11-0764 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
j- 11=-00000764
.-.--52645_AVENIDA RAMIREZ
773-291-019-6 -000000-
PLUMBING
COVE RESIDENTIAL
1247
Tity/ 4 4.Q"
Architect or. Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
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 Professionals Code, and my License is in full force and effect.
License CI ss: C10 C20 C3 ' license No.: 811114
Date: ntractor:
OWNER -BUILDER DECLARATION
I hereby affirm under pepalty 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.)
(_ 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 town owner of
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
pursuantto the Contractors' State License Law.).
(_ 1 I am exempt under Sec. , BAP.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:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
/11
Owner:
SUSAN PANNONI
Il v
52645 AVENIDA RAMIREZ
-bWK-NGWN,. CA 99999
LA Clu(►-ITA
�30iW7�
Contractor:
CALIFORNIA DELTA-MECHNICAL
INC
6052 E. BASELINE RD,
#155
MESA, AZ 85206
(866)692-5273
Lic. No.: 811114
------=---------------------------------------—
WORKER'S COMPENSATION DECLARATION
1 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.
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
insurance carrier and policy number are:
Carrier STATE FUND Policy Number 1697823-11
_ 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 all fo hwith comply with those provisions.
iDate: (/ A c
E RE W
ant:
WARNING: FAILU TO SECUORKERS' 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 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 days will subject
permit to cancellation.
'I certify that 1 have read this application and state that the above information is correct. I agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of thiisscco tnty enter upon the above-mentioned prope i pectin purposes.
Da et : U O I/ Si ure (Applicant or Agent):
Application Number . . . . .
11-00000764
Permit I... PLUMBING
Additional desc .
Permit Fee 22.50
Plan Check Fee
5.63
Issue Date
_
J Valuation . .
0
Expiration Date 2/04/12
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 ELECTRIC. WATER
HEATER.
CARBON MONOXIDE ALARM (S)TO BE
INSTALLED
PRIOR TO FINAL INSPECTION. 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
.00 .00
29.13
LQPERMIT
-
Prescriptive Certt&Rte.tif.COMP Mance: Residential Water Heatin CF-IR-ALT=WH
Genera( Informetlon
Site Address*4 n( ,
Myth Climate Zona: % Date:
i.v. c:. nr arm ce onl frsed or akeraHon or addition o IV410 heat! t flu.
I
WATER MATING
List water heaters and boilers for beth domestic hot wafer (DH99 heaters and hydronic space he.r ng Indlvfdual dwelling DHW
heaters must be gas or propane feed, "and may not exceed 30 gallons. Hot water Alpe insulation firm the DEW heater to the
kitchens and on all tmd and hot water tees is r rred fn all Companent a
P *ger to all climate zones.
Water Heater / . Energy pastor or
Distribution a Number of Tank Capacity . Thermal 131rtemal Tank
Fuel• , Stexaderd S "eza E�eiew ation R -Values
q e e L Standard
1. lndkoto 7ypt (StorOP Gas, Heat Pump, rm&wtatiaoua, etc) �
a �a>restlatGrg s}tstwK, serving multiple dwelling units shall matt the
notaffaw thtelln rVCir+ritfatiott rsquiremems of ISO(n), T lits Prescrtefira rtvutrtmenes do
gin
o ire
3. The Wawv '
hHottrlg tank andpipes shall be lhsulattd to meet the rgqutrtnrents of 1 SO(/),
• I certify first this Coitifioate of Compliance documcatation is accurate and oomplete. --
• I am eligible under Division 3 of the California Boaineea andPmfesd= Code to an t n�ponsr�lllity for the building d�aign.identified on
this Certificate of Compliance;
• I certify that fm energy features and porforraance speeifroatloae fbr the building degiga Identified on tbia Certificate of Cxnpliaace aoaform
to the rKairemaais of Title 24, Parts 1 and 6 of the California Code of Regulations.
• The building design featmu iden0ed oa this Cerooate of Cgmpliance axe comi&nt with tho"inibrmetioa provided to coorrmoat this
building design OILthe other applicable oompliaama
ee 10r, warl®heetB, ealculationa, pIme end specifications submitted to=the aaftcemc=
a far approval with this builft palmit WpHedtlon.
Nemo i i`/
Ta W f-) sigaeturc:
Co
o I"W-Callfomle Delta Meeh cal Date:
A'Mrw"6056 E, Be9611ne Rd., #155 l
Lie
C1ty/3tatrlLip:Mesa, AZ 86206
"h :860-892-52.7,;
X008 Restdenligl Comphatrce Forms -
March 2010
�/c d SES '°N 1d3INdHDIW d1130 M0V'0:! el
I in #
o 36 7$ 37 ty Of La Quinta -
,v3V Bulling 8r Safety Dlvlslon
Permit # 0�
re # P.O. Box 1504, 78.495 Calle Tamplt:o
ulnta, CA 92253
,��
- (760) 777-701.2
Building Permit Applicatlon and Trackfn g Shit
Project Address:
t
UP.h► dYi11 ri�i�
Owner's Name: V54 nQi7n Aryi
A- P. Number:
Address. �����
Lagei Description:
City, ST, Zip:
Contractor,
Tel hone: 626 �`f 0-q$'
Address; Los& E, g '�
..sr
.
PrgjootA®sarlption;
Cis, ST, Zip: /
Z ?5Zv 6
Telephone: 6
�
stela Llc # :
City Liu, #; �D � 00
Arab,, Bngr,, Designer:
Address;
`
City,, ST, zip:
,
Telephone;
;
Construction Typn: Occupancy;
.� Stats Lia #; � .
Name of Contact Pinson: �% ��iUi
ProJoct typo (olrcle sae): Now Add', Alter lapelr Demo
Telephone # of Contact person: 966-6q
Sq- Ft; storms: I # Unita:
Esdradad value oPpraJectflitnCheckDapoglt
APPLICANT: DO NOT WFirrE 13UOW THIS LINE
# BubtnttkalRec�9ACPIG
Plnn Seta
Plan Check submitted
P$RA�T S8
'
gtrnetursl Cala
Reviewed, ready l'or cotTectloae
AMognt
Trues Calca.
Called Contact Personbalance-
Tltte 24 Cala.
Plane ple6d up
Construction
i
Flood p111.11 plan
Plans resubmitted
,
Grading plan
•
Z°" Revlew, readyfor corrections/Issue
mechanical
5ubcantactor Llat
Called Contaatparaon
Moctrlcal
Grant Deed
Plena kicked up
Plumbing
H-04 Approval
Plans resubmitted
IN HOY181i:-
'" Revlcw, ready.ibr norrectlons/lssuc
Grading
Doveloper)'Mpact Fee
Planging Approval
Called Contact person
Pub' Wks- A''ppr
Date atpermit Issue
5chodl Rees
. Total Permit sect .
S/Z, •d S6H
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