BP 12-0684P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 12-00000684
Property Address: 51605 AVENIDA ALVARADO
APN: 773-122-013-3-000000-
Application description: MECHANICAL
Property Zoning: COVE RESIDENTIAL
Application valuation: 6000
Fry `_000�,Wc W,7,!Vd#_ W'A
I
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
LORETTA KRAMER
51605 AVENIDA ALVARADO
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/20/12
Contractor:
Applicant: Architect or Engineer:
J ANTHONY PLUMBING HEAT/AIR\
72216 NORTH SHORE STREET, #101
THOUSAND PALMS, CA 92276'
(760) 328-8096
.
Lic. No.. 777794
f
`�
as
-1,
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECL1fRAT1b
I hereby affirm under penalty of perjury thAt I am licensed under provisions of Chapter 9 (commencing with
I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Busin
ss and Professionals Code, and my License is in full force and effect.
_ I have and will maintain a certificate of consent to self -insure fo�oikers' compensation, as provided
license lass: C20-C36
License No.: 777794 -
for by Section 3700 of the Labor Code, for the performanceof the work for which this permit is
Date:
ntractor:
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
OWNER -BUILDER DECLARATION
insurance carrier and policy number are:
I hereby affirm under penalty of perjury that 1 am exempt from the Contractor's State License Law for the
Carrier GRANITE STATE Policy Number WC065255599
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to
_ I certify that, in the performance of the work for which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
person in any mann as to become subject to the workers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
and agree that*Ifhosuold become subject to the workers' compe rovisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
3700 of the L I shall forth I provisions.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 (S500)•:
ate: v ��✓ 0plican
1—) 1, 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 _
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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.).
(_) 1, 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:
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety 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.
I certify that I have read this application and state �to
6in
information is correct. I agree to comply with all
city and county ordinances and state laws relatingbullnstruction, �hereby authorize representativeso`fthis c nt to enter upon the above-mentionedspec '
'Date:� G' I~�p6nature (Applicant or Agent):
LQPERMIT
Application Number . . . .
Permit . . . MECHANICAL
Additional desc . .
Permit Fee . . . . 40.50
Issue Date . . . .
Expiration Date . . 12/17/12
12-00000684
Plan Check Fee . . 10.13
Valuation . . . . 0
Qty Unit Charge Per
Extension
BASE
FEE
15.00
1.00 9.0000 EA MECH
FURNACE <=100K
9.00
1.00 16.5000 EA MECH
B/C >3-15HP/>100K-500KBTU
16.50
----------------------------------------------------------------------------
Special Notes and Comments
HVAC CHANGE -OUT: REPLACE 3.5 TON
14 SEER
SYSTEM, FURACE, CONDENSER, INCOOR COIL,
2010 CODES.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN
(SB1473)
1.00
Fee summary Charged
Paid Credited
Due
-------------------------------------
Permit Fee Total 40.50
----------
.00
----------
.00
40.50
Plan Check Total 10.13
.00
.00
10.13
Other Fee Total 1.00
.00
.00
1.00
Grand Total 51.63
.00
.00
51.63
LQPERMIT
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