BPLB2019-004278-495 CALLE TAMPICO ' p V �� VOICE (760) 777-7125
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011
DESIGN & DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 3/21/2019
Permit Type/Subtype: PLUMBING/ Owner:
Application Number: BPLB2019-0042 MEIR BEN SHOSHAN
Property Address: 53665 AVENIDA CORTEZ 17099 EDGEWATER LN
APN: 774101013 HUNTINGTON BEACH, CA 92253
Application Description: BEN-SHOSHAN / ABANDON SEPTIC / CONNECTTO SEWER
Property Zoning:
Application Valuation: $3,450.00
Applicant: P
Contractor:
AMERIPAN INC DBA COMPLETE MECHANICAL SER AMERIPAN INC DBA COMPLETE MECHANICAL SER
74850 JONI DR #G MAR 21 2019D 74850 JONI DR #G
PALM DESERT, CA 92260 PALM DESERT, CA 92260
CITY OF LA QUINTA
DESIGN & DEVELOPMENT DEPARTMENT (760)972-8068
Llc. No.: 896899
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 {commencing with Section 70001 of Division 3 of the Business and Professions Code,
and my License is in full force and effect.
Licensee Class:
C36. 0355, r,20. C10. B Licen IN
)a7tte:0 / —?///% 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.).
(_) 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 Name.•
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 th
A ❑rkforwhich 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: ACE AMERICAN INSURANCE COMPANY Policy Number: C65196785
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.
Dates• a3�� ( If? 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 orAga
Application Number:
BPLB2019-0042
Property Address:
53665 AVENIDA CORTEZ
APN:
774101013
Application Description:
BEN-SHOSHAN / ABANDON SEPTIC / CONNECTTO SEWER
Property Zoning:
Application Valuation:
$3,450.00
Applicant:
AMERIPAN INC DBA COMPLETE
MECHANICAL SER
74850 JONI DR #G
PALM DESERT, CA 92260
Date: 3/21/2019
Owner:
MEIR BEN SHOSHAN
17099 EDGEWATER LN
HUNTINGTON BEACH, CA 92253
Contractor:
AMERIPAN INC DBA COMPLETE MECHANICAL SER
74850 JONI DR #G
PALM DESERT, CA 92260
(760)972-8068
Llc. No.: 896899
Detail: ABANDON SEPTIC TANK AND FILL WITH SLURRY OR SAND, HOOK UP TO CITY SEWER. PER 2016 CALIFORNIA PLUMBING CODE.
FINANCIAL
DESCRIPTION ACCOUNT QTY AMOUNT
BSAS SB1473 FEE
101-0000-20306 0 $1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
PERMIT ISSUANCE
101-0000-42404
0
$101.40
Total Paid for PERMIT ISSUANCE: $101.40
DESCRIPTION
ACCOUNT
QTY
AMOUNT
BUILDING SEWER
101-0000-42401
0
$26.68
DESCRIPTION
ACCOUNT
QTY
AMOUNT
BUILDING SEWER PC
101-0000-42600
0
$18.68
Total Paid for PLUMBING FEES: $45.36
DESCRIPTION
ACCOUNT
CITY
AMOUNT
RECORDS MANAGEMENT FEE
101-0000-42416
0
$10.00
Total Paid for RECORDS MANAGEMENT FEE: $10.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
VA7� COACHELLA VALLEY WATER DISTRICT
a�srrx►L� P.O. BOX 1058, COACHELLA, CALIFORNIA 92236 (760) 398-2651
INVOICE Date:2/2812019
SUBJECT: SANTA CARMELITA, 53665 AVENIDA CORTEZ, LA QUINTA, LOT 7, LID 687972 (SCC ONLY)
MEIR BEN-SHOSHAN Project:
19-9716
17099 EDGEWATER LN Project Date:
2/28/2019
Amount Due:
$4,851.00
HUNTINGTON BEACH, CA 92649 GEO:
06-06-12-3
Planner:
SARA LOPEZ
TO INSURE PROPER CREDIT, PLEASE RETURN THIS PORTION WITH
REMITTANCE AND INCLUDE THE PROJECT ON YOUR CHECK
SUBJECT: SANTA CARIAELITA, 53665 AVENIDA CORTEZ, LA QUINTA, LOT 7, LID 687972 (SCC ONLY)
COACHELLA VALLEY WATER DISTRICT
P.O. BOX 1058, COACHELLA, CALIFORNIA 92236 (760) 398-2651
Page 1
Contractor Name:
Address: *7L4$50
City, St, Zip RA__+
Telephone:
Email:
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State Lic:9%10�
C-7.
City Bus Lic:
New SFD Construction:
Conditioned Space
Garage
Patio/Porch
Fire Sprinklers
SF
_SF
SF
SF
Architect/Engineer Name: Construction Occupancy:
Address: Grading:
City, St, Zip
Telephone: Bedrooms: Stories: # Units:
Email:
State Lic: City Bus Lic:
78495 CALLE TAMPICO
LA QUINTA, CA 92253
760-777-7000
OFFICE USE ONLY
# Submittal Required Received
Plan Sets
Structural Calcs
Truss Calcs
Title 24 Calcs
FCVWD Fire Flow Letter
SUIIS KeF1Vl L
Grading Plan (PM10)
Landscape Plan
Subcontractor List
Grant Deed
HOA Approval
School Fees
Burrtec Debris Plan
Planning approval
Public Works approval
Fire approval
City Business License