BPLB2016-001378-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
`ter 4 lw491K
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
1 IIIIII 11111 IIII IIII
07
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/26/2016
Application Number:
BPLB2016-0013
Owner:
Property Address:
52765 AVENIDA DIAZ
WILLIAM HOWARD
APN:
773311017
52765 AVENIDA DIAZ
Application Description:
HOWARD / CONNECT TO SEWER
LA QUINTA, CA 92253
Property Zoning:
Application Valuation:
$1,000.00
Applicant:
Contractor:
B CONSTRUCTION INC
B CONSTRUCTION INC
P 0 BOX 10758
P 0 BOX 10758
PALM DESERT, CA 92255
PALM DESERT, CA 92255
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 {commencing with Section 70001 of Division 3 ofthe Business and Professions Code,
and my License is in full force and effect.
License Cla : A License ND.: $89388
�r--
Date �' Cantrattor I
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.).
() 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
Lender's Add
(760)27.5-6698
Llc. No.: 889388
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 he lvork for which this permit is issued.
�1 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 certifythat 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 subjectto the
workers' compensation provisions of Section 3700 of the LaborEQdc., I shall forthwith
comply withthos provisions.
Date: 1 2�V L Applicant:
1
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 cancellatioh.
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 the
above meat' ned property for inspection purposes.
Date Signature (Applicant or Agent):
DESCRIPTION
FINANCIAL INFORMATION
ACCOUNT QTY AMOUNT
PAID
PAID DATE
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 $0.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid for PERMIT ISSUANCE: $91.85 $0.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
BUILDING SEWER
101-0000-42401
0
$12.09
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
BUILDING SEWER PC
101-0000-42600
0
$12.09
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid for PLUMBING FEES: $24.18 $0.00
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Bin If
Permit if
-l'i of ect Address:
City of La Q Uill to
BuMiny 8t Safety Division
- 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
A. P_ Number:
Address: , U�
Legal Description:
City, ST, Zip:'Pa � e , DO
Contractor:' J C_ p w -5 Q, 1
-
-'elepbonc: 'j
,edaress: d -7-S�
�'rojetT-Description:
riry, ST, Zip: A'�v�sZ
f`� �����
f•' I.J e C ^� �.. ���
S.}ate Lic. #F
Arch., Engr., Designer:
Address;
City, ST, Zip:
Telephone:
;:g;:::::; ,?c:
Construction Type: Occupancy:
State Lic. It:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:
#F Stories: # Units:
Telephone 4of Contact Person:
stimated Value of Project I r7
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Rcq'd
Ree'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calls.
Reviewed, ready for corrections
Plan Check Deposit
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
Gran( Deed
Plans picked up
S.M.I.
II.O.A. Approval
Plans resubmitted
Grading
IN I10USE:-
' Rcvie)v,,ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fces,
"Total Permit Fees
z
COACHELLA VALLEY WATER DISTRICT
P.O. BOX 1058, COACHELLA, CALIFORNIA 92236 (760) 398-2651
INVOICE Date:112512016
SUBJECT: SANTA CARMELITA, 52765 AVENIDA DIAZ, LA QUINTA, LOT 2, LID 685010, "SCC FEE ONLY"
W & B HOWARD F ILY TRUST Project:
51001 EI ER DR
,4fQr Project Date:
Amount Due:
LA QUINTA 53 00 /f 4 GEO:
Planner:
TO INSURE PROPER CREIAT, PLEASE RETURN THIS PORTION WITH
REMITTANCE AND INCLUDE THE PROJECT ON YOUR CHECK
16-6921
1 /25/2016
$4,851.00
06-06-12-2
SANDRA VILLALOBOS
1.00IFF SCC-COLLECTION $Z415.00 $2.415.00
1.00 FJ ISCC-TREATMENT $2.436.00 $2,436.00
$4,851.00
PAID $ ¢ 9S"0. 0.0 1// A- 7ka-a--
Development Services Department
JAN 2 5 2016
Coachelfa Valley Water District
75-515 Hovley Lane East
Palm Desert, CA 92211
SUBJECT:SANTA CARMELITA, 52765 AVENIDA DIAZ, LA QUINTA, LOT 2, LID 685010, "SCC FEE ONLY"
COACHELLA VALLEY WATER DISTRICT
P.O. BOX 1058, COACHELLA, CALIFORNIA 92236 (760) 398-2651 Pagel