13-0653 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO `
LA QUINTA, CALIFORNIA 92253
Application Number: 13-00000653
Property Address: 54130 RIVIERA
APNI 775-031-045-
Application
75-031-045 Application description: MECHANICAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 11700
i
4 rT' �
BUILDING &SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
FLECK JIM
54130 RIVIERA STREET
LA QUINTA, CA 92253
(
Applicant: Architect or Engineer- .
--------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
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 Professionals Code, and my License is in full force and effect.
License Class: C20 License No.: 686310
Dater 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 _ 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 thereui.,
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 contractorls) licensed
pursuant to the Contractors' State License Law.).
(_ 1 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:
LQPERMIT
Contractor:
GENERAL AIR CONDITI
31170 RESERVE DRIVE
THOUSAND PALMS, CA
(760)343-7488
Lic. No.: 686310
VOICE (760) 777-7012
FAX (760) 777-7011 .
INSPECTIONS (760) 777-7153.
Date: 5/23/13
i
G
6 MAY 23 2013
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:
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 ZENITH INS CO Policy Number Z071741502
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' ?.3 13 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.
APPLICANTACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety 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 county to enter upon the above-mentioned property for inspection purposes.
'` ate:..) L] Signature (Applicant or Agent): �t1%
Application Number . . . . . 13-00000653
Permit MECHANICAL 2013
Additional desc .
Permit Fee . . . 71.50 Plan -Check Fee-.
..00
Issue Date Valuation
0
Expiration Date 11/19/13
Qty Unit Charge Per
Extension
1.00 35.7500 EA MECH FURNACE
35.75
1.00 35.7500 EA MECH CONDENSER/COMP
35.75
- -- -- - ----------------------------------------------------------
Special Notes and Comments
HVAC CHANGE OUT - (1) 2 TON
13SEER/78AFUE [2008 ENERGY] CARBON
MONOXIDE ALARMS) TO BE INSTALLED PRIOR
TO FINAL INSPECTION. 2010.CALIFORNIA
BUILDING CODES.
May 23, 2013.12:58:45 PM AORTEGA
---------------------
------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB147.3)
1.00
PERMIT ISSUANCE M/P/E
90.57
PLAN CHECK, MECHANICAL
47.66,
Fee summary Charged Paid Credited
Due
Permit Fee Total 71.50 00 .00
71.50
Plan Check Total .00 .00 .00
.00
Other Fee Total 139.23 .00 .00
139.23
.Grand Total 210.73 .00 .00
210.73
LQPEFN9IT
ft City of La Quinta
P 0L Ba r�78-49s
4Qtdnt4 CA 9225I -4760) 777-7012
• Bulft Permit ApplWo;n and Trac ft Sheet
Pw)atA4*= 54130 RIVIERA STREETOwadst�mo:. JIM FLECK :
A. P. Adm 54130 Ad5.4130 RIVIERA STREET
LoW Dewipdow csiy.sr,rq; LA QUINTA, CA 92253
Ci mbactce: GENERAL A/C & HEATING Tdepaac
Addrm- 31170 RESERVE DRIVE "iaD n CHANGE OUT (1) AIC 2 TON.
CRY-$T-Ar THOUSAND PALMS, CA 92276 FURNACE 70,000 BTU & COIL
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