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BMCH2016-020378-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Ta4t 4 4 Qu&z COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date:. 7/6/2016 Application Number: BMCH2O16-0203 Owner: Property Address: 78098 LAGO DR JIM GRIESGRABER APN: 646200001 78098LAGO DR Application Description: HVAC CHANGING OUT EXISTING 3.5 TON PACKAGE UNIT ON ROOF LA QUINTA, CA 92253 Property Zoning: Application Valuation: $9,972.00 Applicant: Contractor: CAROLYN CEBALLOS PREFERRED'PLUMBING 74998 COUNTRY CLUB DR PO BOX 5120, PALM DESERT, CA.92260 PALM SPRINGS, CA 92263 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that 1 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: C36, C16. C10, C20 License No.: 457554 Date: Contractor: 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 Lender's Add Llc. No.: 457554 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 for 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: _ Polity 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 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. Date: Signature (Applicant or Agent): DESCRIPTION FINANCIAL •R ACCOUNT, • QTY AMOUNT PAID PAID DATE BSAS SB1473 FEE 101-0000-20306 0 $1.00 $1.00 6/10/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY Carolyn Ceballos CREDIT WEB863 2016061022525029680 EPRS Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 $1.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE HVAC CHANGEOUT - PACKAGED UNIT 101-0000-42402 0 $36.26 $36.26 6/10/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY Carolyn Ceballos CREDIT WEB863 2016061608202525029 EPRS DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE HVAC CHANGEOUT - PACKAGED UNIT PC 101-0000-42600 0 $24.17 $24.17 6/10/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY Carolyn Ceballos CREDIT WEB863 2016061022525029 680 EPRS Total Paid for CHANGEOUT: $60.43 $60.43 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE Credit Card Fee 101-0000-43505 0 $3.37 $3.37 6/10/16 PAID BY METHOD : RECEIPT # CHECK # CLTD BY Carolyn Ceballos CREDIT WEB863 201606 8202525029 EPRS Total Paid for Credit Card Fee: $3.37 $3.37 ' DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE PERMIT ISSUANCE 101-0000-42404 0 $91.85 $91.85 6/10/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY Carolyn Ceballos CREDIT WEB863 2016061022525029EPRS 680 . Total Paid for PERMIT ISSUANCE: $91.85 $91.85 TOTALS: Description: HVAC CHANGING OUT EXISTING 3.5 TON PACKAGE UNIT ON ROOF . Type: MECHANICAL - HVAC Subtype: Status: ISSUED Applied: 6/10/2016 EPRS CHANGEOUT(WEB) ZIP Approved: 6/10/2016 EPRS Parcel No: 646200001 Site Address: 78098 LAGO DR LA QUINTA,CA 92253 Subdivision: TR 4295 & INT IN COMMON AREA Block: Lot: 1 Issued: 6/10/2016 EPRS Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $9,972.00 Occupancy Type: Construction Type: Expired: 12/7/2016 EPRS' No. Buildings: 0 No. Stories: 0 No. Unites: 0 permits@ahptesting.co m Details: SCREENED PREFERRED PLUMBING PO BOX 5120 ADDITIONAL SITES CHRONOLOGY CONTACTS CITY STATE ZIP PHONE FAX EMAIL NAME TYPE NAME ADDRESSI APPLICANT CAROLYN CEBALLOS 74998 COUNTRY CLUB DR PALM DESERT CA 92260 (760)851-8648 permits@ahptesting.co m CONTRACTOR PREFERRED PLUMBING PO BOX 5120 PALM SPRINGS CA 92263 (760)851-8648 OWNER JIM GRIESGRABER 78098 LAGO DR LA QUINTA j CA I 92253 j (760)851-8648 Printed: Wednesday, July 06, 2016 11:36:00 AM 1 of 3 C SYSTEMS INSPECTIONS PARENT PROJECTS Printed: Wednesday, July 06, 2016 11:36:00 AM 2 of 3 V? SYSTEAAS CLTD DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT #- CHECK # METHOD PAID BY BY 201606102 BSAS SB1473 FEE 101-0000-20306 0 $1.00 $1.00 6/10/16 WEB863 252502968 CREDIT Carolyn Ceballos EPRS 0 Total Paid for BUILDING STANDARDS ADMINISTRATION $1.00 $1.00 BSA: 201606102 HVAC'CHANGEOUT - 101=0000-42402 0 $36.26 $36.26 6/10/16 WEB863 252502968 CREDIT Carolyn Ceballos EPRS PACKAGED UNIT 0 201606102 HVAC CHANGEOUT - 101-0000-42600 0 $24.17 $24.17 6/10/16 WEB863 252502968 CREDIT Carolyn Ceballos EPRS PACKAGED UNIT PC 0 Total Paid for CHANGEOUT: $60.43 $60.43 201606102 Credit Card Fee 101-0000-43505 0 $3.37 $3.37 6/10/16 WEB863 252502968 CREDIT Carolyn Ceballos EPRS 0 Total Paid for Credit Card Fee: $3.37 $3.37 201606102 . PERMIT ISSUANCE 101-0000-42404 0 $91.85 $91.85 6/10/16 WEB863 252502968 CREDIT Carolyn Ceballos EPRS 0- Total Paid for PERMIT ISSUANCE: $91.85 $91.85 TOTALS: $156.65 $156.6S INSPECTIONS PARENT PROJECTS Printed: Wednesday, July 06, 2016 11:36:00 AM 2 of 3 V? SYSTEAAS BOND INFORMATION Printed: Wednesday, July 06, 2016 11:36:00 AM 3 of 3 -` SYSTEINS