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BPLB2019-005078-495 CALLE TAMPICO Ct J D il4a I LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT BUILDING PERMIT Permit Type/Subtype: PLUMBING/ Application Number: BPLB2019-0050 Property Address: 53830 AVENIDA VALLEJO APN: 774163005 Application Description: GERTSMAN / CONNECT TO SEWER AND ABANDON SEPTIC Property Zoning: Application Valuation: $10,100.00 VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 4/1/2019 Owner: PHIL GERTSMAN 481 W 23RD AVE VANCOUVER BC CANADA VSY, H5 92253 Applicant: Q Contractor: ALMS UNDERGROUND CONSTRUCTION INCALMS UNDERGROUND CONSTRUCTION INC 38703 VISTA DRIVE D 38703 VISTA DRIVE CATHEDRAL CITY, CA 92234 APR 0 12019 CATHEDRAL CITY, CA 92234 (760)324-1911 CITY OF LA QUINTA Llc. No.: 482180 DESIGN & DEVELOPMENT DEPARTMENT 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 of the Business and Professions Code, and my License is in full force and effect. License Class: C21, C42 License No.: 482180 ibp.�� ;iCaritraCtor: 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 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 of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of rk for which this permit is issued. haveand will maintain workers' compensation insurance, as required by sect7o'n'fti 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: RWCC65201240 I 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 laws of California, and agree that, if 1 should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Yate: +L U�f q Appllont: A—ett 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 cancellation. 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-mentioned property for inspection purposes. Iat : / + '~'Signature (Applicant or Agehf. Application Number: BPLB2019-0050 Property Address: 53830 AVENIDA VALLEJO APN: 774163005 Application Description: GERTSMAN / CONNECTTO SEWER AND ABANDON SEPTIC Property Zoning: Application Valuation: $10,100.00 Applicant: ALMS UNDERGROUND CONSTRUCTION INC 38703 VISTA DRIVE CATHEDRAL CITY, CA 92234 Date: 4/1/2019 Owner: PHIL GERTSMAN 481 W 23RD AVE VANCOUVER BC CANADA V5Y, H5 92253 Contractor: ALMS UNDERGROUND CONSTRUCTION INC 38703 VISTA DRIVE CATHEDRAL CITY, CA 92234 (760)324-1911 Llc. No.: 482180 Detail: ABANDON SEPTIC TANK AND FILL WITH SLURRY OR SAND, HOOK UP TO CITY SEWER. PER 2016 CALIFORNIA PLUMBING CODE. FINANCIAL • 1 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 $101.40 Total Paid for PERMIT ISSUANCE: $101.40 DESCRIPTION ACCOUNT QTY AMOUNT BUILDING SEWER 101-0000-42401 0 $26.68 DESCRIPTION ACCOUNT QTY AMOUNT BUILDING SEWER PC 101-0000-42600 0 $18.68 Total Paid for PLUMBING FEES: $45.36 DESCRIPTION ACCOUNT QTY AMOUNT i RECORDS MANAGEMENT FEE 101-0000-42416 0 $10.00 Total Paid for RECORDS MANAGEMENT FEE: $10.00 i DESCRIPTION ACCOUNT QTY AMOUNT TECHNOLOGY ENHANCEMENT FEE 502-0000-43611 0 $5.00 Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00 t(V QU&t(4J CALIFORNIA L PERMIT # PLAN LOCATION: Project Address: 93 0 ve,,,�e,�,q� �b� c 7Project Description: APN #:- Cs Patio/Porch SF rO- Applicant Name: P,,o,Wek State Lic: Z f3oCity Bus Lic: Address: 1670-3 State Lic: City Bus Lic: f City, ST, Zip: C fit ( Telephone: Q -- Zai— On Email: G; -� S 6 �rl� �� (e Valuation of Project IIrl k: k 1 0- v --�, Contractor Name: j _ !�S �� New SFD Construction: Address: Conditioned Space SF City, St, Zip Garage SF Telephone: Patio/Porch SF Email: Fire Sprinklers SF State Lic: Z f3oCity Bus Lic: Architect/ Engineer Name: Construction Occupancy: Address: 15 Prvv�,,L A4 Grading: City, St, Zip Construction Type: Occupancy: Telephone: Bedrooms: Stories: # Units: Email: State Lic: City Bus Lic: Property Owner's Name: New Commercial/ Tenant Improvements: Address: Total Building SF City, ST, Zip Construction Type: Occupancy: Telephone: 7 Email: v 78495 CALLE TAMPICO LA QUINTA, CA 92253 760-777-7000 OFFICE USE ONLY # Submittal Plan Sets Required Received ............. Structural Calcs ... Truss Calcs Title 24 Calcs CVWD Fire Flow Letter 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 ,rfATFR COACHELLA VALLEY WATER DISTRICT 4�5rR�G� P.O. BOX 1058, COACHELLA, CALIFORNIA 92236 (760) 398-2651 INVOICE Date: 4/112019 SUBJECT: SANTA CARMELITA, 53830 AVENIDA VALLEJO, LA QUINTA, LID 689182, "SCC FEE ONLY" REBECCA LUND Project: 19-9833 53830 AVENIDA VALLEJO Project Date: 4/1/2019 Amount Due: $4,851.00 LA QUINTA, CA 92253 GEO: 06-06-12-4 Planner: SANDRA VILLALOBOS TO INSURE PROPER CREDIT, PLEASE RETURN THIS PORTION WITH REMITTANCE AND INCLUDE THE PROJECT ON YOUR CHECK SUBJECT: SANTA CARMELITA, 53830 AVENIDA VALLEJO, LA QUINTA, LID 689182, "SCC FEE ONLY" COACHELLA VALLEY WATER DISTRICT P.O. BOX 1058, COACHELLA, CALIFORNIA 92236 (760) 398-2651 Pagel