BMCH2016-031378-495 CALLE TAMPICO
V VOICE (760) 777-7125
ESIGN & DEVELOPMENT DEPARTMENT - IN
BUILDING PERMIT
Owner:
JOHN MCCOY
54195 AVENIDA VALLE
ENSER AND AIR HANDLER LA QUINTA, &.92253
Contractor:
CARRERA AIR
78-970 SON ESTA WAY
LA Q-UINTA, CA 92253
(760)343-6675
Llc. No.: 959853
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011
D SPECTIONS (760) 777-7153
- Date: •9/2/2016.
Application Number: BMCH2O16-0313
Property Address: 54195 AVENIDA VALLEJO
APN: 774212020 JO
Application Description: SWAP OUT HEAT PUMP COND
Property Zoning:
Application Valuation: $2,000.00
Applicant: .
CARRERA AIR
78-970 SONESTA WAY
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 Professions Code,
and my License is in full force and effect.
License Class: C20 License No.: 959853
Date:
Contractor:
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.
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:
OWNER -BUILDER DECLARATION
Carrier: STATE COMPENSATION INSURANCE FUND Policy Number: 9155895
1 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
1 certify that in the performance of the work for which this permit is issued, I
city or county that requires a permit to construct, alter, improve, demolish, or repair
shall not employ any person in any manner so as to become subject to the workers'
any structure, prior to its issuance, also requires the applicant for the permit to file a
compensation laws of California, and agree that, if I should become subject to the
signed statement that he or she is licensed pursuant to the provisions of the
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division
comply with those provisions. .
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
Date: Applicant:
permit subjects the applicant to a civil penalty of not more than five hundred dollars
($500).:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
( ) I, as owner of the property, or my employees with wages as their sole
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
compensation, will do the work, and the structure is not intended or offered for sale.
ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
(Sec, 7044, Business and Professions Code: The Contractors' State License Law does not
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
apply to an owner of property who builds or improves thereon, and who does the work
INTEREST, AND ATTORNEY'S FEES.
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
APPLICANT ACKNOWLEDGEMENT
within one year of completion, the owner -builder will have the burden of proving that
IMPORTANT: Application is hereby made to the Building Official for a permit subject to '
sh
he or e did not build or improve for the purpose of sale.).
the conditions and restrictions set forth on this application.
(� I, as owner of the property, am exclusively contracting with licensed contractors
1. Each person upon whose behalf this application is made, each person at whose
to construct the project. .(Sec. 7044, Business and Professions Code: The Contractors'
.request and for whose benefit work is performed under or pursuant to any permit
State License Law does not apply to an owner of property who builds or improves
issued as a result of this application ; the owner, and the applicant, each agrees to, and
thereon, and who contracts for the projects with a contractor(s) licensed pursuant to
shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and
the Contractors' State License Law.).
employees for any act or omission related to the work being performed under or
(� I am exempt under Sec. B.&P.C. for this reason
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
Date: t Owner:
work for 180 days will subject permit to cancellation.
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 Na
Lender's Ad
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 city to enter upon the
above-mentioned property for inspection purposes.
Date: Signature (Applicant or Agent):
Date. 9/2/2016
Application Number:
BMCH2016-0313
Owner:
Property Address:
54195 AVENIDA VALLEJO
JOHN MCCOY'
APN:
774212020
54195 AVENIDA VALLEJO '
Application Description:
SWAP OUT HEAT PUMP CONDENSER AND AIR HANDLER
LA QUINTA, CA 92253
Property Zoning:
-
Application Valuation:
$2,000.00
' Applicant:
Contractor:
CARRERA AIR
CARRERA AIR
78-970 SON ESTA WAY
78-970 SONESTA WAY
LA QUINTA, CA 92253
LA QUINTA, CA 92253
(760)343-6675
Llc. No.: 959853
Detail: 14 SEER r-410A.
FIRARCIAL INFORMATION
DESCRIPTION ACCOUNT CITY AMOUNT
BSAS SB1473 FEE 101-0000-20306 0 $1.00 .
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION.
ACCOUNT
CITY
AMOUNT
HVAC CHANGEOUT - SPLIT -SYSTEM
101-0000-42402
0
$72.52
DESCRIPTION
ACCOUNT
QTY
AMOUNT
-HVAC CHANGEOUT - SPLIT -SYSTEM PC
101-0000-42600
0
$36.26
Total- Paid for CHANGEOUT: $108.78
DESCRIPTION
ACCOUNT
CITY '
AMOUNT
Credit Card Fee
101-0000-43505
0
$4.44
Total Paid for Credit Card Fee: $4.44
DESCRIPTION
ACCOUNT
CITY
AMOUNT
PERMIT ISSUANCE
101-0000-42404
0
$91.85
Total Paid for PERMIT ISSUANCE: $91.85