04-4758 (MECH)P.O.. Box 1504 ,
78-495 CALLS TAMPICO
LA OUINTA, CALIFORNIA 92253
BUILDING
(760).777-7012
FAX (760) 777-7011
INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number 04-00004758
Date; 6/03/04
�Property'Address . . . . 52040-AVENIDA
VALLEJO
APN: 773-223-002-21
-000000-
Application description . . . MECHANICAL
Property.Zoning COVE RESIDENTIAL`
..-Application valuation
45.0-0
Owner
Contractor
- - - - - - - - - - - - - - - - - - - - - - - -
-CAREY JOHN L
-- - --- - - - - - - - - - - - - --- - - -
MENDEZ JR, ENRIQUE
- - 7
.*NOT ON FILE
45975 COLGATE COURT
UNKNOWN CA 99999
INDIO
CA 92201
(760) 342-7651
WCC: NONE
WC: EXEMPT
02/28/05
CSLB: 791437
02/28/05
CCC: C20
- - - - - - - - - --- - --7 - - - - - - 7 --- - - - - --- - - - - - - - -
Permit* . . . . . . MECHANICAL
- - - - - - --- - - - - - - - - - - - - - 7 - - - -
- - - I - - - - --- - - -
'Additional d es c
Permit Fee 33.,-00
Plan Check Fee
.6.00
'Issue Date
Valuation
.0
Qty Unit Charge Per
Extension
BASE
FEE
1.00 9.0000 EA MECH
FURNACE <-' -0,K
1.00 9.0000 EA MECH.B/q
<=3HP/106kf'BTU
9.00
-------------------------- --------------
Permit, PLUMBING
------------------------------------
Additional desc.
Permit Fee 18..00
Plan' Check Fee
4.50,
Issue Date..
Valuation ... . . .
0
Qty Unit Charge Per
Extension
BASE
FEE
15.00
1.00 -3. . 0000 EA. PLB GAS PIPE 1-4 OUTLETS
3.00
------------------------------------------------%
1, •----
" '
-------------
-Special Notes and :Comments
CHANGE OUT 3 TON ROOF PACKAGE GAS
UNIT.
2001 CODES
Fee summary, Charged
--
'Paid Credited
Due
- - - - - - - - - - - - - - - - - .7 - - - - - -- -
Permit Fee*Total 51.00.
- - - - - - --- - - - - - - - - - - - - -
.00 ob
- - - - - - -
51.00
--- P.O. Box 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
Application Number: Dy- 41758
Applicant: A I Architect or Engineer:
Applicant's Mailing Address:
VOICE (760) 777-7012
FAX (760) 777-701 I
INSPECTIONS (760) 777-7153
Date:
Hrcrinect or Lngineer's Address:
Lic. No.
BUILDING 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 Li . sem 'n u11 force and effect.
License Class , ' LicVN7101Z`(
DateO,
OW UILDER 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 theretrom 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).):
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 o1 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. . 8.8 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
of the work for which this permit is issued.
I have and wil: maintain workers' compen ion insurance, as required by Section 3700 of the Labor Code• for the performance of the work for which this
issued. My workers' compem ' n Eel carrier and policy number are: permmt is
artier o icy Number
I certify that, in the performance f the work for wh' h this penin i sued. I shall not employ an
compensation laws of California, and agr at, ' I sho me subject to the workers' tbmp�ensation prorson in any visionsro Section so as to become
700 of the�bor Code, to the kers,
forthwith comply with those provisions /'j __�v shall
WARNING: FAILURE TO SECURE ERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDREb 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.
I herebyaffirm under CONSTRUCTION LENDING AGENCY
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.).
Lenders Name
Lenders Address t7��
IMPORTANT Application is hereby made to the Director of BuildingAPPLICANT
ACKNOWLEDGEMENT
Safety Apermit
1.
Each person upon whose behalf this application is made. each person at whose request t and for conditions
ose benefit�work snperfo set fmted under or pursuant to an
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 day* 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 inI'; a � is I
construction, and hereby authorize representatives of this county to a er u�4 and ?� with all city and county ordinances and state laws relating to building
property for inspection purposes.
�te ��nature (Applicant or Agen