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
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