BMCH2015-021079315 Mandarina
BMCH2015-0210
78-495 CALLE TAMPICO TAtyl 4ha w
LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number:
Property Address:
APN:
Application Description
Property Zoning:
Application Valuation:
BMCH2O15-0210
79315 MANDARINA
776270018
MORGAN RESWIDENCE HVA(
$5,864.00
Applicant:
IE INC. "
32115 LA BAYA
WESTLAKE VILLAGE, CA 91362
LICENSED CONTRACTOR'S DECLARATION -
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing with Section 7000) of Division 3 of the Business and Professions Code,
and my License is in full force and effect.
License Class: C20 License No.: 686310 .
Date:(Q / / X /1 ) Contractor:
OWNER -BUILDER DECLARATIOW
I hereby affirm under penalty of perjury that I am exempt from the Contr ,ctor'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
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 ) 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
Lender's
VOICE (760) 77777125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/18/2015
Owner:
CHARLES MORGAN -
79315 MANDARINA.
LA QUINTA, CA 92253
Contractor:
HARRISON ENTERPRISES INC DBA G
31-170 RESERVE DRIVE STE A
THOUSAND PALMS, CA 92276
(760)343-7488
Llc. No.: 686310
. • 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.the work which this permit is issued.
I have and will maintain workers' compensation insurance, as required by
Section 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: _
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 I should become subject to the
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with those provisions.
Date: Applicant: '
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION 0 ERAGE IS UNLAWUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP T
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"
mentione propert for inspection -purposes.
Date Signature (Applicant or Agent
FINANCIAL • •
t: y' 1 -
DESCRIPTION AMOUNT ', ' PAID ^_.'
Y. z; ,4 + .,, rA000UNT
PAID DATE.
BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00
PAID BY -_ i# #;$METHOD•,.' z'".'RECEIPT# a"`CHECK #' `
r
CLTDBY,.
Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $1.00 $0.00
8. DESCRIPTION e
s
ACCOUNT `<s
r
Q TY
t. ;
AMOUNT ,#
e PAID ; .
PAID DATE
HVAC CHANGEOUT - SPLIT -SYSTEM
101-0000-42402
0
$72.52
$0.00
t q' `=PAID BY
r4 , 't- ,
-` METHOD x ; p
' , ° itECEIPT# a
-4-.CHECK
aCLTD BY
DESCRIPTION ' is , . ;
? _ •• - ACCOUNT
„ .....
QTY'
.. _
:.. PAID `'
PAID DATE.
HVAC CHANGEOUT - SPLIT -SYSTEM PC
101-0000-42600
0
$36.26
$0.00
a , PAID BY j
METHOD
E" :RECEIPT # €
CHECK #
` CLTD'BY
Total Paid forCHANGEOUT: $108.78 $0.00
DESCRIPTION T 9
ACCOUNT
F
iaty
_
r
kPAID.DATE
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
PAID.'BY a a
.. -.9.
r= x METHOD { y r>
.=
.RECEIPT # r ` ;
4 CHEEK # -
a
CLTD BY d
Total Paid forPERMIT ISSUANCE: $91.85 $0.00
TOTALS:00
c
,
r
Description: MORGAN RESWIDENCE HVAC CHANGE OUT
Type: MECHANICAL Subtype: Status: APPROVED
Applied: 6/18/2015 MFA
Approved: 6/18/2015 MFA
Parcel Nb: 776270018 Site Address: 79315 MANDARINA LA QUINTA,CA 92253
Subdivision: TR 28447 Block- Lot: 18
Issued:
Lot Sq Ft: 0 Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $5,864.00 Occupancy Type: Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0 No. Unites: 0.
Details: HVAC CHANGE OUT - 14 SEER / SPLIT SYSTEM [2008 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL
INSPECTION. 2013 CALIFORNIA BUILDING CODES.
FINANCIAL INFORMATION
,
Printed: Thursday, June 18, 2015 8:30:27 AM 1 of.2
SYSTEMS.
W
V
DESCRIPTION
ACCOUNT,
QTY
AMOUNT
PAID
Al`PD DATE
RECEIPT #
CHECK #u`
METHOD
PAID BY
-
-;
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$0.00
Total Paid forBUILDING STANDARDS ADMINISTRATION
$1.00 $0.00
BSA:
HVAC CHANGEOUT -
101-0000-42402
0
$72.52
$0.00
SPLIT -SYSTEM
HVAC CHANGEOUT -
101-0000-42600
0
$36.26
$0.00
SPLIT -SYSTEM PC
Total Paid forCHANGEOUT: $108.78 $0.00
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
Total Paid for PERMIT ISSUANCE: $91.85 $0.00
TOTALS:$0.00
PARENT ,..PROJECTS
BOND INFORMATION
Printed: Thursday, June 18, 2015 8:30:27 AM 2 of 2
sysTCMs
City of La Quinta
&Mk?z sc Safety UvWm
P.O. Box 1504,'78-49S Cage Tampico
14.Qtrk" CA 92253 -=(760) 777-7012
" 02 C) Building Permit Application and Tracking Sheet
Pemik N
M GIA 20 (vS
Poojca-Add=* 79315 MANDARINA Owaer'sNamc:. CHARLES MORGAN '
A- P. Number. Address: 79315 MANDARINA
Lgal Descripdon: City, ST. Zip: LA QUI NTA, CA 92253
Contractor. GENERAL A/C & HEATING Telephone: 760-777-9984
Address: 31170 RESERVE DRIVE Poojea;tDescription:
City. $T.Zip: THOUSAND PALMS, CA 92276 CHANGE OUT A/C 4 TON
Tekphone: 760-343-7488
Sate Lia #: 686310. (Sty Lia k
Arch. EW..
Address
City. ST. Zip:
Telephone: Construction Type:. Occupancy:
StaOc Lie #' Project type (trade one): New Add'n Alter Repair Dela
Name of Contra Perm: PATRICK Sq. Ft.: # Stories: Unity
TekPhonc Y of CoMd Person: 7.60-343-7488' E dmatod• V&h c of pmjoct 5864.00
APPLICANT: DO NOT WRITE BH.OW THM UNE
N submittal Req'd 'Reed TRACKVG PERbilT FM
Plan Seb Pian Cleett aabmltted Item Amort
Stractwd Cyln.
R-kw4 ready for corrections Plan Ckeck Deposit,
Tnu Com.
Called Cbataet Person Plan Cleek Balance
'Me U Wei.
Pian picked up Caustra tion
Hood pal* pan
Plans resubmitted Meelks aicai
Gradlap Pea
P! R vi—, ready for eorrectiowrimte Electrical
Sat coataewr I3st
Called Contact Person Plumbing
Grant Deed
Pines Picked up S.M.6
H.O.A. Approrai
Plans resabaritted Gradfag
IN HOUSE:-
''• Review, ready for eorrectlonvissae Devdoper Impact Fee
.
Planning Approrai
Cali eQ Contact Person
Pub. Wks- Appr
Date of permit Ime
SAW Fen
Total Permit Fees