MECH (05-1555)52425 Avenida Madero
05-1555
BUILDING & SAFETY DEPARTMENT
Box -1504 760 777-7
( ). 012
4 -4 CALLE TAMPICO FAX (760) 777-7011
16T,0 A QU TA', CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
A pl ' ation Number . . 00_00.1.5-5.5 Date 4/26/05
Pr. erty Address . . . 52425 AVENIDA MADERO
APN: 773-241-024-15 —000000 -
Application description MECHANICAL
Property Zoning . . . COVE RESIDENTIAL
Application valuation 3000
Owner Contractor ,
.HENNING EDWARD J PALOMA AIR CONDITIONING
2.8952 LOTUS GARDEN DR P.O.*BOX 3510
CANYON COUNTRY, CA 91351 PALM.DESERT, CA 92261
(760) 347-1712
WCC:. STATE FUND
WC: 133-2004 07/01/05
CSLB: 619091 10/31/05
CCC: C20
1
r
P.O. B O x 1504
/
78-495 CALLS TAMPICO Y VOICE (760) 777-7012
LA QUINTA, CALIFORNIA 92253 44FAX (760) 777-7011
INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: O J • 175
Applicant:
Applicant's Mailing Address:
Date: q - JL( _ O r
Architect or Engineer:
Architect or Engineer's Address:
Lic. No.:
ISUILUINU PERMIT DECLARATIONS
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 Professionals
Code, and my License imn f i 0orce and effect.
y cense Class l License No. y 't
ate—_2'CA ractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' 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 Contractors' 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 fora permit subjects
the applicant to a civil penalty of not more than five hundred dollars ($500).):
U 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 or 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.).
U 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.).
U I am exempt under Sec. , BA P.C. for this reason
Date Owner.
WORKERS' 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
_L 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
t/wor mC sation rance carrier a d TI %mbt a&, rer _ -.-Policy
[!
1 certify that, in the performance of the work for which this perm -iris 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, 1 shall
forthwith comply with those provisions.
ate plicant
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.
CONSTRUCTION LENDING AGENCY
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
APPLICANT ACKNOWLEDGEMENT
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 ouinta, 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 en e -mentioned property for inspection purposes.
Date ^ SKn-ature (Applicant or Agent):
- - - - - -_ -1
Application Number 05-00001555
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- - - - -. - - - - - - -
Permit . . . . MECHANICAL
Additional desc
Permit Fee . . . . 24.00
Plan Check Fee
6.00
Issue Date
Valuation . . .
. 0
Expiration Date 10/23/.05
Qty Unit Charge Per
Extension.
BASE
FEE
15.00
1.00 9.0000 EA MECH
B/C <=3HP/100K BTU
9.00
-------------- 7-------------------------------------------------------------
.Special Notes and Comments
REPLACE 3.5 TON ROOF'MOUNTED A/C
UNIT
Fee summary Charged
Paid Credited
Due
Permit Fee Total 24.00
.00 .00
24.00
Plan Check Total 6.00
.00 00
6.00
Grand Total 30.00
.0.0 .00
30..00