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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