BMCH2017-028601,
78-495 CALLE TAMPICO <�z D �iNlU�it/
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BMCH2O17-0286
Property Address:
50067 CALLE OAXACA
APN:
773340028
Application Description:
INSTALL 5 TON SPLIT SYSTEM LIKE FOR LIKE
Property Zoning:
Application Valuation:
$12,669.00
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 7000) 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
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).:
(1 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
(1 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 ) 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 Na
Lender's Ad
VOICE (760)777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/1/2017
Owner:
DEBORAH DEUTSCH
50-067 CALLE OAXACA
LA QUINTA, CA 92253
Contractor:
DESERT AIR CONDITIONING INC
590 WILLIAMS ROAD
PALM SPRINGS, CA 92264
(760)323-3383
Llc. No.: 276E86
WORKER'S COMPEASATION DECLARATION
I hereby affirm under penalty of perjury ore of the following declarations:
I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section -700 of the Labor Code, for the performance
of the work for which this permit is issued-
_ I have and will maintain worker_' compensation insurance, as required by
Section 3700 of the Labor Code, for the pe-formance of the work for which this permit is
J
issued. My workers' compensation insurance carrier and policy number are:
Carrier: BENCHMARK INSURANCE COMPANY Policy Number: CSTS008762
_ 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: 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 PROVIDEDFOR IN SECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT: Application is hereby made tm the Building Official for a permit subject to
the conditions and restrictions set forth or this application.
1. Each person upon whose behalf this a-jplication is made, each person at whose
request and for whose benefit work is perbrmed 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 _o 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.
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 crdinances 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):
Application Number: BMCH2017-0286
Property Address: 50067 CALLE OAXACA
APN: 773340028
Application Description: INSTALL 5 TON SPLIT SYSTEM LIKE FOR LIKE
Property Zoning:
Application Valuation: $12,669.00
Applicant:
DESERT AIR CONDITIONING INC
590 WILLIAMS ROAD
PALM SPRINGS, CA 92264
Detail
Owner:
DEBORAH DEJTSCH
50-067 CALLS OAXACA
LA QUINTA, CA 92253
Contractor:
DESERT AIR CONDITIONING INC
590 WILLIAMS ROAD
PALM SPRINGS, CA 92264
(760)323-338;
Llc. No.: 276536
Date: 8/1/2017
-,• FINANCIAL INFnRMATInN
DESCRIPTION
ACCOUNT QTY AMOUNT
BSAS SB1473 FEE
101-0000-20306 0 $1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
Credit Card Fee
101-0000-43505
0
$1.84
Total Paid for Credit Card Fee: $1.84
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PERMIT ISSUANCE
101-0000-42404
0
$96.27
Total Paid for PERMIT ISSUANCE: $96.27
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $S.00
TOTALS:04