PLBG (11-0394)51025 Mandarina
11-0394
PCO. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Applicationdescription:
Property Zoning:
Application valuation:
Applicant:
r11-00000394 -e
51025 MANDARINA
772-2107016- - -
PLUMBING
LOW DENSITY RESIDENTIAL
1263
. VOICE 760 777-7012
FAX (760) 777-7011
BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 4/18/11
Owner:
DARYL BRADY
51025 MANDARINA
LA QUINTA, CA 92253
Contractor:
Architect or Engineer: CALIFORNIA DELTA MECHNICA
6052 E. BASELINE RD, #155
MESA, . AZ 85206
/ (866)692-5273
Lic. No.: 811114
,p o
i
z c AaR 2 0 201
GI'rY OF !.A gU1t4S'A
- - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - --- - - - - - - - - - - -
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 CI ss: B -C10 -C36 -License No.: 811114
•
for by.Section 3700 of the Labor Code, for the performance of the work for which this permit is
q
at/ !/ II C ractor.
r
issued.
1' 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 Coder 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 become subject 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
of the Labor Cod R forthwith comply with those provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
/y1n %7/00
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
ate: A scant:
(_ ) 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
WARNING: FAILU 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 1, 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'_) 1 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
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:
LQPERD1IT
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 that.the above information is correct. I agree to comply with all
city and unty ordinances and state laws relating to building construction, and hereby authorize representatives
of thi o ter upon he above-mentioned property forr iestion purp s.
te: S' atura (Applicant or Agent(:
Application Number .
. . . .
11-00000394
Permit
PLUMBING
Additional desc
Permit Fee . . . .
22.50
Plan Check.Fee
5.63.
Issue Date
Valuation
0
Expiration Date
10/15/11.
Qty. Unit Charge'
Per
Extension
BASE FEE
15.00
1.00 7.5000
EA PLB
WATER HEATER/VENT
7.50
Special..Notes and Comments
INSTALL NEW 75 GALLON
GAS WATER
HEATER. .
2010 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
.0.0
.'00
29.13
' LQPERMIT
.
Prescriptive Certificate of Corn llnnee: Resldentinl WATHR HEATER
Date: CF -1 R -ALT- WoWr Heater
Enforcement Agency; Climat ne; # of Stories Permit#
Site Address:
$uiidizh Sip a Fa mil o Multi Femil
NOTE: This ornr is trot to be used or NetVl ConstructedBuildhigs or Additiars
• I certitj► under penalty of perjury, under the laws of the State of Califomlo, the fnf'hrmadon
end complete. provided on this farm la accarsta
. Y nertify ftt the energy feab=rl and pertbrmoeca speaifieadom identified ori this Cordficate of Ca Bance confbun to the
uirementg of Tide 2 Part 11 and 6 of the Califb21,05"Mcilalfons,
Name: tur •
GZE,D ERIGV
Company:
Address• ato-
co • ,
•mo F..: £ ISS License:
City/State/Zlp: Phone: .—
5 Z CXR. Lo (9 q 2 -
For
For assistnuce or questions regarding the Energy Standards, conNet the Miergy $oHine at 1-Btlll-772-3300.
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Din #
Fees
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Oty of Ca Quinta
Buiiding Bi Safety DMklon
Permit #
P,O. Box 150¢, 78.495 Calle Tampico
La Qulnta, CA 92253 - (760) 7'77.7012
BuildIng Permlt Application and Tracking Sheet
Projeot Address; 5 I 2
Mf tJ p- I N A
Owner's Name:
L
A. P, Number:
Address: I
Legal Desert Non: '
N
City, ST, Zip; L •f c
LA
Contractor'
i 1
If —
Telephone' 1 ,56
Address: LLL E , g
,SJ°
Project Descrlotion.
City, ST, zip: 4 Z_
"6'0? 0?
Telephono: f7 " e02 "" J`?
wC/ '_
State Lia fA ;
City Liu, #k /0 yoo l
r
Arch,, Bngn, Dom -per
7.
Address:
City. ST, Zip:
Telephone:
Construction T*!.
Stets Lic. #:
Name of Contact Person:
pmJaattype (okole one): N6W Add'n Alter',spa Damao
, ,
Sq. Ft .,
Telephone # of Contact person; 866^6 Z— 3
# Storied: #Unite:
Betlmated Value of ProjecQ
t:
APPLICANT'
00 NOT WAIT@ BELOW THIS LINE
0 Submittal At Id
Rectd
TRA CImYG1
Plan Bots
Pian Check submitted
P0"OT i
Straaturai Cates,
Reviewed, ready for corrections
Item
Amount
Trues Cala.
Pian CheckDepostt
Called Contact Person
Plan Check Ralanca,
Title 24 Calcs.
Plana picked up
Flood plain plan
,
Plana reaubmltted
Conak•uctlon
Grading plan
Z*! Review, ready for corrections/issue
Mechanical
Electrical
Subconmctvr Ust
Called ContaetPerson
Grant Deed
Plana picked up
Plumb(tIQ
H-04 ApproVal
Plane resubmitted
9.M.f. •
INXOUSE:.
'i° Reylely, ready for corcectlana/Issue
Grading
PlantangApproval
Celled Contaeeperson
Aoveloper fmpaet Ree
Pub, Ms. Appr
Date of permit Woe
A.LP,P.
Schodl Pees
Fees
lZ/Z 'd 'tiOSB 'ON 3A31S Wd10:6 l lOZ 11 "IV