13-0745 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 13-00000745
Property Address: 79797 DECLARATION CT
APN: 604-511-025-32 -24197:
Application description: MECHANICAL
Property Zoning: PARKS & RECREATION
Application valuation: 5000.
T -VY 4 40AM.
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Applicant: Architect or Engineer:
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjurythat l am licensed under. provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business an dRrofessionels'Code, and my License is in full force and effect.
license Class: B C10,20,1 License No-: 856936
Date: Contractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that) am exempt fromthe Contractor's State License Law for the
following reason (Sec. 7031.5,•Businus 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 requiresthe applicant for the
permit to file a signed statement that he or she is licensed pursuant to the provisions of the, Contractor's State
License Law (Chapter 9 (commencing with Section 70.00) of Division 3 of the Business and Professions Code) or
that he or sheds exempt therefrom 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 (6$00).:
1_) 1, es,owner of the property,:ormy employees with wages as their sole compensation, will do the work, and
the structure isnot intended or offered for sale (Sec. 7044; Business and Professions Code: The
Contractus' State License Law:does not apply to en owner of property who builds or improves thereon,.
and who does the^work himseif or herself through his or her own employees; provided that the
improvements are,nct intended or offered.fu sale. If, however„the building or improvement is sold within
one year of completion, the owner -builder will have the burden of proving,that h&orshe did. not build or
improve for the purpose of sale:).
(_ 1 I, as owner of the property, am exclusively contracting with.licensed contractus 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.).
(_ 1 1 am exempt under See. , B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there We 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:
WPERMIT
Owner:
REYNOLDS TIMOTHY
79797 DECLARATION C1
LA QUINTA, CA 92253
Contractor:
TELFORDJONES., INC.
25,920 IRIS AVE, STE 13A-400
MORENO VALLEY, CA 9255:1
(951)486-0337
Lic No.: 856936
VOICE (760) 7774012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date:. 6/17/13
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty'of perjury one of the following declarations:
1 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.
have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
Code, for the performance of thework for which this permit is issued. My workers' compensation
insurance caller and policy number are:
Carrier STATE HAND Policy Number
I certify that; in the performanceofthe work for which this permiCis'issued, I,ahali not employ any
personin 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, I shell forthwith comply with those;provlsions.
Date: Applicant:
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 (0 100,000). IN ADDITION TO THE COST OF COMPENSATiON, OAMAGES.AS PROVIDED FOR IN.
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the.Director of Building and Sefety for a permit subject to the
conditiorwand 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 tnermless the City
of La Oulnta,.its officers; agents and employew,for•any actor 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.issuence of such permit,or ceasation of work for 180 -days will subject
permit to cancellation.
I certify''that I have read this.applieation and state that the above information is correct. I agree to compiywlth all
city and county ordinancesand state laws relating to building construction, and hereby authorize representatives
of this county to enter upon the above-mentioned property for inspection purposes.
Signature (Applicant or Agent):
I.QPSRMIT
pp31i4tion Number . . . . . 13-00000745
ermi MECHANICAL 2013
A ional�desc . .
Permit Fee . . . . 71.50 Plan Check Fee .00
Issue Date Valuation . . . . 0
Expiration Date 12/14/13
Qty Unit Charge. Per
Extension
1.00 35.7500 EA MECH FURNACE
35.75
1.00 35.7500 EA MECH CONDENSER/COMP
35.75
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Special Notes and Comments
HVAC CHANGE OUT - 16SEER CONDENSER AND
INDOOR COIL [2008 ENERGY] CARBON
MONOXIDE.ALARM(S) TO BE INSTALLED PRIOR
TO FINAL INSPECTION. 2010 CALIFORNIA
BUILDING CODES.
June .17; 2013 12:12:24 PM.AORTEGA
-----------------------------------------------------------
Other Fees . . . . . . . . BLDG STDS ADMIN (SB1473.)
------------
1.00
PERMIT ISSUANCE M/P/E
90.57
PLAN CHECK, MECHANICAL
47.66
Fee summary Charged Paid Credited
-----------------
Due
----------------------------------------
Permit Fee Total 71.50 .00 .00
71.50
P1an.Check.Total .00 .00 .00
.00
Other Fee Total 139.23 .00 .00
139.23
Grand Total 210.73 ..00 .00
210.73
0