BMCH2015-00111
c&tit
Q�i Qalarcu
78-495 CALLE TAMPICOD
LA QUINTA, CALIFORNIA 92253 �'7 COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BMCH2O15-0011
Property Address:
81175 GOLF VIEW DR
APN:
762280017
Application Description:
REPLACE (2) TON FAN COIL & DONDENSER
Property Zoning:
Application Valuation:
$5,922.00
Applicant:
DESERT AIR CONDITIONING
INC
590 WILLIAMS ROAD
PALM SPRINGS, CA 92264
LICENSED CONTRACTOR'S DECLARATION '
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing with Section 70001 of Division 3 of the Business and Professions Code,
and my License is in full force and effect.
License Class: C20, C43 License No. 276586
JAWDate: l- 4 - `- Contr :
OWNER -BUILDER DECLARATION
I 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
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
Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division
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
permit subjects the applicant to a civil penalty of not more than five hundred dollars
($500).:
( ) 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 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.).
I ) 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.).
( ) I am exempt under Sec. . B.&P.C. for this reason
Date:. Owner:
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:
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/9/2015
Owner:
DONNA KIM
8175 GOLF VIEW DRIVE
LA QUINTA, C 92253
Contractor:
DESERT AIR CONDITIONING INC
590 WILLIAMS ROAD
PALM SPRINGS, CA 92264
(760)323-3383
.Uc. No.: 276586
WORKER'S COMPENSATION DECLARATION
I hereby-;ffir` 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.
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:_ Policy Number: _
I 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, I shall forthwith
comply with those provisions.
ate, _/ , "� ► Applic awn t:
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 ($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.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT: Application is hereby made to the Building Official 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, 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.
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 permit to cancellation.
1 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: Signatureicant or Agent):
M
FINANCIAL IN FORMATION
M�Q
St 1 -PAID?,DATE,-'
MIPTI Ni AI
fa
BSAS SB1473 FEE 101-0000-20306
0
$1.00 r ;Li, $0.00
PAIR ByjZi tA METHOD H 0 D,!�- AR
CHECK F1 CLTD:-BY2k-.
—1- .. T.I. M,
Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $1.00 $0.00
t,!A% A 'OjNT,,
Yr
-MI D TE7
HVAC CHANGEOUT - SPLIT -SYSTEM
101-0000-42402
0
$72.52
$0.00
vy
EIPTa
A V,
t
Via X4
Ig
FARwn-
;V,� -'v
r' $
4W "AC OVI
ink
ry
�.i'PAID �,I, Ni
'_�QATE
HVAC CHANGEOUT - SPLIT -SYSTEM PC
101-0000-42600
0
$36.26
$0.00
PAID BY �i
"0
METHOD
g.7
,�ECEIF, #BY
. T;, g -
.CHECCLT
Total Paid forCHANGEOUT: -$108.78 $0.00
SCRI �_# , -
Y,
`cT-
PAID , -t-`
!PAID DATE'
PERMIT ISSUANCE
101-0000-42404,,t,;_0
$91.85
$0.00
—QP�,w-PAIDBY',--
R1' ECEIPTt f p�
j ;�Z
t D,
Total Paid for PERMIT ISSUANCE: $91.85 $0.00
TOTALS::*. $201.63 00
REQUEST FOR PERMIT
590 Williams Rd.
Palm Springs, CA. 92264
760-3233383
760-323-8983
To: Philip Juarez
Email: pjuarez@ta-q-uinta.org
Phone Number: 760-777-7050
Fax Number: 760777-7011
Date: 10/15/2414
Pages: 7
Re: Permit application — 78795 LIMA
Notes/ Comments:
Replace (4) split systems on ground like for like.
Thank You,
Keri Skov
Description: REPLACE (2) TON FAN COIL & DONDENSER
Type: MECHANICAL Subtype: Status: UNDER REVIEW
Applied: 1/9/2015 PJU
Approved:
Parcel No: 762280017 Site Address: 81175 GOLF VIEW DR LA QUINTA,CA 92253
Subdivision: TR 28838-1 AMENDED Block: Lot: 54
Issued:
Lot Sq Ft: 0 Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $5,922.00 Occupancy Type: Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0 No. Unites: 0
Details: REPLACE (2) TON FAN COIL & HP SPLIT SYSTEM .78 ENERGY 13 SEER 2013 CALIFORNIA MECHANICAL CODES. CARBON MONOXIDE
ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2013 CALIFORNIA BUILDING CODES
DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY CLTD
BY
BSAS SB1473 FEE 101-0000-20306 0 .$1.00 $0.00
Total Paid forBUILDING STANDARDS ADMINISTRATION $1.00 $0.00
BSA:
Printed: Friday, January 09, 2015 4:05:24 PM 1 of 2 CRWYSTEMS
REVIEWS
T
21
7,7_Rffi_
IE REVIE ERfv, kSE%,,DATE,' _7_�t ZnM.4k. N
01
W
'ACC
BOND
INFORMATION
X�,,11:"DESCRIP I
NT1'
ID;
-PAIDD
1� ECEIRT 5
i
x:
u
-V"
HVACCHANGEOUT-
101-0000-42402
0
$72.52
$0.00
SPLIT -SYSTEM
-
HVAC CHANGEOUT -
HVACCHANGEOUT-
101-0000-42600
0
$36.26
$0.00
SPLIT -SYSTEM PC
I
I
Total Paid for CHANGEOUT: $108.78 $0.00
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
Total Paid forPERMIT ISSUANCE: $91.85 $0.00
TOTALS: $201.63 $0.00
REVIEWS
T
21
7,7_Rffi_
IE REVIE ERfv, kSE%,,DATE,' _7_�t ZnM.4k. N
01
W
ti
Printed: Friday, January 09, 2015 4:05:24 PM 2, of 2 CRWIYSTEMS
BOND
INFORMATION
ATTACHMENTS
ti
Printed: Friday, January 09, 2015 4:05:24 PM 2, of 2 CRWIYSTEMS