10-1365 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
10-00001365
Property Address:
51415 CALLE JACUMBA
APN:
770-165-020-9 -000000-
Application description:
PLUMBING
Property Zoning:
MEDIUM DENSITY RES
Application valuation:
1000
Tiht 4 4 4"
Applicant: Architect or Engineer:
6W/14tAuA- Rok
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 Class:; C36 License No.: 935651
.L Date:12—M—t d Contractor: (.11 :..O. n —A—
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 contractors) licensed
pursuant to the Contractors' State License Law.).
(_) I am exempt under Sec. , B.&P.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:
LQPERAIIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 12/14/10
Owner:
HARRELL DUANE J & MARILU F
51-415 CALLE JACUMBA
LA QUINTA, CA 92253
AM
Contractor: n
.A+ MECHANICAL PLUMBI ' , 1 ``t 2010
81-370 PALUDOSA DRIVE y�
'L
INDIO, CA 92201 V -:F c AQiANYA
(760) 423-7237 CITY FFt 4!'.i4C::fiErT
Lic. No.: 935651
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 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 EXEMPT Policy Number EXEMPT
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, I shall forthwith comply with those provisions.
*ate:t2d %%%4' o Applicant: IAPe_0 12 . a
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.
t
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
of this county to enter upon the above-mentioned property for inspection purposes.
:l 2-
9pate—(f
4—lti Signature (Applicant or Agent): w 2161-
Application Number . . . . . 10-00001365
Permit . . . . . . PLUMBING
Additional desc . .
Permit Fee . . . . 22.50
Plan Check
Fee
5.63
Issue Date . . . .
Valuation
. . .
. 0
Expiration Date 6/12/11
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 7.5000 EA PLB WATER
HEATER/VENT
7.50
----------------------------------------------------------------------------
Special Notes and Comments
50GAL [ELECTRIC] WATER HEATER CHANGE
OUT. 2007/2008 CALIFORNIA•BUILDING
CODES.
December 14, 2010 1:16:46 PM AORTEGA
----------------------------------------------------------------------------
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 _CF-1R-AL.'1-DLLW
Residential Alteratioils Page ,r'
Pmjet t Name: ` r Climate Zone: Permit #: �•
--•-•.-_----_— ._._.l
General Infurma_ticrn —_____
Site Address:
_ ____
Enforcement A-ent : Date: 2-1 etc)
_
Building Type: VSinEle Family ❑ Multi Family
ProjectType: e laceme it or Chanjt,,eOut of Water Heater –
WATER HEATING
-
List newly installed water heaters and boilers for both domestic hot water heaters (D 1,M) and h.vdronic space hearing.
Neu•!v installed
DWH heaters and boilers must be gets. pro an or ore the existing fiteI r% - pe. - —
_
Distribution Type 'Tank
Extenial Tank
Water Heater Number In Energy Factor or
(Standard,
Insulation
Type/Fuel Type' System Capacity (gal) Thermal Efficiency _
Recirculating)-
R -Value
Date:
190
1 z- c 4
Address:
License:
�(-3Zo.--�g.� ..��.o Sat � �•— ---
`t3 6 S
City/StatcrLip:
Phone:
' CQ 12,2_0
11C,6 423-12 3�
1. ltulic•ate Ayte (Storage Gas, Heat Pump. Instantaneous, etc.)
2. Recirculating s_j•siems serving nnthiple dwelling units shall meet the recirculation requirements q1' §150(n).
The Prescriptive
requirements do nor allow the installation of a recirculating water healing system fnr single dwelling units.
3. The external water healing tank and pipes shall be insulated to meet the requirements of § 150(').
Contractor or Homeowner (Documentation Author's/Responsible Building Designer's Declaration Statement)
• I certify that this Certificate of Compliance documentation is accurate and complete.
• I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the building design
identified on this Certificate of Compliance.
• I certify that the energy features and performance specifications for the building design identified on this Certificate of Compliance
conform to the requirements of Title 24, Part I and 6 of the Califomia Code of Regulations.
• The building design features identified on this Certificate of Compliance are consistent with the information provided to document this
building design on the other applicable compliance forms, worksheets, calculations. plans and specifications submitted to the
enforcement agency for approval with this building permit application. _
Name:
AA
Signature:
Company:
Date:
A+ M ��.1 P 1,�.�. �
1 z- c 4
Address:
License:
�(-3Zo.--�g.� ..��.o Sat � �•— ---
`t3 6 S
City/StatcrLip:
Phone:
' CQ 12,2_0
11C,6 423-12 3�
CITY OF LA QUINTA
BUILDING & SAFETY DEPT,
APPROVED
�1
tow
v O �
moo
l
April 2010 UIN
Bin #
City of La Quinta
Building & Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, G4 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: , 5 (L f (S C l te-
Owner's Name: ivtof f a l x �A a r e t l
A. P. Number:
Address: ( q 5 C l V tAn..
Legal Description:
City, ST, Zip• L-0 4. CAZ
Contractor: a A eQG, q n• P t V tM�Q
Telephone: -
Address: $' (-'3' j D ,
City, ST, Zip: �v ��'�c� C,ot O
Telephone:' 6 23-1-4
State Lic• # : 9 .6 City Lie. C
'
Project Description: CI(N aK . f
_
a a c.:� fr
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone: ' Coasdvction Type: Occupancy:
State Lic. #: Project type (circle one): New Add'a Alter Repan Demo
Name of Contact Person: Sq. Ft : #Stories: #Units:
Telephone # of Contact Person: Estimated Value of Project: p p O
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Rec'd
TRACING
PERMIT FEES
Plan Sets
Plan Check submitted
Lfxm Amonnt
Strnctoral Cafes.Reviewed,
ready for corrections
Plan Check Deposit
Plan Check Balance
Truss Glee.
Called Contact Person
Title 21 Glee
plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2'' Review, ready for correctionsAssue
Electrical
Subcontactor Ust
Called Contact Person
I
Plumbing
S.M.I.
Grant Deed
Plans picked up
H.O.A. Approval
Plans resubmitted
Grading
Developer Impact Fee
A.LP.P.
IN HOUSE:
''� Review, ready for comctlonstissue
Planning Approval
Called Contact Person
Pub. Wits. Appr
Date of permit Issue
School Fees
Total Permit Fees