11-0843 (PLBG)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
D. l4�gte: Q /'0.8✓�hl.
Application Number: 11-00000843' Owner:
Property Address: 44185 CAMINO AZUL FRANK A ORLETT /,
APN: 604-180-068-33 -24517 - 44185 CAMINO AZUL ALI( �� ZU ) Ii
Application description: ME -E i rb ft�&M,06 LA QUINTA, CA 92253 /' j
Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 1040 "`,.�zp �]
`q '
Contractor:
Applicant: Architect or Engineer: CALIFORNIA DELTA MECHNICAL INC
6052 E. BASELINE RD, #155
MESA, AZ 85206
(866)692-5273
�f P( LiC. No.: 811114
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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
Lice CI ss: CIO C20 C3 License No.: 811114 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
�,/) issued.
Date: / ontractor: VEL 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 STATE FUND Policy Number 1697823-11
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 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 3700 of the Labor C FTa11 forth[ ith 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
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: Date• Applicant:
(_ I 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: 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.).
(_ I 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. , 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
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 Ouinta, 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 county ordinances and state laws relating to building construction, andherebyauthorize representatives
ofm
this co y Ilp enter upon the above-mentioned prope spectio purposes.
tatfte: L) II Sign re (Applicant or Agent):
Application Number . . . . . 11-00000843
Permit . .
. PLUMBING
Additional desc .
.
Permit Fee . . .
. 22.50
Plan Check Fee
5.63
Issue Date . . .
.
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
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Special Notes and
Comments
INSTALL NEW 50 GALLON GAS WATER
HEATER.
2010 CODES.
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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 Certificate of Compliance: Residential Water Heating CF -1R ALT -WH
General Information
Site Address: 4YkiM0 Za Climate Zane: �� Date: %i
NOT Thin orm is onl used or altervlion or addition of water heaf&r systegm
WATER BEATING
List seater heaters and boilers for both domestic hot water (DRM beaters and hydrontc space heatingbuftWdual dwellwgDRW
heaters must be gas or propmw firers and may nor exceed 50 ga lons. Hot water pipe insulation from the DHW heater to the
kitchm(s)and on all underground hot water pipes is in aucoHmwpons packages in all dwuze Zones.
• I certify &d the emu fimtam and pefmmaCe moons far the building design ideafdodon this Ce&cate of Com4liw=cot3fonn
to tin rcqmk=cuW of Ilde 24, Pants I and 6 of de California Code ofReguWiau&
• The bmlding design feaim= kkmbfiad on ibis C at fieate of C.oa>plianee ate cansisteatwitb dr: iaAMM lien PMV dedto ftumag flue
1 umV Factor or
agmy fnr qpvW wif this bail bg pemut qplicafiaL
waw Heater Type f
Distribution Type
Number of Tank Capacity
Thermal
isxtental Tank
P4tel T '
Sta a
)
Efficiency
hadatimR V
4I1 S
Standard
M-116 $a
Q . Z
L buMnale Type (Smmge Ga& HawAmq, Iastmrlmeem etc)
2 Recnwlativ ay:v wu s®virtg mdttple &wWwg wE* shall meet the rmbadadon rogwremenb of 15t1(n). The j- awy*g regm4m ramir do
rmt affaw die hg&ffaaon of radyguldbig water hzm*m austmn for ainde d e7lnre md&
3 M xaterhealft tarikw d pipes shall he insulated to meet the regWmweats ofISO(V.
Coutmdor (Doeummdatiaa Author's TespomMle Deg4pWg Dedarntfou 5�oeat)
• I cu fy that this Cm fieate of Compliaace doCVMMtation is awe amd campb*
• I am efig►ble vndm Diviaion 3 -of tin CaUmmia Business awl Pmfr dad Code to accept rewmmUlly far Ste bml&g design idmfified an
dfM C eatifi=tC of CMMP canoe.
• I certify &d the emu fimtam and pefmmaCe moons far the building design ideafdodon this Ce&cate of Com4liw=cot3fonn
to tin rcqmk=cuW of Ilde 24, Pants I and 6 of de California Code ofReguWiau&
• The bmlding design feaim= kkmbfiad on ibis C at fieate of C.oa>plianee ate cansisteatwitb dr: iaAMM lien PMV dedto ftumag flue
bmldmg design on the ather applicable coaThaoce £awns, wmk*eeb,.wkulations, plmas and sp =ficadm ambamted to the ofuumot
agmy fnr qpvW wif this bail bg pemut qplicafiaL
Nam will w
-carrfornia Della MeAdcal
A fr056 E. Baseline Rd., #155
L`c"er811114
aw 3p'Mesa, AZ 85206
Phrm 86"92-5273
Residential Compliance Fonar
Bin #
po Q0f La Quinta
BuIldinr 8T Safety DWisfon
StOM # P.O. gox 1504, 78.495 Caffe Tampico
Permit #
La Qum, CA 92253 - (760) 777.7012
Building ;Permit Application and Tracking Sheet
Project Addfeas: y
) 1 Owner's Name; yt Q r .Pj
A. P. Number:
Address:
City, 8T, Zip: vl
Telephone; -
Legal, Descri ti14) th ue? w
Contractor:
Addreas: 6Qs6 , hasp ?v,;-5 :
1?rgjectDescription:
city, ST, zip: 2 �,SZ?J b
aloe_ QL%L gj
Telephone: 946 4q2.iv—
State Lie. #: -111119 1 City Lle. #
Arch., l3ngr., Designer; "
Address; �
,
City., ST, Zip:
Telephone:
Construction Typo: Occupancy;
State Ltc. 0:
Proje¢ttypa (circle one)- NewAdd'ne'.rpa[r Demo
Nene of Caatact Person: A �
Sq, Ft: 6 Stori4: #Units:
Telephone 0 of Contaut Porson: 86 6--6 � — 5-Z'' 3
$stimated Value o:PProJet t
APPLICANT: 00 NOT WRITE BELOW THIS LINE
0 submittal Re 'd Rec?d TRACMGi PERMTFM
Plau sets Plan Check submitted Item Amount
structural Calce. Reviewed, ready for corraotions Plan ChsakDepoolt
Truss Calm
Ca)led Contact Person
Pi Ra Omit Balance •
Title 24 Calca.
Plana picked up
Conatraction '
Flood plain plan
Plant resubmitted
Mechanical
Grading plan
211 Review, ready,for correetlons/inue
$lectricRl
90oontactor Llet
Called Contacthraon
Plumbing
Grant.Deed
Plana pteked up
S.M.I.
1.1,0.A- Approvtl
Plans resubmitted
Grading
IN Ii0U8>1 i•
'"' R vlaw, ready for correetlonalissue
developer Impact Pee
Planning Approval
Celled Contaetperson
Pub, Ma. Appr
Date of penult hasue
SOW Fees
Total Permit Fecs
I
. .:
LSO 'IN 3315' WdlO�� l101 '� ';iny
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