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BPLB2016-000878-495 CALLE TAMPICO 4 aw LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT Application Number: BPLB2016-0008 Owner: Property Address: 53425 AVENIDA MARTINEZ JUAN N APN: 774091021 534251 Application Description: MENDEZ RESIDENCE / REPLACE GAS LINE LA QUIZI Property Zoning: Application Valuation: $500.00 Applicant: JUAN & CANDELARIA MENDEZ 53425 AVENIDA MARTINEZ LA QUINTA, CA 92253 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: License No.: 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).: () ],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 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 Co Llc. No.: 05 VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 1/20/2016 'Z -- 7 -, DA�MA�iTINEZ :A.92255 -�--� JAN 2 0 U116 GINGF / L fUTR R'lTy DEVELOPhiENTDEPARTfAENT '~- 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. 1 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 polity 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. _ A/ Date: — t/—' 6,gnature (Applicant or Agent): DESCRIPTION FINANCIAL INFORMATION ACCOUNT QTY AMOUNT PAID" ,PAID DATE BSAS 581473 FEE 101-0000-20306 0 $1.00 $1.00 1/20/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY JUAN & CANDELARIA MENDEZ DEBIT R12222 BPLB2016-0008 MFA Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 $1.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE PERMIT ISSUANCE 101-0000-42404 0 $91.85 $91.85 1/20/16 PAID BY METHOD RECEIPT # , • CHECK # CLTD BY JUAN & CANDELARIA MENDEZ DEBIT R12222 BPLB2016-0008 MFA Total Paid for PERMIT ISSUANCE: $91.85 $91.85 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE GAS SYSTEM, 1-4 OUTLETS 101-0000-42401 0 $12:09 $12.09 1/20/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY . JUAN & CANDELARIA MENDEZ DEBIT R12222 BPLB2016-0008 MFA DESCRIPTION ACCOUNT QTY AMOUNT • PAID PAID DATE GAS SYSTEM, 1-4 OUTLETS PC 101-0000-42600 0 $24.17 $24.17 1/20/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY JUAN & CANDELARIA MENDEZ DEBIT R12222 BPLB2016-0008 MFA Total Paid for PLUMBING FEES: $36.26 $36.26 TOTALS: Description: MENDEZ RESIDENCE / REPLACE GAS LINE NAME TYPE Type: PLUMBING Subtype: Status: ISSUED Applied: 1/20/2016 MFA Approved: 1/20/2016 MFA Parcel No: 774091021 Site Address: 53425 AVENIDA MARTINEZ LA QUINTA,CA 92253 Subdivision: SANTA CARMELITA VALE LA QUINTA Block: 211 Lot: 9 Issued: 1/20/2016 MFA UNIT 20 53425 AVENIDA MARTINEZ LA QUINTA CA 92253 (760)459-9843 Lot Sq Ft:, 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $500.00 Occupancy Type: Construction Type: Expired: 7/18/2016 MFA No. Buildings: 0 No. Stories: 0 No. Unites: 0 Details: REPLACE 3'4" PROPANE GAS PIPING FROM SERVICE TO SWELLING (TO MATCH EXISTING PIPING) PER 2013 CALIFORNIA BUILDING CODE ADDITIONAL SITES FINANCIAL INFORMATION Printed.: Wednesday, January 20, 2016 12:40:01 PM 1 of 2 wsrsrrmS NAME TYPE NAME ADDRESSI CONTACTS CITY STATE ZIP PHONE FAX EMAIL APPLICANT JUAN & CANDELARIA MENDEZ 53425 AVENIDA MARTINEZ LA QUINTA CA 92253 (760)459-9843 OWNER JUAN MENDEZ 53425 AVENIDA MARTINEZ LA QUINTA CA 92253 (760)459-9843 FINANCIAL INFORMATION Printed.: Wednesday, January 20, 2016 12:40:01 PM 1 of 2 wsrsrrmS DESCRIPTION ACCOUNT CITY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY CLTD BY BSAS 561473 FEE 101-0000-20306 0 $1.00 $1.00 1/20/16 R12222 BPLB2016- DEBIT JUAN & CANDELARIA MFA 0008 MENDEZ Total Paid for BUILDING STANDARDS ADMINISTRATION $1.00 $1.00 BSA: PERMIT ISSUANCE 101-0000-42404 0 $91.85 $91.85 1/20/16 R12222 6PLB2016- DEBIT JUAN & CANDELARIA MFA 0008 MENDEZ Total Paid for PERMIT ISSUANCE: $91.85 $91.85 GAS SYSTEM, 1-4 101-0000-42401 0 $12.09 $12.09 1/20/16 R12222 BPLB2016- DEBIT JUAN & CANDELARIA MFA OUTLETS 0008 MENDEZ GAS SYSTEM, 1-4 101-0000-42600 0 $24.17. $24.17 1/20/16 R12222 BPLB2016- DEBIT JUAN & CANDELARIA MFA OUTLETS PC 0008 MENDEZ Total Paid for PLUMBING FEES: $36.26 $36.26 TOTALS: $129.11 $129.11 INSPECTIONS PARENT PROJECTS ...... "' BOND INFORMATION Printed: Wednesday, January 20, 2016 12:40:01 PM 2 of 2 EAJFCgruff SYSTEMS Bin #i Permit #i Project Address: City of La Qi. rota Building St Safety Division 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet CL wner's Name: A. P. Number: Address: Legal Description: e City, ST, Zip: ^ Contractor: Q TeleA hone Address: Pro•ect Description: City, ST, Zip: i P 9 .4 o l N Telephone: State Lic. # : City Lic. Arch., Engr., Designer: . Address: 1 1 City, ST, Zip: Telephone: <»�� Occupancy: Construction aneYTYPe• a • # State to Lic. ne): New Add'n Alter Repairair DemoProJect type (circle o Name Of Contact Person: Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: stimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE H Submittal Req'd Rcc'd TRACKn\,G PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cafes. Reviewed, ready for corrections Plan Check Deposit Trus Cates. Called Contact Person Plan Check Balance Title 24 Calcs., Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2nd Review; ready for corrections/issue Electrical Subcontactor Lis( Called Contact Person ' Plumbing Grant Deed Plans picked up S.M.I. II.O.A. Approval Plans resubmitted Grading IN IIOUSE:- ' Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees, Total Permit Fees 5�?