BPLB2022-0094Description: JACKSON / SEWER CONNECT AND SEPTIC TANK ABANDONMENT
Type: PLUMBING - SEWER Subtype: Status: ISSUED
Applied: 6/22/2022 EPRS
CONNECT/SEPTIC ABANDON
(WEB)
Approved: 6/22/2022 JLIM
Parcel No: 773114009 Site Address: 51655 AVENIDA DIAZ LA QUINTA,CA 92253
Subdivision: SANTA CARMELITA VALE LA QUINTA Block: 24 Lot: 2
Issued: 6/27/2022 ONLINE
UNIT 2
Lot Sq Ft: 0 Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $5,000.00 Occupancy Type: Construction Type:
Expired: 6/27/2023 EPRS
No. Buildings: 0 No. Stories: 0 No. Unites: 0
STATUS
Details: SEPTIC TANK ABANDON BY FILLING WITH SLURRY OR SAND AND HOOKING UP TO CVWD SEWER SYSTEM. INSPECTOR TO VERIFY IF
BACKWATER VALVE IS NEEDED AT THE PROPERTY PER 2019 CALIFORNIA PLUMBING CODE.
CHRONOLOGY
Printed: Monday, April 03, 2023 8:36:04 AM 1 of 4
WsYsrEMS
CONDITIONS
CONDITION
DATE
DATE DATE
CONTACT
STATUS
REMARKS
NOTES
TYPE
ADDED
REQUIRED SATISFIED
CONTRACTOR INFOMRATION AND CURRENT CITY
BUSINESS LICENSE IS REQUIRED.
READY TO ISSUE
JACK LIMA
6/22/2022
6/27/2022
6/27/2022
COMPLETE
COMPLETE
SITE PLAN IS REQUIRED.
CHECKLIST
pending site p
COMPLETE
CONTACTS
NAME TYPE
NAME
ADDRESSI
CITY
STATE ZIP
PHONE FAX
EMAIL
APPLICANT
justin jackson
4990 via campeche riverside
CA 92507
(562)447-7595
jacksonhomesllcl@gm
ail.com
Printed: Monday, April 03, 2023 8:36:04 AM 1 of 4
WsYsrEMS
FINANCIAL INFORMATION
CONTACTS
CLTD
DESCRIPTION ACCOUNT QTY AMOUNT
PAID
PAID DATE RECEIPT # CHECK # METHOD PAID BY
NAME TYPE
NAME
ADDRESSI
CITY
STATE
ZIP
PHONE
FAX
EMAIL
CONTRACTOR
JUSTIN JACKSON - OWNER BUILDER
51655 AVENIDA DIAZ
LA QUINTA
CA
92253
(562)447-7595
jacksonhomesllcl@gm
ail.com
OWNER
JUSTIN JACKSON
4990 via campeche
riverside
CA
V9V1T
(562)447-7595
jacksonhomesllcl@gm
ail.com
FINANCIAL INFORMATION
CLTD
DESCRIPTION ACCOUNT QTY AMOUNT
PAID
PAID DATE RECEIPT # CHECK # METHOD PAID BY
BY
BSAS SB1473 FEE 101-0000-20306 0 $1.00
$1.00
6/27/22 WEB12349 6378 3678 CREDIT justin jackson
EPRS
97
Total Paid for BUILDING STANDARDS ADMINISTRATION $1.00 $1.00
BSA:
PERMIT ISSUANCE
101-0000-424040
$105.60
$105.60
6/27/22
WEB12349
6378 3678
CREDIT
justin jackson
EPRS
97
Total Paid for PERMIT ISSUANCE: $105.60 $105.60
SEWER
CONNECTION/SEPTIC
101-0000-42401
0
$27.79
$27.79
6/27/22
WEB12349
637873678
CREDIT
justin jackson
EPRS
97
ABANDON
SEWER
CONNECTION/SEPTIC
101-0000-42600
0
$19.45
$19.45
6/27/22
WEB12349
637873678
CREDIT
justin jackson
EPRS
97
ABANDON PC
Total Paid for PLUMBING 2021: $47.24 $47.24
RECORDS
101-0000-424160
$11.00
$11.00
6/27/22
WEB12349
637873678
CREDIT
justin jackson
EPRS
MANAGEMENT FEE
97
Total Paid for RECORDS MANAGEMENT FEE: $11.00 $11.00
TECHNOLOGY
502-0000-436110
$5.00
$5.00
6/27/22
WEB12349
637873678
CREDIT
justin jackson
EPRS
ENHANCEMENT FEE
97
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00 $5.00
TOTALS::4
Printed: Monday, April 03, 2023 8:36:04 AM 2 of 4
WsYsrEMS
SEQID
INSPECTION TYPE
INSPECTOR
SCHEDULED
DATE
INSPECTIONS
COMPLETED
DATE
RESULT
REMARKS
NOTES
DUE DATE
RETURNED
DATE
STATUS
REMARKS
NOTES
6/27/2022 3:24 PM justin jackson
CONTRACTOR INFOMRATION AND CURRENT CITY
1ST PERMIT TECH —
ETRAKIT (1 DAY)
JACK LIMA
Contact Name: justin jackson
6/23/2022
6/22/2022
APPROVED-
CONDITIONS
BUSINESS LICENSE IS REQUIRED.
SITE PLAN AND OWNER BUILDER PACKAGE IS
Site Address: 51655 AVENIDA DIAZ
REQUIRED.
Phone:5624477595
e -Mail: jacksonhomesllcl@gmail.com
SEPTIC ABANDONMENT
BBL
6/28/2022
6/28/2022
PARTIALLY
eTRAKiT Inspection
APPROVED
Request
Septic system has been removed and is
approved.Waste line requires backflow
valve, not installed at this time.OK to backfill
from street to the step in the pool at the spa
location. Keep remaining portion of trench
open, to allow for inspection of backflow
valve and waste line clean out.
7/5/2022 12:43 PM justin jackson
Contact Name: justin jackson
eTRAKiT Inspection
Site Address: 51655 AVENIDA DIAZ
SEPTIC ABANDONMENT
BBL
7/6/2022
7/6/2022
APPROVED
Request
Phone: 5624477595
e -Mail: jacksonhomesllcl@gmail.com
OK to final permit.
PARENT PROJECTS
Printed: Monday, April 03, 2023 8:36:04 AM 3 of 4
WsYsrEMS
REVIEW TYPE
REVIEWER
SENT DATE
DUE DATE
RETURNED
DATE
STATUS
REMARKS
NOTES
CONTRACTOR INFOMRATION AND CURRENT CITY
1ST PERMIT TECH —
ETRAKIT (1 DAY)
JACK LIMA
6/22/2022
6/23/2022
6/22/2022
APPROVED-
CONDITIONS
BUSINESS LICENSE IS REQUIRED.
SITE PLAN AND OWNER BUILDER PACKAGE IS
REQUIRED.
Printed: Monday, April 03, 2023 8:36:04 AM 3 of 4
WsYsrEMS
Printed: Monday, April 03, 2023 8:36:04 AM 4 of 4
WsYsrEMS
ATTACHMENTS
Attachment Type
CREATED
OWNER
DESCRIPTION PATHNAME
SUBDIR 1117-
ETRAKIT ENABLED
Subcontractors List
DOC
6/24/2022
JACK LIMA
SUBCONTRACTOR LIST
1
Fillab..... pdf
OWNER -BUILDER Untitled Extract
DOC
6/24/2022
JACK LIMA
1
DECLARATION Pages.pdf
DOC
6/27/2022
JACK LIMA
SITE PLAN Screen Shot ..... pdf
1
Etrakit Public
CVWD CONNECTION FEE
PHOTO
6/22/2022
IMG_0344.JPG
1
Registration
RECEIPT
Printed: Monday, April 03, 2023 8:36:04 AM 4 of 4
WsYsrEMS
CALIFORNIA
Disclosures & Forms for Owner -Builders Applying for Construction Permits
IMPORTANT! NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application for a buildin p it has b8endubm�fgg %ypur Warne listing yourself 1, th��u e� the property
improvements specified at �1 AVenl a Iaz Avenic a Ula a Ulna C
We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you
aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the
Owner -Builder. We will not issue a building permit until you have read, initialed your understanding of each
provision, signed, and returned this form to us at our official address indicated. An agent of the owner
cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority.
OWNER's ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
DIRECTIONS: Read and initial each statement below to signify you understand or verify this information.
4zi. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -
Builder" building permit that erroneously implies that the property owner is providing his or her own labor and
material personally. I, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries
sustained by an unlicensed person and his or her employees while working on my property. My homeowner's
insurance may not provide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of
the limits of my insurance coverage for injuries to workers on my property.
42. 1 understand building permits are not required to be signed by property owners unless they are responsible
for the construction and are not hiring a licensed Contractor to assume this responsibility.
. I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I
may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or
her name instead of my own.
Z. I understand Contractors are required by law to be licensed and bonded in California and to list their license
numbers on permits and contracts.
.ZZ5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and
the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be
considered an "employer" under state and federal law.
,�,-06. 1 understand if I am considered an "employer" under state and federal law, I must register with the state and
federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to
unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject
me to serious financial risk.
. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family
residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by
licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the
work is performed under contract with a licensed general building Contractor.
/08. 1 understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for
any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction
defects in the workmanship or materials.
Page 3 of 4
_Z3. I understand I may obtain more information regarding my obligations as an "employer" from the Internal
Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments,
and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State
License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed
contractors.
I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand
that I am the party legally and financially responsible for proposed construction activity at the following address:
�1. I agree that, as the party legally and financially responsible for this proposed construction activity, I will
abide, by all applicable laws and requirements that govern Owner -Builders as well as employers.
12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the
information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public.
If you contract with someone who does not have a license, the Contractors' State License Board may be unable to
assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed
Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or
employee of that individual or firm is injured while working on your property, you may be held liable for damages. If
you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or
not those Contractors are properly licensed and the status of their workers' compensation insurance coverage.
Before a building permit can be issued, this form must be completed and signed by the property owner and
returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's
license, form notarization, or other verification acceptable to the agency is required to be presented when
the permit is issued to verify the property owner's signature.
06-24-22
Signature of Property Owner: Date:
Note: The following Authorization Form is required to be completed by the property owner only when
designating an agent of the property owner to apply for a construction permit for the Owner -Builder.
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby
authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to
obtain an Owner -Builder Permit for my project.
SEWER CONNECT/SEPTIC ABANDON
Scope of Construction Project (or Description of Work):
51655 Avenida Diaz, La Quinta, CA 92253
Project Location or Address:
Justin Jackson
Name of Authorized
Address of Authorized Agent:
4990 via campeche, riverside, ca 92507
Phone:
562-447-7595
I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled
out the above information and certify its accuracy. Note: A copy of the owner's driver's license, form notarization, or
other verification acceptable to the agency is required to be presented when the permit is issued to verify the
property owner's signature.
Signature of Property Owner: Date:
06-24-22
Page 4 of 4
51655 Avenida Diaz,La Quints, CA 92253 CITY OF LA QUINTA
]OB ADDRESS PERMIT NUMBER BPLB2022-0094 OWNER Justin jackson BUILDER Justin jackson
This form shall be posted on the iob with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on the list or their employees are
authorized to work on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoopage of work
and/or the voidance of building permmit. For each applicable trade, all information requested below must be completed by the applicant. "On File" is not an accepatble resonse.
TRADE/CLASSIFICATION
CONTRACTOR
STATE CONTRACTOR'S LICENSE
WORKER COMPENSATION INSURANCE
CITY BUSINESS LICENSE
Company Name
Classification
(e.g. A, B, C-8)
California
License
Number
Exp. Date
Carrier Name
(e.g. State Fund, CalComp)
Policy Numbers
(Format Varies)
Exp. Date
License Number
Exp. Date
EARTHWORK (C-12)
CONCRETE (C-8)
FRAMING (C-5)
STRUCT. STEEL (C-51)
MASONRY (C-29)
PLUMBING (C-36)
ustin aCkS�n
LATH, PLASTER (C-35)
DRYWALL(C-9)
HVAC (C-20)
ELECTRICAL (C-10)
ROOFING (C-39)
SHEET METAL (C-43)
FLOORING(C-16)
GLAZING(C-17)
INSULATION (C-2)
SEWAGE DISP. (C-42)
PAINTING (C-33)
CERAMIC TILE (C-54)
CABINETS (C-6)
FENCING (C-13)
LANDSCAPING (C-27)
POOL (C-53)
COACHELLA VALLEY WATER DISTRICT
* CUSTOMER RECEIPT
Oper; VC1428 Type, OC Drawer: 2
Date: 6/21/22 10 Receipt no; 979120
Year Number
2022 13589
PZ PLANNING
Trans number;
Tender detail
CA CASH PAYMENT
Total tendered
Total payment
Change
Amount
& ENGINEERING
4533,00
0680033
a600 , 00
4600,00
4533,00
$67,00
Trans date: 6/21/22 Time: 15;12;32
*TRUE CONSERVATION USE WATER WISELY*
(760) 398-2651
COACHELLA VALLEY WATER DISTRICT
58, COACHELLA, CALIFORNIA 92236 (760) 398-2651
IVOICE
Date: Jun 1, 2022
JTA, 51655 AVENIDA DIAZ (LOT 2) LID 681264. **SCC ONLY**
Project:
Project Date:
Amount Due:
GEO:
Planner:
PER CREDIT, PLEASE RETURN THIS PORTION WITH
AND INCLUDE THE PROJECT ON YOUR CHECK
Type Description
Subject: SANTA CARMELITA, 51655 AVENIDA DIAZ (LOT 2) LID 681264. **SCC ONLY**
COACHELLA VALLEY WATER DISTRICT
P.O. BOX 1058, COACHELLA, CALIFORNIA 92236 (760) 398-2651
Charge
Amount
$2,748.00
$1,785.00
22-13589
05/31/2022
$4,533.00
06-06-01-3
LISA SANCHEZ
Total Amount
$2,748.00
$1,785.00
$4,533.00
Septic
aandoned
sewer line
56 Linear loot. flinch wide
zei❑ epivanV Zei❑ epiuz