The URL can be used to link to this page

BMCH2016-0229i n 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 T-d4t 4 4 Q" COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT Application Number: BMCH2O16-0229 Property Address: 43415 BORDEAUX DR APN: 609620056 Application Description: HVA CHANGE OUT 16SEER/13EER SPLIT Property Zoning: Application Valuation: $9,972.00 Applicant: CAROLYN CEBALLOS 74998 COUNTRY CLUB DR PALM DESERT, CA 92260 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.: 791437 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 nct 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 ) 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 Na Lender's Address: VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 7/6/2016 Owner: CHARLES DICARLO . 43415 BORDAEUX DR LA QUINTA, CA 92253 Contractor: MENDEZ AC PO BOX 871 THOUSAND PALMS, CA 92276 (7.60)343-5041 Llc. No.: 791437 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: _ 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 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. R Date: Signature (Applicant or Agent): DESCRIPTION FINANCIAL •• • ACCOUNT QTY AMOUNT PAID . PAID DATE BSAS SB1473 FEE 101-0000-20306 0 $1.00 $1.00 6/27/16 PAID BY METHOD. RECEIPT # CHECK # CLTD BY Carolyn Ceballos CREDIT WEB892 201606234222482415 EPRS Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 $1.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE HVAC CHANGEOUT - SPLIT -SYSTEM 101-0000-42402 0 $72.52 $72.52 6/27/16 PAID BY. ' METHOD RECEIPT # CHECK # CLTD BY''. Carolyn Ceballos CREDIT WEB892 2016062722482415342 EPRS DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE' HVAC CHANGEOUT - SPLIT -SYSTEM PC 101=0000-42600 0 $36.26 $36.26 ' 6/27/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY ' Carolyn Ceballos CREDIT WEB892 201606237 22482415 EPRS Total Paid for CHANGEOUT: $108.78 $108.78 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE Credit Card Fee 101-0000-43505 0 $4.44 $4.44 6/27/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY, Carolyn Ceballos CREDIT WEB892 20160623742 482415 EPRS Total Paid for Credit Card Fee: $4.44 $4.44 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE PERMIT ISSUANCE 101-0000-42404 0 $91.85 $91.85 6/27/16 PAID BY METHOD- RECEIPT # CHECK # CLTD BY Carolyn Ceballos CREDIT WEB892 2016062722482415 342 EPRS Total Paid for PERMIT ISSUANCE: $91.85 $91.85 TOTALS:0. 0. Description: HVA CHANGE OUT 16SEER/13EER SPLIT CONDITIONS Type: MECHANICAL = HVAC Subtype: Status: ISSUED Applied: 6/27/2016 EPRS CHANGEOUT (.WEB) Approved: 6/27/2016 EPRS Parcel No: 609620056 Site Address: 43415 BORDEAUX DR LA QUINTA,CA 92253 Subdivision: TR 29323-3 Block:. Lot: 50 Issued: 6/27/2016 EPRS Lot Sci Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $9,972.00 Occupancy Type: Construction Type: Expired: 12/24/2016 EPRS No. Buildings: 0 No. Stories: 0 No. Unites: 0 Details: CONTRACTOR MENDEZ AC PO BOX 871 CHRONOLOGY CONDITIONS CONTACTS NAME TYPE NAME ADDRESSI CITY STATE ZIP PHONE FAX EMAIL APPLICANT CAROLYN CEBALLOS 74998 COUNTRY CLUB DR PALM DESERT CA 92260 (760)851-8648 permits@ahptesting.co m CONTRACTOR MENDEZ AC PO BOX 871 THOUSAND PALMS CA 92276. (760)851-8648 OWNER CHARLES DICARLO 43415 BORDAEUX DR LA QUINTA CA 92253 (760)851-8648 FINANCIAL INFORMATION, Printed:' Wednesday, July 06, 2016 11:40:30 AM 1 of 3 ' JS YS TEAM1S r. INSPECTIONS Printed: Wednesday, July 06, 2016 11:40:30 AM 2 of 3 0 SYSTEIviS- CL DESCRIPTION ACCOUNT QTY _ AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY :. BY Y 201606272 BSAS SB1473 FEE 101-0000-20306 0 $1.00 $1.00 6/27/16 WEB892 248241534 CREDIT Carolyn Ceballos EPRS 2 Total Paid for BUILDING STANDARDS ADMINISTRATION $1.00 $1.00 BSA: 201606272 HVAC CHANGEOUT - 101-0000-42402 0 $72.52 $72.52 6/27/16 WEB892 248241534 CREDIT Carolyn Ceballos EPRS SPLIT -SYSTEM 2 201606272 HVAC CHANGEOUT - 101-0000-42600 0 $36.26 $36.26 6/27/16 WEB892 248241534 CREDIT Carolyn Ceballos EPRS SPLIT -SYSTEM PC 2 Total Paid for CHANGEOUT: $108.78 $108.78 Credit Card Fee 101-0000-43505 0' $4.44 $4.44 6/27/16 WEB892 12016062721 248241534 CREDIT Carolyn Ceballos EPRS 2 Total Paid for Credit Card Fee: $4.44 $4.44 201606272 PERMIT ISSUANCE 101-0000-42404 0 $91.85 $91.85 6/27/16 WEB892 248241534 CREDIT Carolyn Ceballos EPRS 2. Total Paid for PERMIT ISSUANCE: $91.85 $91.85 TOTALS:0.$206.07 INSPECTIONS Printed: Wednesday, July 06, 2016 11:40:30 AM 2 of 3 0 SYSTEIviS- - u� v� an CyL�' u "roEn�� Printed: Wednesday, July 06, 2016 11:40:30 AM 3 of 3 _ SYSTEMS