10-1335 (PLBG)79760 Arnold Palmer
`. " . ' IIIIIIIIIIIIIIIIIIIIIIIII 27 I & VIN
P.O. BOX 1504 _._r _ _ _ __ _ - J VOICE(760) 777-7012
78-495 CALLE TAMPICO 440FAX(760)777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING&SAFETY DEPARTMENT INSPECTIONS (760)777-7153
BUILDING PERMIT
Date: 12/07/10
Application Number: 10-00001335 Owner:
Property•Address: 79760 ARNOLD PALMER BOB LINDSTROM
APN: 775-241-067- - - 79-760 ARNOLD PALMER
Application description: PLUMBING LA QUINTA, CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 962
i
Contractor: ; +
Applicant: Architect or Engineer: CALIFORNIA DELTA MECHNICAL C
6052 E. BASELINE RD, #155
Q
1010
MESA, AZ 85206
(866)692-5273 CITY FLA QUINTA
' Lic. No. : 811114 P?s1 "le
--- ------- ------------------- ----- - -------- ---- -- - ---------------- ------- ---------
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
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 Business and Professionals Code,and my License is in full force and effect. _ I have and will maintain a certificate of consent to self-insure for workers'compensation,as provided
License Clas : -C10-C 6 i nse No.: 811114 for by Section 3700 of the Labor Code,for the performance of the work for which this permit is
issued.
Date: /OContramor: L 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 I am exempt from the Contractor's State License Law for the Carrier STATE FUND Policy Number 1697823
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 manner so 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,if'I should becom Iubject to the workers'compensation provisions of Section
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or 700 of he Labor Code,I forthwith O mply with those provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by f /0
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars IS500).: Dates Applicant:
(_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.). APPLICANT ACKNOWLEDGEMENT
(_1 I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044,Business and Professions Code: The Contractors'State License Law does not apply to an owner of conditions and restrictions set forth on this application.
property who builds or improves thereon,and who contracts for the projects with a contractor(s)licensed 1. Each person upon whose behalf this application is made,each person at whose request and for
pursuant to the Contractors'State License Law.). whose benefit work is performed under or pursuant to any permit issued as a result of this application,
(_1 I am exempt under Sec. ,B.&P.C.for this reason the owner,and the applicant,each agrees to,and shall defend,indemnify and hold harmless the City
of La Quints,its officers,agents and employees for any act or omission related to the work being
performed under or following issuance of this permit.
Date: Owner: _ 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
CONSTRUCTION LENDING AGENCY permit to cancellation.
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify that I have read this application and state that the above information is correct. I agree to comply with all
work for which this permit is issued(Sec.3097,Civ.C.). city and county ordinances and state laws relating to building construction,and hereby authorize representatives
of this cou ty enter upon the above-mentioned property a si s ction .
Lender's Name:_ // 5-7
Date: !V gnature(Applicant or Agentl: r
Lender's Address: JA
LQPERMIT
Application Number 10-00001335
Permit PLUMBING
Additional desc .
Permit Fee . . 22.50 Plan Check Fee 5.63
Issue Date . . Valuation . . . . 0
Expiration Date . . 6/05/11
Qty Unit Charge Per Extension
BASE FEE 15.00
1.00 7.5000 EA PLB WATER HEATER/VENT 7.50
-------------------------------------------------------------------=--------
Special Notes and Comments
REPLACE 50 GALLON GAS WATER HEATER. 2007
CODES.
--------------------------------------------------------------------------
Other Fees . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00
Fee summary Charged Paid Credited Due
----------------- ---------- ---=------ ---------- ----------
Permit Fee Total 22.50 .00 .00 22.50
Plan Check Total 5.63 .00 .00 5.63
Other Fee Total 1.00 .00 .00 1.00 .
Grand Total 29.13 .00 .00 29.13
LQPERMIT
Dec. 7. 2010 10: 58AM DELTA MECHANICAL No, 4017 P. 15
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antral Cor(Uoc.uziterttat,ion Author's
/ResponsibleDeSignFl��ypecloration Stakement
c::rli;y(iutt!Lis Certifcatc of Compliestoe documents ) -
i under Division 3 of, tior!itt accurate auzd complete• —
tbe California Au„iness and Profausions Code to accept responsibifi f
Cerlulc2tc of Com
plialicc, ty o,the
: .�rtifa'lir'rl the euergy featurog andperfamance speci.Ptcativps fou' b►111d111g desJ�gn idr,LrSie4 r•
Of Title tri,Pbrts 1 ahcl 6 ofthe Caliiornis Cacho Fteli2�g deWgn,deatifed on this Carti$oote u{Compliauec cam_
r:.b�ildrrlo d'3ign fc8lures identibcd on thita Ccrtiticaif M a gulahons,
'•'uiicii�g riesi&n nn the other R lieable c D:Fnaaplianoe are consistent With_ :uct,for a 'oval with this buildiu apl„urce fomas,worksheets,ctzleolations,' the tnforma8on. riled to docruncat thls
F.permit a Hcatiou, _ pldris anli•�pe�e�tl ittedto the cnfurcenl*=u
c.a.trornia Delta Mtachatllcal
Date
"605C E. baseline Rd„#•15516
License; — -
Ia":(\gesa,A7_85208 81 1114
r
866-8925273
Dec, 7. 2010 10: 57AM DELTA MECHANICAL No- 4017 P. 14
City of La Quinta 1
Building&•Safety Division
Permit /J�V'j P.O.Box 1504, 78-495 Calle Tampico
✓✓`�� La Quints,CA 92253- (760)7777012
���1 Building Permit Application and T
racking Sheet
Prof cct Address:',6 _ PP Gro Owner's Namc: � is
A.P.Number: Addrass_ "1, l i
Legal Description: City.ST,Zip. A' q2'
2
Contraetnr.�' �.yy ;
�. Telephone; �—
Address: Pmjat Description:
City,ST,zip: I Y Z gS J b
Telophonc: 66.�q2—�2�3 _ V
State Lie, r�_LiM/0C) y
Arch.,EW.,Ibesigner.
Address:
City-,ST,Zip:
TelBphone: Construction Type: Occupancy;
State Lia#: Project type(circle one): New Add'n Alter repair Demo
Name of Contact Person:tSfUh� M i O Sq.FL: #Stories: $Cinits
Telephone#of Couto person:966-6Z-5Z-7 Estkiftd Value of Project: C1 to ,
APPUCANT:DO NOT WHITE BELOW THIS LINE
# Btthmittal Regld Recd TRAGJQNG PFItM1T F�E9
Plan sets -Plan CherR submitted Iteta Amount
Structural Calm Reviewed,rea4Y for corrections Plan Check Deposit
Truss Cales, Called contact rrvson Plan Cheek Balance.
•1'ttie 24 Calca. Plans picired up Construction
Flood plain pian Pans reaubmltted Mechanical
C_ding plan 2°d Review,ready for correetioustisme Liectrieal
Subcontactor List Called Contact Person Plumbing
Grant Deed Plans picked up sayiy
H.O.A.Approval Plans resubmitted Grading
IN ROM% '^'Review,ready Or correctionslissue Developer Impact Fee
Planitiag Approyal Called Contact Person AyP.P.
Pub.Wks,Appr Date of permit issue
School Fees
Total Permit F.
. i�