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BPLB2016-007001 78-495 CALLE TAMPICO U �NNf�Cl/ LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT Application Number: BPLB2016-0070 Property Address: 77135 CALLE DURANGO APN: 773201002 Application Description: BENGSTON / WATER HEATER CHANGE OUT (SMALL/GAS) Property Zoning: Application Valuation: $240.01 Applicant: AMERIPAN INC DBA COMPLETE MECHANICAL SER 77564 COUNTRY CLUB DR #368 B PALM DESERT, CA 92211 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: C36, D35, C20, C10, B License No.: 896899 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).: . (1 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 Address VOICE (760) 777-7125 FAX(760) 777-7011 INSPECTIONS (760) 777-7153 Date: 6/23/2016 Owner: CANDACE BENGSTON 77135i Calle Durango La Quinta, CA 92253 Contractor: AMERIPAN INC DBA COMPLETE MECHANICAL SER 77564 COUNTRY CLUB DR #368 B -PALM DESERT; CA 92211 (760)972-806.8 LIC. No.: 896899 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. - Date: Signature* (Applicant or Agent): DESCRIPTION FINANCIAL • + • .ACCOUNT QTY AMOUNT PAID. PAID DATE BSAS SB1473 FEE 101-0000-20306 0 $1.00 $1.00 5/12/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY John C. Doyle CREDIT WEB779 20160518222 163917 ECON Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 $1.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE Credit Card Fee 101-0000-43505 0 $2.47 $2.47 5/12/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY John C. Doyle CREDIT WEB779 2016051223163917ECON 822 Total Paid for Credit Card Fee: $2.47 $2.47 DESCRIPTION ACCOUNT ' QTY AMOUNT PAID PAID DATE PERMIT ISSUANCE 101-0000-42404 0 $91.85 $91.85 5/12/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY John C. Doyle CREDIT WEB779 2016051223163917 822 ' ECON Total Paid for PERMIT ISSUANCE: $91.85 $91.85 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE WATER HEATER/VENT 101-0000-42401 0 $.12.09 $12.09 5/12/16 PAID BY METHOD - RECEIPT # CHECK # CLTD BY John C. Doyle 1 CREDIT WEB779 2016051223163917 822 ECON DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE WATER HEATER/VENT PC 101-0000-42600 0 $7.25 $7.25 5/12/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY John C. Doyle CREDIT WEB779 201605182223163917 ECON Total Paid for PLUMBING FEES: $19.34 $19.34 TOTALS: .. Permit Details PERMIT NUMBER' City of La Quinta MB201- 0070 Description: BENGSTON / WATER HEATER CHANGE OUT (SMALL/GAS) CONDITIONS Type: PLUMBING - WATER HEATER Subtype: Status: ON HOLD Applied: 5/12/2016 ECON CHANGEOUT (WEB) ZIP Approved: 5/12/2016 ECON Parcel No: 773201002 Site Address: 77135 CALLE DURANGO LA QUINTA,CA 92253 Subdivision: SANTA CARMELITA VALE LA QUINTA Block: 39 Lot: 2 Issued: 5/12/2016 ECON UNIT 3 APPLICANT AMERIPAN INC DBA COMPLETE MECHANICAL SER Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $240.01 Occupancy Type: Construction Type: Expired: 11/8/2016 ECON No. Buildings: 0 No. Stories: 0 No. Unites: 0 AMERIPAN INC DBA COMPLETE MECHANICAL SER Details: PALM DESERT CA ADDITIONAL SITES Approved to Issued Printed: Thursday, lune 23, 2016 8:46:57 AM 1 of 3 r SYSTEMS CONDITIONS CONTACTS CITY STATE ZIP PHONE FAX EMAIL NAME TYPE NAME ADDRESSI APPLICANT AMERIPAN INC DBA COMPLETE MECHANICAL SER 77564 COUNTRY CLUB DR #368 B PALM DESERT CA 92211 (760)972-8068 john@completemecha nicalservice.com CONTRACTOR AMERIPAN INC DBA COMPLETE MECHANICAL SER 77564 COUNTRY CLUB DR #368 B PALM DESERT CA 92211 (760)972-8068 john@completemecha nicalservice.com OWNER CANDACE BENGSTON 77135 Calle Durango La Quinta CA 92253 (760)972-8068 Printed: Thursday, lune 23, 2016 8:46:57 AM 1 of 3 r SYSTEMS INSPECTIONS Printed: Thursday, June 23, 2016 8:46:57 AM 2 of 3 J _ SYSTBNIS CL DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY BY. 201605122 BSAS SB1473 FEE 101-0000-20306 0 $1.00 $1.00 5/12/16 "WEB779 316391782 CREDIT John C. Doyle ECON 2 Total Paid for BUILDING STANDARDS ADMINISTRATION $1.00 $1.00 BSA: 201605122 Credit Card Fee 101-0000-43505 0 $2.47 $2.47 5/12/16 WE9779 316391782 CREDIT John C. Doyle ECON 2 Total Paid for Credit Card Fee: $2.47 $2.47 201605122 PERMIT ISSUANCE 101-0000-42404 0 $91.85 $91.85 5/12/16 WEB779 316391782 CREDIT John C. Doyle ECON 2 Total Paid for PERMIT ISSUANCE: $91.85 $91.85 201605122 WATER HEATER/VENT 101-0000-42401 0 $12.09 $12.09 5/12/16 .WEB779 316391782 CREDIT John C. Doyle ECON 2 WATER HEATER/VENT 201605122 101-0000-42600 0 $7.25 $7.25 5/12/16 WEB779 316391.782 CREDIT John C. Doyle ECON PC Total Paid for PLUMBING FEES: $19.34 $19.34 TOTALS: $114.66 $114.66 INSPECTIONS Printed: Thursday, June 23, 2016 8:46:57 AM 2 of 3 J _ SYSTBNIS Printed: Thursday, June 23, 2016 8:46:57 AM 3 of 3 CIFSYS TENIS