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11-0865 (MECH)�r • i!tP.O. {BOX 1504 VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINT'A,. CALIFORNIA 92253 _ BUILDING & SAFETY DEPARTMENT _. INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 8/10/11 Application Number: 11-000008-65— Owner: Property'Address: ;80580 SPANISH .BAY PETER & KRISTI MITCHELL APN: 775-320-005-. - - 80580 SPANISH BAY Application description: MECHANICAL LA QUINTA, CA 92253 Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 500 - Contractor, ` aUr1 J;_ yyy • Applic/nQt(/� Architect or Engineer: ACS AIR CONDITIONING SERV 4, E �� CJ P "O "BOX 5428 CITY0; i LA QUINTA, CA 92248 �a�r-AQ�'NT • - - - '� (760) 64.1-6517 Lic: No.: 364956 LICENSED CONTRACTOR'S DECLARATIONWORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that I am -licensed -under provisions of Chapter 9 (commencing with - I hereby affirm under penalty of perjury one of the following declarations: Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect._ I'have and will maintain a certificate of consent to self -insure for workers' compensation, as provided 'License Class: C20 License No.: 364956 - . • for by Section 3700 of the Labor Code, for the performance of the'work for which this permit is . � _ issued. - Date:�C Contractor: , .. _ I have andwill 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 -- - - - ^ OWNER -BUILDER DECLARATION insurance carrier and policy number are: - - I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier NONE Policy Number EXEMPT - following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to _ I certify that, in the performance of the' work for which this permit is issued, I shall_ not employ any construct, alter, improve, demolish, or repair any structure, prior to its issuance, also.requires the applicant for the person in any manner so as to become subject totheworkers' compensation laws of California, permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I should become subject to the workers' compensation provisions of Section License'Law (Chapter 9 (commencing with Section -7000) of Division 3 of the Business and Professions Code) or - - 3700 of the Labo e, I shall forthwithamply,with those provisions. ' .that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by - ti-•�� ,o ,, ��///D any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars 155001.: "Date: D �"'-�Applican_ (_ 1 I, as owner of the property, or my employees with wages as their.sole compensation, will do the work, arid - �tp— _ - the structure is not intended or offered for sale ISec. 7044, Business and Professions Code: The WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL „ -- _ - Contractors' State -License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND - and who does the work himself or herself through his or her own employees, provided that the DOLLARS' 1$100,000). INADDITIONTO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN . improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. ' 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.)- - - - - - APPLICANT ACKNOWLEDGEMENT ` ('_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. .. - IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the 7044; Business and Professions Code: The Contractors' State License Law does not apply to -an owner of conditions and restrictions set forth on this application. - property who builds or improves thereon, and who contracts for. the projects with a contractor(s) licensed 1 . Each person upon whose behalf this application is made, each person at whose request and for pursuant to the Contractors' State License Law.). - whose benefit work is performed under or pursuant to any permit issued as a result. of this application_, I . 1 I am exempt under Sec. B.&P.C. for this reason 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. - Date: Owner: - 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 `CONSTRUCTION LENDING AGENCY • permit to cancellation. - I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify that I have read this application and state that the above information is correct. I agree to comply with all work for which this permit is issued (Sec. 3097, Civ. C.). city and county ordinances and state laws relatingt w 'ng construction, and hereby authorize representatives m of this co y enter upon the above-mentioned rop r or inspection purposes. Lender's Name: : _ �- (DateI b N Signature (Applicant or Age ): Lender's Address: _ LQPEPNIIT - _ :Application Number -11-00000865. Permit . . . MECHANICAL - Additional desc,. - Permit Fee. 24.00 Plan Check Fee. 6.00.. Issue .Date Valuation : 0 Expiration Date 2/06/12- ` Qty. Unit,Charge- ;Per 'Extension BASE FEE" 15.00 1.00 9.0000 EA ' MECH'APPL REP/ALT/ADD' 9.00 -- - - - - - - - -- - - - - - -•- Y------------------------- Other Fees --- - - -- BLDG STDS-ADMIN (SB1473`) - 1.00 , Fee,summary. Charged Paid Credited Due Permit Fee Total 24.00 .00 00.. 24.00 Plan Check Total 6.00 .00 .00 6.0.0 Other Fee Total 1.00 .00 .00- 1.00 Grand Total 3.1.00 .00 .00 31-A0 . LQPEILMIT - .. .. . r Bin # City of La •Qurnta Building ,& Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application, and Tracking Sheet Per 'it # b A(J J Project Address: Q 5 Owner's Name: pt? h b fg, A. P. Number: Address: S It N B e>• Legal Description: Contractor: City, ST, Zip:., i { Telephone: .f �a.•#:>.:. >:<;::vr::':::;;';:<r> Address:a 2 kg 0 2r.r— Project Description: 00 G t pp City, ST, Zip: n +0t Telephone: --0 State Lic: # : 3 (p City Lic. Arch., Engr., Designer: Address: City., ST, Zip: Telephone:•.;:.:.;:.;:.>.:;:: •$:•�'�•�t'••:'!:3� 'i viv%J;iJiry�Yii:%�?'?i$'F'}:Sn4ii�'v: itiY%isi�.'}•'r'.M<:+v�%{:}.'.•,v'.�..'I,.$i{^: rriih:�ii::::j� State Lic. #:;N n:#: Name of Contact Person: u GVn a Construction Type: Occupancy: ' Project type (circle one): New Add'n ter Repair Demo Sq. Ft.: #Stories: #Units: Telephone # of Contact Person:' ( Estimated Value of Project. APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount' Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Cities. Called Contact Person Plan Check Balance Title 24 Cales. Plans picked up Construction Flood plain. plan Plans resubmitted Mechanical Grading plan 2" Review, ready for correctionsfissue Electrical Subcontactor List Called Contact Person Plumbing . Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- ",.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(( -00