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MECH (04-6073)BUILDING & SAFETY DEPARTMENT P.O.. Box 1504 (760).777-7012 78-495 CALLS TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT Application Number . . . . . X0470-0=006:07.3=== -- Property Address . . . . . . 51484 AVENIDA MENDOZA APN: 773-102-005-6 -0000 Application description . . . MECHANICAL Property Zoning . . . . . .COVE RESIDENTIAL I Application valuation . . . . 4200 Owner ------------------------ MISURACA JACKIE 51-484 AVENIDA MENDOZA LA QUINTA CA 92253 8/27/04 CITY OF LA 01171"" , fFIG�QC�� DAY. Contractor ------------------------ OWNER --------------------------------7------------------------------------------- Permit . . . . MECHANICAL Additional desc '. Permit Fee 33.00 Plan Check Fee 8.25 Issue Date . . . Valuation 0 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 9.0000 EA MECH FURNACE <=100K 9.00 1.00 9.0000 EA MECH B/C <=3HP/100K BTU 9.00 Fee summary Charged Paid Credited Due --------------------------- Permit Fee Total ---------- 33.00 -------------------- .00 .00 33.00 Plan Check Total 8.25 .00 .00 8.25` Grand Total 41.25 .00 .00 41.25 P.O. Box 1504 • VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: Applicant: Applicant's Mailing Address: Date: Architect or Engineer: Architect or Engineer's Address: Lic. No.: tsUILUING 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 is in full force jand effect. License Class License No. Date Contractor 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 violafion 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).): 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 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 t 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 Licens w.). &6_11"am exempt under Sec. BA P.C. for this reason Date O / Owner c �`�t��S �[ L S LI—IC-C L� 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 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 it-rPolicy Number 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, 1 shall forthwith comply with those provisions. Date Applicant —d-t.C,_r � f 1-/2C.0 WARNING: FAIL RE 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 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 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, indemnity 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 su ' c pe to cancellation. I certify that I have read this application and stat that the ab ve information is correct. 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representative f this coufity to enter upT the above- tinned property for inspection purposes. Date Si ature (Applicant o Gc_ l/� CITY OF LA QUINTA SUB -CONTRACTOR LIST JOB ADDRESS5Sa___// &eA)iD4 /1�) �p�oz�r_ PERMIT NUMBER OWNER BUILDER .' This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list'or�the� employees are authorized to work on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Fail a to COMIDIV will result in a stoppage of work and/or the voidance of building permit. For each applicable trade, all information requested. below must be Completed by aDDlicant. "On File" is not an acceptable resoonse `+, Trade / Classification Contractor State Contractor's License Workers Com ensation Insurance City Business License Company Name Classification . (e.g. A, B, C-8) License Number (xxxxxx) Exp. Date (xx/xx/xx) Carrier Name (e.g. State Fund, CalComp) Policy Number (Format Varies) Exp. Date (xx/xx/xx) License Number (xxxx) Exp. Date (xx/xx/xx) EARTHWORK (C-12) CONCRETE (C-8) FRAMING (C-5) ' STRUCT. STEEL (C-51) . MASONRY (C-29) PLUMBING (C-36) LATH, PLASTER (C-35) DRYWALL (C-9) HVAC (C-20) Deset+ Coaier "/g0 05- 3/� D5- 0,71X& ELECTRICAL (C-10) ROOFING (C-39) SHEET METAL (C-43) FLOORING (C-15) GLAZING (C-17). INSULATION (C-2) SEWAGE DISP. (C-42) PAINTING (C-33) " CERAMIC TILE (C-54) CABINETS (C-6) FENCING (C-13) LANDSCAPING (C-27) POOL (C-53) C�IT�Y OF LA QUINTA i �F�o� ��UILDING &SAFETY DEPARTMENT O T001>t � , \ 777-7012 INSPECTION REQUEST LINE 777-7153 Permit Number 04-6073 POST ON JOB IN CONSPICUOUS PLACE INSPECTOR MUST SIGN ALL APPLICABLE SPACES JOB ADDRESS 51-484 AVENIDA MENDOZA REPLACE MECHANICAL A/C UNIT WITH DUCT ALTERATION. TYPE OF INSPECTION I DATE I INSPP, TEMPORARY POWER SETBACKS U/G PLUMBING / WASTE U/G ELECTRICAL/ GROUNDING FOOTINGS / STEEL CONCRETE SLAB DO NOT POUR CONCRETE UNTIL ABOVE SIGNED FRAMING COMBINATION ROUGH ELECTRIC Pnl I ;H PI I IMRIMr. COVER NO WORK UNTIL ABOVE SIGNED INTERIOR GYP. BD. DRYWALL EXTERIOR LATH GAS TEST SEPTIC ABANDONMENT SEWER CONNECTION SEPTIC / GREASE INTERCEPTOR MASONRY INSPECTIONS FOOTINGS / STEEL BOND BEAM POOL / SPA / WATER FEATURE INSPECTIONS PRE-GUNITE / SETBACKS U/G PLUMBING U/G GAS U/G ELECTRICAL PRE -PLASTER (ALARMS/ BARRIERS FINAL INSPECTIONS TEMP. USE OF PERMANENT POWER ELECTRICAL PLUMBING MECHANICAL PUBLIC WORKS DEPARTMENT COMMUNITY DEVELOPMENT DEPT. FINAL / JOB COMPLETED 1g '� - 0 (/ I / / ABOVE APPROVALS DO NOT INCLUDE RIGHT TO TURN ON UTILITIES OR OCCUPY BUILDING