BMCH2015-0167t
r-
78-495 CALLE TAMPICO .
LA QUINTA, CALIFORNIA 92253
4
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BMCH2O15-0167
Property Address: 47875 VIA JARDIN
APN: 643130035
Application Description: WELCH / 16SEER CONDENSOR AND COIL
Property Zoning:
Application Valuation: $6,125.00
.Applicant:
A R S AMERICAN RESIDENTIAL SER
965 RIDGE LAKE BLVD SUITE 201
MEMPHIS, TN 38120
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: C36, C10, C20 License No.: 765074
Date: >� ,�'�� Contractor:
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 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
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 APPLICANT ACKNOWLEDGEMENT
are not intended or offered for sale. If, however, the building or improvement is sold IMPORTANT: Application is hereby made to the Building Official for a permit subject to
within one year of completion, the owner -builder will have the burden of proving that, the conditions and restrictions set forth on this application.
he or.she did.not build or improve for the purpose of sale.). 1. Each person upon whose behalf this application is made, each person at whose .
(� I, as owner of.the property, am exclusively contracting with licensed contractors request and for whose benefit work is perf•)rmed under or pursuant to any permit
to construct the project. (Sec. 7044, Business and Professions Code: The Contractors' . issued as a result of this application , the owner, and the applicant, each agrees to, and
State License Law does not apply to an owner of property who builds or improves shall defend, indemnify and hold harmless,*he City of La Quinta, its officers, agents, and
thereon, and who contracts for the projects with a contractor(s) licensed pursuant to employees for any act or. omission related to the work being performed under or
the Contractors' State License Law.). following issuance of this permit.
(_) I am exempt under Sec. . B.&P.C. for this reason 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 car•cellation.
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/14/2015
Owner:
BARRY WELCH
47875 VIA JARD.IN
LA QUINTA, C4 92253
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-
--- ave and.will maintain worker 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 insugance 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.
Date: 5-��'\S 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 ($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.
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: Q.
Lender's
Lender's Address:
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
bove"mentionedprropertyfor inspection purposes."
L
Date: � A45 Signature (Applicant or Ag ij�
:—;elz
n
D
Contractor:
A R S AMERICAN RESIDENTIAL SER
965 RIDGE LA{E BLVD SUITE 201
MEMPHIS, TN 38120 z c
N
M
z
(951)276-9744
Llc. No.: 765074 m
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-
--- ave and.will maintain worker 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 insugance 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.
Date: 5-��'\S 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 ($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.
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: Q.
Lender's
Lender's Address:
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
bove"mentionedprropertyfor inspection purposes."
L
Date: � A45 Signature (Applicant or Ag ij�
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PERMIT'ISSUANCE 101-0000-42404 0 :$91'.85 $0:00
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Description: WELCH / 16SEER CONDENSOR AND COIL
Type: MECHANICAL Subtype: `.Status: UNDER REVIEW
Applied: 5/14/2015 SKH
Approved:
Parcel No: 643130035 Site Address: 47875 VIA JARDIN LA QUINTA,CA 92253
Subdivision: TR 26152 Block: Lot: 35
Issued:
Lot Sq Ft: 0 Building Scl Ft: 0 Zoning:
Finaled:
Valuation: $6,125.00 Occupancy Type:.. Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0 No. Unites: 0
Details: HVAC CHANGE OUT - 16SEER CONDENSOR AND COIL. [2013 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO .
FINAL INSPECTION. 2013 CALIFORNIA BUILDING CODES.
+D" DITIONAL
CHRONOLOGY,
IVI
CONbiTiO
CONTACT
.y�i is
NAMExTYPE.:
Vis_ .0
3"... •" �`',. •CI'I°Y..: �. vSTATE.�� „ , x�IP, �+r , - ���P�Ot�E ��� �:,'�KqX���.... �, : -.-SEM L�� . "�.';.
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APPLICANT A R S AMERICAN RESIDENTIAL SER
965 RIDGE LAKE BLVD MEMPHIS TN
38120
SUITE 201 '
CONTRACTOR • A R S AMFRIrON RFSIgENTIAL SER
966 RIDGE LUKE BLVD
MEMRI IIS RN
98120
SUITE 201
OWNER BARRY WELCH
47875 VIA JARDIN
LA QUINTA CA
92253
Printed:. Thursday, May 14, 2015 12:39:00 PM 2 of 2 'CffWSYSTE'iviS
t
y
-IRK
BSAS,SB147.3 FEE
101-0000-20306
0
-$1.00
$0.00
Total Paid fnrBUILDING STANDARDS ADMINISTRATION
$1.00 $0.00
BSA:
HVAC C HANGEOUT
'
101-0000-42402
0
$36.26
$6.60
CONDENSER ONLY
HVAC CHANGEOUT-
101-0000-42600
0
$24.11
$0.00
CONDENSER-ONLY PC
HVAC CHANGEOUT-
REPAIR/ALTERATION
101-0000-42402
.0
$12.09
$0.00
-
.HVACCHANGEOUT
REPAIR/ALTERATION
101-0000-42600
0
$4.83
$0.00
Total Paid forCHANGEOUT: $77.35 $0.00
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
Total Paid for PERMIT ISSUANCE: $91.85 $0.00
T 6" O 76.20 -: 00
......... ..
Printed:. Thursday, May 14, 2015 12:39:00 PM 2 of 2 'CffWSYSTE'iviS
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Permit #;
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'La Quinta, CA 92253 (760) 777 7012,
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}Submittal.
Req'd
:Ticc'd. TItACI[ING#. PERMITTEES. -
Plan Scis
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