10-0925 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
10-00000925 -
Property Address:
52130 AVENIDA CORTEZ
APN:
773-202-007-16 -000000-
Application description:
PLUMBING
Property Zoning:
COVE RESIDENTIAL
Application valuation:
865
c&ty/ 4 4 Q" .'.
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
--------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
I 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 ClWBCl C36 License No.: 811114
tractor:
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).:
(_ 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 1, 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.).
1 _ 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
Owner:
KNUDSEN CATHERINE ANNE
52-130 AVENIDA CORTEZ
LA QUINTA, CA 92253
Contractor:
CALIFORNIA DELTA MECHNICAL
6052 E. BASELINE RD, #155
MESA, AZ 85206
(480)898-0007
Lic. No.: 811114
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/16/10
------------------
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.
I have and willmaintain 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
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
3 00 of th Labor Co, all forthwit comply with those provisions.
ate: 0 plicant:
WARNING: FAILURE TO SECURE WORKERS' 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 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, and hereby authorize representatives
ofShis co ty t enter upo he above-mentioned property r ns 4pp
Date: �t/ nature (Applicant or Agent): �
Application Number . . . .
10-00000925
Permit. . .
PLUMBING
Additional desc . .
Permit Fee . . . .
22.50
Plan Check
Fee
5.63
Issue Date . . .
Valuation
. . .
. 0
Expiration Date . .
3/15/11
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
1.00 7.5000
EA PLB
WATER HEATER/VENT
7.50
-----------------------7----------------------------------------------------
Special Notes and Comments
INSTALL NEW 38 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
1.0.0
.00
.00
1.00
Grand Total
29.13
.00
.00
29.13
LQPERMIT
Sep. 15. 2010 - 3:53PM STEVE No, 4904 P. 5
Prescriptive Certificate of Compliance: Residential Nater Heating
General Information
Site Address: SW O .,q-yQ,f,Ai 69 timate Zone: 15- —IDate,
MIS ISform is only used or oHeration or addition of water heetinKsysUe—Im-
WATER HEATING
List water heaters and boilers for both domestic hot water (DHO9 heaters and hydronic space heatuig. ItrdMdual dwelling DHfir
heaters trust be gas or propane fired, and may not exceed 50 gallons. Hot water pipe insulation from the Dh7 heater to the
klrchen(s) and on all underground hot water pipes is reptred in all conponentPa as in all climate zones.
Bnesgy Factor or
Water Heater Type / Distrtbution a Number of Tank Capacity T11e1uta1 Extemg Tank
Fuel et Standard System(W) Efficiency tion R Value
Standard /340M
540 519 0,60 16.1
I. Inecate Type (SAorrtga Gas, I3'eat 1'ft M Itrstmrtmreovs, etc)
2, Recbmtatmg sysfem serving multiple dwellim wa& shall meet ds recinc lotion ragwpemem of 150(n) no ZnMg IDdye rrae0e nen& do
net agm the g—ot—S t7on of a recirculatinP wafer heatbt swam for stint!- dweltinn mdts.
3. The waw heating zw* andprpss shag be bmlated to meet the regutrmments of 130
Coutractor (Docameutadon Author's /Respoustble D er'a Deciatatfoa Statoneat)
• I cacti$+ that this CcMeft of Complimce docoateutatioa is aceuratc and complete.
• I an aligUo under Divisiea 3 cf the Califb1mia Business and Professions Code to uuxept respmsibi2ity for the building design identified on
this Certificate of complieace.
• I certify that tit energy fcat<aes and performance specifications for the banding design identifted on this Certifieae of Compliance conform
to the requitemrmh of Title A Parts I and 6 of tho California Code of Regulasma.
• 11re building design feat identified oa this Cettificate of Compliance are consistent whir the idformatiotn provided to docummA this
bnHding design on the other applicable c=pliaace f =6 wurWeets, calculations, plans and speeificad bmine$ to the eatbrcameot
RM fa appoval with this bwft Peaut a heation.
Nam'Elena Johnson
c4MP1mY,Cal1fomia Delta Mechanical base
Addresa;6056 E. Baseline Rd„ #155 81811114
Ciry5tawipUesa, AZ 85200 Phoa468-892-5273
2008 Residential Cornpliance Fonns March 2010
Sep. 15. 2010 3:53PM STEVE No.4904 P. 4
Bin #
Permit #
0 '01
Proj=t Address: JAZ. � ?J
ty 0f La Quinta
Building & Safety Division
P.O. Box 1504, 78-495 Calle Tampico
la Quinta, CA 92253 - (760) 7777012
Building Permit Application and Tracking Sheet
7AV94L4 fitc?_ ownct•'s X=ee7:
A. P- Nurnber. -
Legal Description:
Address: S L 130
City, ST, Zip: �-GIS/'� �i Z Zg 3 "
Coat�cror 01 `4'vl Gj
Telephone: �� — �
Address: �OS6 �tzse?,ll'i�@. �5.�
Prgjedl}escriptlon:
City, ST, Zip: J`Le8 Z
5�?-� b
ct c� � 23 0,1� 67 aS
Telephone:
Stato Lic # :J City Lia. #: j0 y00 y
Arch., ' Dsslls=
Addttss:
City, ST, Zip.
Telephone: nstrucNon Type: Occupancy:
Stato Lia M roject typc (circle one): New Add'n Alter ' = flair Demo
Name of Contact Person: Et"t x.4WCFL__ r. : # 3tmies #Units
Telephone # of Coact Pcrson: Fsu-maed Va1ae oYPmject: F6,5." /,3
APPLICANT: DO NOT WRITE BELOW THIS LINT:
# Submittal Req'd geed TRACLUNG PERWIMEES
Plan Sets
Plan Check enbmitted
Xtem
Amotntt
3traetaral Calm
Revtewiid, ready fbr corrections
Play Check Deposit
Truss Calm.
. Called Contact Pi son
Plan Check Balance.
Title 24 Cala.
Plans pleked up
Construction '
Flood plain plan
plans resubmi'tted
Mechanical
Grading plan
Zed Review, ready for correcYwnsfiasue
Electrical
SubcontactorList
Called Contact Person
Plumbing
GrantDeed
Pians picked up
H.O.A. AppraJal
Plans resubmitted
Grading
IN HOUSE:,
Review, ready for correctioneliasuc
Developer Impact 17ca
Planning Approval
Called Contact Person
Pub. Wks. Appr
Date of permit issue
Schodl Fees
Total Permlt Fees
Received From: �u�
/''f
COACHELLA VALLEY WATER DISTRICT
CASH RECEIPT DETAIL
/ '
: {
Date:
Address:
Account No.
Lot(s) _- Tract C
Service Address
,ol LITE . Con T is G.A. Code
/ ^/
VMeier(s)
CJ
IE-<',lce(s)�/
Q� S � r
(�
❑ Backflow(s)
❑ House Lateral(s)
❑ Detector Check(s)
❑ Meter Surcharge
anl'tation Capacity Charge
a Ut a
1 :72, 77
❑ W.S.B.F.C.
❑ Temporary Construction Meter
❑ Turn on Charge
❑ Uncollected Account - Name
❑ Inspection Fee - Tract -
Fee -
❑ Plan Check Fees Water i Sewer -
Tract -
❑ Bond Payment- A.D. -
Bond
Assmt.
❑ Customer Deposit
❑ Other
dG'
TOTAL
$ " ---
Remarks:
❑Copy to:
Cash
Check GI o -i.-7
Money
Order
Water Service
Cashier.