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BPLB2018-0124OWNER -BUILDER DECLARATION 1 hereby afflrm under penalty of perjury that I am exempt from the Contractor's State L€cense 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 far 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 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 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 w4tr4lp4a4rw DESIGN & DEVELOPMENT DEPARTMENT BUILDING PERMIT Permit Type/Subtype: PLUMBING/ Application Number: BPLB2018-0124 Property Address: 53905 AVENIDA VALLEJO APN: 774162021 Application Description: SEWER CONNECTION / SEPTIC ABANDON Property Zoning: Application Valuation: $4,000.00 Applicant: RANDY FULCHER 38800 PRIMROSE LN q INDIO, CA 92203 OCT 1U2018 CITYOFLAQUINTA� ` ........................... C 1NMI1HfIY0EyEIOPh1ENT0EPAHfMEM LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter I hereby affirm under penalty of perjury one of the following declarations: 9 fcommencing with Section 7000) of Division 3 of the Business and Professions Code and +nY License is in full Force and effect_ 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 License Class: C12 License No.: 842M74 of the work for which this permit is issued. Date: ^-� — _ Contractor: r I have and will maintain workers' compensation insurance, as required by 5ec6on 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: _ VI 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 Paws of California, and agree that, jf I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code. I shalt forthwith comply with those provisions. Date: Applicant: VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 10/10/2018 Owner: PATRICK LINDOP 3140 WILLINGTON AVE VANCOUVER BC CANADA V513; X8 92253 Contractor: BOB'S EQUIPMENT RENTAL PARTNERS 38800 PRIMROSE LN INDIO, CA 92203 (760)345-8123 Llc. No.: 842374 WARNING: FAILURE TGSECURE 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 Nork for 180 days will subject permit to cancellation. 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 :onstruction, and hereby authorize representatives of this city to enter upon the above -mentioned property for inspection purposes. )ate: _ U _ 1 Y Signature (Applicant or Agent):.�[f�t/�`" �"4. Date: 10/10/2018 Application Number: Property Address: APN: Application Description: Property Zoning: Application Valuation: Applicant: RANDY FULCHER 38800 PRIMROSE LN INDIO, CA 92203 BPLB2018-0124 53905 AVENIDA VALLEJO 774162021 SEWER CONNECTION / SEPTIC ABANDON $4,000.00 Detail: ABANDOED SEPTIC / CONNECTTO SEWER. PER 2016 CALIFORNIA BUILDING CODE Owner: PATRICK LINDOP 3140 WILLINGTON AVE VANCOUVER BC CANADA VSR, X8 92253 Contractor: BOB'S EQUIPMENT RENTAL PARTNERS 38800 PRIMROSE LN I N DIO, CA 92203 (760)345-8123 Llc. No.: 842374 ACCOUNT CI��AM�OUNIT101-0000 DESCRIPTION 00 00 20306 BSAS SB1473 FEE ADMINISTRATION BSA: $ 1.00 Total Paid for BUILDING STANDARDS ACCOUNT CITY AMOUNT DESCRIPTION 0 $101.40 101-0000-42404 PERMIT ISSUANCE Total Paid for PERMIT ISSUANCE: $101.40 ACCOUNTg DESCRIPTION 101-0000-42401 E BUILDING SEWER ACCOUNT101-0000-42600 DESCRIPTION BUILDING SEWER PC Total Paid for PLUMBING FEES: $45.36 QTY AMOUNT �DESPTIONACCOUNT 0 $10.00RECORAGEMENT FEE 101-0000-42416 Total Paid for RECORDS MANAGEMENT FEE: $10.00 ACCOUNT QTY AMOUNT DESCRIPTION 0 $5.00 TECHNOLOGY ENHANCEMENT FEE 502-0000-43611 Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00 PERMIT#�+ } Project Address: 7,3q (9 S oqu, l/,4t-t e j o APN #: Applicant Name: 7qpp Address: S Gt, �(� r M R o S U City, ST, Zip: ry �l r .2 G 3 Telephone: 7(y G `1L-/ 7 Email: Contractor Name: Address: U 4 J e' City, St, Zip �w/3<6 Cr 9 ? 2G 3 Telephone: i✓ U Y��_ Lfo L % Email: State Lic: y 2 317 City Bus Lic: Yc' � `1 d155- Arch/Eng Name: Address: City, St, Zip Telephone: Email: State Lic: City Bus Lic: Property Owner's Name: Address: s 3�C�S �UC-fG City, ST; Zip w (— Telephone: 7 (tea - �f-m 0 S- f Email: PLAN LOCATION: Project Description: Pool, Remodel, Add't, Elect, Plumb, Mech 1 b/1 N0/0a-) Sir r f l C rTL/ .SC' LcJ Valuation of Project $ New SFD Construction: Conditioned Space Garagp Patio/Porch Fire Sprinklers Construction Type: Grading: Bedrooms: I Stories: �C--/ SF SF SF SF Occupancy: # Units: New Commercial / Tenant Improvements: Total Building SF Construction Type: Occupancy: 78495 CALLE TAMPICO LA QUINTA, CA 92253 760-777-7000 OFFICE USE ONLY # Submittal Req'd Req'd Plan Sets Structural Calcs Truss Calcs Title 24 Calcs Soils Report Grading Plan (PM10) Landscape Plan Subcontractor List Grant Deed HOA Approval School Fees Burrtec Debris Plan Planning approval Public Works approval Fire. approval City Business License ,NATE� COACHELLA VALLEY WATER DISTRICT d�S Rl� P.O. BOX 1058, COACHELLA, CALIFORNIA 92236 (760) 398-2651 INVOICE Date:10/3/2018 SUBJECT: SANTA CARMELITA, 53905 AVENIDA VALLEJO, LOT 10, LA QUINTA, LID 689150 **SCC ONLY** RAMOS, SERGIO Project: 18-9317 48255 MONROE ST., APT#9 Project Date: 10/3/2018 (z r7 Amount Due: $4,851.00 INDIO, CA 92201 U / GEO: 06-06-12-4 Planner: RUBEN MONTIEL TO INSURE PROPER CREDIT, PLEASE RETURN THIS PORTION WITH REMITTANCE AND INCLUDE THE PROJECT ON YOUR CHECK Units Co Fee Type Desi•�IIIl&- Total Amount 1.00 FF SCC-COLLECTION $2,415.001 $2,415.00 1.00 FJ SCC-TREATMENT $2,436.001 $2,436.00 $4,851.00 PAID Development Services Depa=Wl OCT 03 2018 Coadhe,110 Valley Water District . /13-515 HoWey Lane East In, ?eser1, CA 92211 SUBJECT: SANTA CARMELITA. 53905 AVENIDA VALLEJO, LOT 10, LA QUINTA, LID 689150 **SCC ONLY** COACHELLA VALLEY WATER DISTRICT P.O. BOX 1058, COACHELLA, CALIFORNIA 92236 (760) 398-2651 Pagel ��� e- � &I f 1 t ram tb5�s',s S 3 9 o S �� 0 v04-4-d-Tv /� P to