO SEWER CORONA, CA 92253 Property Zoning: Application Valuation: $7,880.00 Applicant: Contractor: HAMMER PLUMBING AND PUMPING INC HAMMER.PLUMBING AND PUMPING INC P O BOX 2448 P O BOX 2448 CATHEDRAL CITY, CA 92235 CATHEDRAL CITY, =A 92235 (760)360-7448 ----------------------------------------------------------- Llc. No.: 661018 ------ Detail: PLUMBING - ABANDON SEPTIC/CONNECT TO SEWER. 2016 CALIFORNIA BUILDING CODE. ---------------------------- i FINANCIAL INFORMATION DESCRIPTION ACCOUNT QTY AMOUNT BSAS SB1473 FEE 101-0000-20306 0 $1.00 Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 DESCRIPTION ACCOUNT QTY AMOUNT PERMIT ISSUANCE 101-0000-42404 0 $96.27 Total Paid for PERMIT ISSUANCE: $96.27 DESCRIPTION ACCOUNT QTY AMOUNT BUILDING SEWER 101-0000-42401 0 $25.33 DESCRIPTION ACCOUNT QTY AMOUNT BUILDING SEWER PC 101-0000-42600 0 $17.73 Total Paid for PLUMBING FEES: $43.06 DESCRIPTION ACCOUNT QTY AMOUNT TECHNOLOGY ENHANCEMENT FEE 502-0000-43611 0 ' .$5.00 Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00 11 Bin # Qty of La Quinta Building & Safety Division Permit ill 78-495 Calle Tampico La Quinta, CA 92253 - (760.) 777-701,2 �-� 20 T b Building Permit Application and Tracking Sheet Project Address: riIrl Owner's Name: Kl+�;•L4 A. P. Number: Address: Legal Description: City, ST, Zip: C 0 V � vt Fh Telephone:Contractor: L pL.,] V Address: ?'L-3 �� 'Z` L( Project Description: — t (. LN•�Uw� City, ST, Zipl \ ' ^ RAL Gr1, t` rC . " C U �J �-Y!C c7i i Tele h0 ne: •U State Lie. # : () ( City Lie. #: Arch.,'Engr., Designer: Address: City, ST, Zip: Tele hone:Construction TYPe: Occupancy: State Lie. #. Project type circle one): New A ddn A'ter Repairair Demo Name of Contact Person: 4 f l: Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: �v V Estimated Value of Project: Z '� APPLICANT: DO NOT WRITE BELOW THIS LINE 9 Submittal Req'd Rcc'd TRACKING PEEMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deport Truss Calcs.. Called Contact Person Plan Check Balance. Title 24 Calcs. Plans picked up Construction ' Flood plain plan Plans resubmitted Mechanical Grading plan 2" Review, ready for corrections/issue Electrical . Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. II.0.A. Approval Plans resubmitted Grading IN HOUSE:- '"' Review, ready for corrections/issue Developer Impacttee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees, " I Total Permit Fees i fA� COACHELLA VALLEY 'WATER. DISTRICT r�ar� P.O. BOX1058, .COACHELLA, CALIFORNIA 92236 (700) '398-2fi51 ' INVOICE Date:, 21W.161.1 SUBJECT: SANTA CARMELITA 77685 CALLE MADRID, LA QUINTA, LOT 1, LID 690690, "SCS FEE ONLY" KENNETH' WOODBURN. Project: 17-7806 752 KINGFISHER CT Project Date: 219!2017 . Amount Due`. $051.00 CORONA, :CA. 928,79,GEO: 06-06-13-1 Planner. SANDRA VILLALOBOS - i TO INSURE PROPER CREDIT, PLEASE RETURN THIS PORTION WITH " • ' REMITTANCE AND INCLUDE THE PROJECT ON`YOUR CHECK , r ►;d�1�A`� ��•, .'�'��'`�ra�cr�-"..�u-Cv,��- �,rr7�y7�S-�i;��, . - r • . . 'b e�y.`�.��`yr-� `'°„t ■sem 1.00 FF SCC -COLLECTION $2,415 CO. 1 $2,415.00 1.00 FJ SCC -TREATMENT $2 43600 $2 436.00 $4,851.00 01 . y Development Services Department; FEB 2,2017•% Coachella Valley Water District 75=515 Hovley Lane East Palm Desert, CA 92211 i :SUBACt-'SANTA CARMELITA, 77685'CALLE MADRID,. LA QUINTA,LOT 1, LID 690690, "SCC FEE ONLY" A i COACHELLA VALLEY WATER DISTRICT P.O.. BOX 1058, COACHELLA,. CALIFORNIA 92216 (760) 198'-2651 A co - - of C • i `jam SL Al