BMCH2017-006078-495 CALLE TAMPICO D "i "�iLMACl/
LA gUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BMCH2O17-0060
Property Address:
81180 NATIONAL DR
APN:
767500023
Application Description:
TURNER RESIDENCE / HVAC CHANGE OUT/ 14 SEER
Property Zoning:
Application Valuation:
$1,803.00
Applicant:
ANTHEM MECHANICAL
53800 POLK STREET
COACHELLA, CA 92236
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: A. B. C20, C46 License No.: 1001659
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, atter, 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
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, 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
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/28/2017
Owner:
DAVID TURNER
81180 National Drve
La Quinta, CA 92253
Contractor:
ANTHEM MECHANICAL
53800 POLK STREET
COACHELLA, CA 9e236
(760)895-2621
Llc. No.: 1001659
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificate :)f 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' conpensation 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: STATE COMPENSATION INSURANCE FUPID Policy Number: 91S4382
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 a:. to become subject to the workers'
compensation laws of California, and agree that, if 1 should become subject to the
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with those provisions. -
Date: Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMIPENSATION 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 ACKNOW _EDGEMENT
IMPORTANT: Application is hereby made to the 3uilding Official for a permit subject to
the conditions and restrictions set forth on this zpplication.
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 thework being performed under or
following issuance of this permit.
2. Any permit issued as a result of this applicat on 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.
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 ordina.lces 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: 3/28/2017
Application Number: BMCH2017-0060 Owner:
Property Address: 81180 NATIONAL DR DAVID TURNER
APN: 767500023 81180 National Dr•ve
Application Description: TURNER RESIDENCE / HVAC CHANGE OUT/ 14 SEER La Quinta, CA 92253
Property Zoning:
Application Valuation: $1,803.00
Applicant:
Contractor:
ANTHEM MECHANICAL
ANTHEM MECHANICAL
53800 POLK STREET
53800 POLK STREET
COACHELLA, CA 92236
COACHELLA, CA 9236
(760)895-2621
---------------------------------------------------------------------------------------------
Llc. No.: 1001659
Detail: Heat Pump Unit
DESCRIPTION 4 ACCOUNT QTY AMOUNT
BSAS SB1473 FEE 101-0000-20306 _ 0 $1.60,
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
HVAC CHANGEOUT - SPLIT -SYSTEM
101-0000-42402
0
$76.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
HVAC CHANGEOUT - SPLIT -SYSTEM PC
101-0000-42600
0
; $38.00
Total Paid for CHANGEOUT: $114.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
Credit Card Fee
101-0000-43505
0
$3.89.
" Total Paid for Credit Card Fee: $3.89
" DESCRIPTION
ACCOUNT .
QTY
AMOUNT
PERMIT ISSUANCE
101-0000-42404
10'
$96.27
Total Paid for PERMIT ISSUANCE:
DESCRIPTION
ACCOUNT
CITY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00,
r Total Paid for TECHNOLOGY ENHANCEMENT FEE: $S.00