BP 10-0457T
ity 4
P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
w� Date: 5/28/10
Application Number: 10-00000457 Owner:
Property Address: 51915 AVENIDA ALVARADO MERNA GUARD
APN: 773-162-020-8-000000- 51915 AVENIDA ALVARADO
Application description: MECHANICAL LA QUINTA, CA 92253 j
Property Zoning: COVE RESIDENTIAL MAY � g.
Application valuation: 5000 '
Q
Contractor: {'fM
Applicant: Architect or Engineer: AIR EXPERTS AIR CONDITIONG-HTG
i/ PO BOX 94 Y"
LA QUINTA, CA 92247
(760) 777-1724
LiC. No.: 725283
ILISED GINTRACTOR'S DECLARATION
I her y affirm under penalty of p rjury thatVofes..donal�d
sauner provisions of Chapter 9 (commencing with
Se lion 7000 of Division 3 of th Business Code, and my license is in full force and effect.
Li ense CI C License No.: 725283
D
at L�
C actor:
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 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
1 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: 6
Lender's Address:
-----------------------------------------------
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.
—_/T-h'aye and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
ode, for he performance of the work for which this permit is issued. My workers' compensation
ra a carrier and policy number are:
Carrier ber EXEMPT
rtify that, in the performan of the work f r which this permit is issued, I shall not employ any
person in any manner so to bec e s act to the workers' compensation laws of California,
and agree that, if I shou become t to the workers' com 'ewmMisi`ons of Section
3700 of the Labor Cod , I shall fo ith comply_WIlA�lF�p ov"i ons.
WARNING: FAILURE TO SECURE WORKERS' OOMPENSATION 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 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 da ill subject
permit to cancellation.
I certify that I have read this application and stPthat�ve information is agree to comply with all
cityand c ty ordinances and state laws relaonstr hereby authorize representatives
of this c my enter upon the above-mentioaction purposes.
Dat Signs OK(Applicant or A
LQPERMIT
Application Number . . . . . 10-00000457
Permit . . . MECHANICAL
Additional desc . .
Permit Fee . . . . 40.50
Plan Check Fee
10.13
Issue Date . . . .
Valuation . . . .
0
Expiration Date . . 11/24/10
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
REPLACE 5 TON HEAT PUMP SPLIT A/C
SYSTEM. 2007 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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