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BMCH2016-037678-495 CALLE TAMPICO D aiLr(w LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT BUILDING PERMIT • r Application Number: BMCH2O16-0376 Property Address: 47585 VIA MONTANA APN: 643120048 Application Description: XANTHOS RESIDENCE / HVAC Property Zoning: Application Valuation: $2,685.00 Applicant: IE INC 31225 LA BAYA WESTLAKE VILLAGE, CA 91362 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty.of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my License is in full force and effect. License Class: C20, C36 License No.: 686310 C: . :�Qatq; - DI I$ I ILo r --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.). (_) 1, 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 Name: Lender's Address: VOICE -(760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Owner: WILLIAM XANTHOS 47585 VIA MONTANA LA QUINTA, CA 92253 Contractor: HARRISON ENTERPRISES IN11 31170 RESERVE DRIVE THOUSAND PALMS, CA 922 (760)343-7488 Llc. No.: 686310 Date: 10/18/2016 z I n' O rn ___q m T T� GENERAL n � O rn 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: INSURANCE COMPANY OF THE WEST Policy Number: WSD5031658 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. Applicant: `f WARNING: FAILURE TO SECUREVORKERS' 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:— ' O M ----Signature (Applicant or Agent) Date: 10/18/2016 Application Number' BfVICH2016-0376 Owner: Property Address: 47585 VIA MONTANA WILLIAM XANTHOS APN: 643120048 47585 VIA MONTANA Application Description: XANTHOS RESIDENCE / HVAC LA QUINTA, CA 92253 Property Zoning: Application Valuation: $2,685.00 Applicant:. Contractor: IE INC HARRISON ENTERPRISES INC DBA GENERAL AIR 31225 LA BAYA 31170 RESERVE DRIVE WESTLAKE VILLAGE, CA 91362 THOUSAND PALMS, CA 92276 (760)343-7488 Llc. No.: 686310 Detail: REPLACE 3500 CFM EVAPORATIVE COOLER PER 2013 CALIFORNIA BUILDING CODE INFORMATION DESCRIPTION , ACCOUNT QTY AMOUNT BSAS 561473 FEE 101-0000-20306 0 $1.00 Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 DESCRIPTION ACCOUNT QTY AMOUNT EVAPORATIVE COOLER 101-0000-42402 0 $12.67 DESCRIPTION ACCOUNT QTY DESCRIPTION , ACCOUNT QTY AMOUNT BSAS 561473 FEE 101-0000-20306 0 $1.00 Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 DESCRIPTION ACCOUNT QTY AMOUNT EVAPORATIVE COOLER 101-0000-42402 0 $12.67 DESCRIPTION ACCOUNT QTY AMOUNT EVAPORATIVE COOLER PC 101-0000-42600 0 $12.67 Total Paid for MECHANICAL: $25.34 DESCRIPTION ACCOUNT QTY AMOUNT PERMIT ISSUANCE 101-0000-42404 0 $96.27 Total Paid for PERMIT ISSUANCE: $96.27 Bin.# City. of La Qulllta Building aSake y Division P.O. Box 1504,78-495 Calle Tampico Ia.Quinta, CA 92253 -:(760) 777-7012 . Building Permit Application and Tracking Sheet Permit # Project Address: 47585 Via Montana Owner'SName:. Xanthos, William A P. Number. Address: 47585 Via Montana Legal Description: City, ST, Zip: La Quinta, CA 92253 Contractor. General Air Conditioning &Plumbing Telephone: 760-564-7410.. Address: 31170 Reserve Drive Project Description: Replace 3500 CFM Evaporative Cooler. City, ST, Zip: Thousand Palms, CA 92276 Telephone: 760-343-7488EN ME City_Lic. 9. State Lic. # : Arch., Engr., Designer Address: City., ST, Zip: Telephone: `�. P .� State Lic. #:`'- f, �j,y� Name of Contact Person: Steven Schnierer Construction Type:. occupancy: Project type (circle one): New Add'n Alter Repair Demo Sq. Ft: # Stories: units. Telephone # of Contact Person: 818-735-7876 Estimated Value of Project: $2,685.00 . APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structaral Cates. Reviewed, ready for corrections Plan Check Deposit. . Trtm Cates. Caped Contact Person Plan Check Balance Tide 24 Calci. Pians picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan V Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M:L H.O.A. Approval Plans resubmitted Grading N HOUSE:- 'Review', ready for corrections/issue Developer Impset Fee Planning Approval Called Contact Person AXP.P. Pub. Wks. Appr Date of permit lssue School Fees Total Permit Fees