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BMCH2016-014878-495 CALLE TAMPICO LA QUINTA/CALIFORNIA 92253 T. �E p3 'f-4 4 1m4�rw COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 6/23/2016 Application Number: BMCH2O16-0148 Owner: Property Address: 79500 CITRUS GINA DE W CRUZ APN: 776140017 ; 79500 CITRUS Application Description: DE W CRUZ RESIDENCE / HVAC CHANGE OUT W QUINTA, CA 92253 Property Zoning: Application Valuation: $14,000.00 Applicant: Contractor: ANTHEM MECHANICAL ANTHEM MECHANICAL 53-800 POLK STREET 53-800 POLK STREET COACHELW, CA 92236 COACHELWr.CA;92235.`j:..;., (760)895-2621 Llc. No.: 1001659 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: A. B. C20 License No.: 1001659 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).: L_) 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 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: 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: _ 1 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 l •• FINANCIAL ACCOUNT i. QTY AMOUNT PAID.. PAID DATE BSAS SB1473 FEE 101-0000-20306 0 $1.00 $1.00 5/10/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY Liliana Luna CREDIT WEB774 2016051017275507586 ECON 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 $145.04 $145.04 5/10/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY Liliana Luna CREDIT WEB774 2016051017275507 586 ECON DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE HVAC CHANGEOUT - SPLIT -SYSTEM PC 101-0000-42600 0 $72.52 $72.52 5/10/16 PAID BY METHOD RECEIPT# CHECK # CLTD BY Liliana Luna CREDIT WEB774 2016051017275507586 ECON Total Paid for CHANGEOUT: $217.56 $217.56 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE Credit Card Fee 101-0000-43505 0 $6.83 .$6.83 5/10/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY . Liliana Luna CREDIT WEB774 20160510 167275507 ECON Total Paid for Credit Card Fee: $6:83 $6.83 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE PERMIT ISSUANCE 101-0000-42404 0 $91.85 $91.85 5/10/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY Liliana Luna CREDIT WEB774 . 2016051508167275507 ECON Total Paid for PERMIT ISSUANCE: $91.85 $91.85 Description: DE LA CRUZ RESIDENCE / HVAC CHANGE OUT NAME TYPE NAME Type: MECHANICAL - HVAC Subtype: Status: ISSUED Applied: 5/10/2016 ECON CHANGEOUT (WEB) Approved: 5/10/2016 ECON Parcel No: 776140017 Site Address: 79500 CITRUS LA QUINTA,CA 92253 Subdivision: TR 24890-7 Block: Lot: 27 Issued: 5/10/2016 ECON Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $14,000.00 Occupancy Type: Construction Type: Expired: 11/6/2016 ECON No. Buildings: 0 No. Stories: 0 No. Unites: 0 53-800 POLK STREET rDetails: CA 92236 (760)469-2525 _,,,j Applied to Approved Approved to Issued CHRONOLOGY NAME TYPE NAME ADDRESS1 CONTACTSCONDITIONS CITY STATE ZIP PHONE FAX EMAIL APPLICANT ANTHEM MECHANICAL 53-800 POLK STREET COACHELLA CA 92236 (760)469-2525 INFO@ANTHEMMECH ANICAL.COM CONTRACTOR ANTHEM MECHANICAL 53-800 POLK STREET COACHELLA CA 92236 (760)469-2525 INFO@ANTHEMMECH ANICAL.COM OWNER GINA DE LA CRUZ 79500 CITRUS LA QUINTA CA 92253 (760)469-2525 FINANCIAL INFORMATION Printed: Thursday, June 23, 2016 8:35:14 AM 1 of 3 Orp srsrrnns Printed: Thursday, June 23, 2016 8:35:14 AM 2 of 3 ,. SYSTEMS CLTD DESCRIPTION ACCOUNT QTY . 'AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY BY 201605101 BSAS SB1473 FEE 101-0000-20306 0 $1.00 $1.00 5/10/16 WEB774 727550758 CREDIT Liliana Luna ECON 6 Total Paid for BUILDING STANDARDS ADMINISTRATION $1.00 $1.00 BSA: 201605101 HVAC CHANGEOUT - 101-0000-42402 0 $145.04 $145.04 5/10/16 WEB774 727550758 CREDIT Liliana Luna ECON SPLIT -SYSTEM 6 201605101 HVAC CHANGEOUT - 101-0000-42600 0 $72.52 $72.52 5/10/16 WEB774 727550758 CREDIT Liliana Luna ECON SPLIT -SYSTEM PC 6 Total Paid for CHANGEOUT: $217.56 $217.56 Credit Card Fee 101-0000-435050 $6.83 $6.83 5/10/16 WEB774 1201605101 727550758 CREDIT Liliana Luna • ECON 6 Total Paid for Credit Card Fee: $6.83 $6.83 201605101 PERMIT ISSUANCE 101-0000-42404 0 $91.85 $91.85 5/10/16 WEB774 727550758 CREDIT Liliana Luna ECON 6:. Total Paid for PERMIT ISSUANCE: $91.85 $91.85 $317.24 $317.24 INSPECTIONS PARENTTOTALS: PROJECTS REVIEWS RETURNED STATUS REMARKS REVIEW TYPE REVIEWER SENT DATE ` DUE DATE NOTES DATE IST PERMIT TECH — MARY 5/10/2016 5/11/2016 5/10/2016 APPROVED ETRAKIT (1 DAY) FASANO Printed: Thursday, June 23, 2016 8:35:14 AM 2 of 3 ,. SYSTEMS BOND INFORMATION Printed: Thursday, June 23, 2016 8:35:14 AM 3 of 3 sysrerns