11-0974 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
11-00000974
Property Address:
43960 GENOA DR
APN:
609-511-015-15 -28457 -
Application description:
PLUMBING
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
851
Applicant:
T4ht 4 4 Q"
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 70001 of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
License Cl ss: C10 C
Date: C20 C3 Lic a No.: 811114
Kontractor:
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, 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 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:
LQPERMIT
Owner:
ALTENBURG ELSA
43960 GENOA DR
LA QUINTA, CA 92253
Contractor:
CALIFORNIA DELTA MECHNICAL
6052 E. BASELINE RD, #155
MESA, AZ 85206
(866)692-5273
Lir_ No.: 811114
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/12/11
E
D
QC -P
J 2 2011
CITY OF LA aUINYe
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 STATE FUND Policy Number 1697823-11
1 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 rthwith comply with those provisions.
Date: Applicant:
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
of [his co nter upon the above-mentioned Property for i coon purpo
Date: 1011 Signature (Applicant or Agent): (
Application Number . . . . . 11-00000974
Permit
PLUMBING
Additional desc .
.
Permit Fee . . .
. 22.50 Plan Check
Fee
5.63
Issue Date . . .
. Valuation
0
Expiration Date
3/10/12
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
WATER HEATER CHANGE
OUT - 38 GALLON/GAS
[2008 ENERGY] 201
CALIFORNIA BUILDING
CODES.
September 12, 2011
12:28:25 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
Prescrlptiye Certificate of Compliance. Residential Water Heating CF-iR-ALT-WH
WATER DATING
ilst water heaters and boilers far both domestic hot water (DH99 heaters and hydronlc space heating. lndtvtdual dwelling DHW
heaters must be gas or propane f9rad, and may not exceed 50 gallons. .Plot water pipe insulation from the DHW heater to the
kitchen(s) and an all underground hot water pipes is mquired to aftcormonant ackages in all climate zones.
• I certify tbat the energy featoree and performance specifications for the building design identified on this Certificate of Compliance conform
to Ura requirements of Title 24, Parts 1 and 6 of the California Code of Regulations,
Energy Factor or
building design an the other applicable compliance forme, wc&aheets, calculation, plane and specifications submitted to the mfaroamont
Water Heater Type /
Distributionpe
Number of Wank Capacity Thermal
Extemal Tank
Fuel e'
Standard
stein al Efficiency
atipu Fwah3ea
-P444 ZeM
Standard
0,
1, Indicate Type (Storage Gas, Heat Punip, Instantaneous, etc.)
2. Jtectreulattng systems serving multiple dwelling units shalt most the recirculation requirements of .150(n). Thy preseriniive reaalremenit do
not allow the (n�tgtla8on of a recirculatinn water heatix� svatemYa d Iline r�:iLv_
3. The water heating tank and,pipes shall be insulated to meet the requirements of 150a).
Contractor (Doeuzentation Author's /Responsible Designer's Aeclarafaon Statement
a X certify that this Certificate of Compliance documentation is accurate acid complete.
4 I am eligible under Division 3 of the California Business and Prufbesions Code to accept responsibility frlr the building design identified an
this Ctrtifioate of Compliance,
• I certify tbat the energy featoree and performance specifications for the building design identified on this Certificate of Compliance conform
to Ura requirements of Title 24, Parts 1 and 6 of the California Code of Regulations,
• The building design features identMcd on this CertMeate of Compliance are eomiatent with the Information provided to document this
building design an the other applicable compliance forme, wc&aheets, calculation, plane and specifications submitted to the mfaroamont
apnr.y for approval with this building emiit licatiou.
Name: )� Signature:
Company:Californla Delta Mech cal Date: -,7/7
Address:6056 E. Baseline Rd., #155
License:811114
City/3tate/zlp!Meaa, AZ 86206
p'one'866-892-5273
20'08 Residandal Co nipllance Fonns. March 2010
0't6 'ON .. 1H3INVH03A' 41130 M) :6 .J 101 '6 . deg .
M
6o
BiR #
Permit #
ProjectAddless: 3960
A. P. Number:
Qty QA L7 QUJr A tQ
Building 8i Safety Division
P.O. Box 1504, 78-495 Came Tamptco
La Quinti, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
ownces Name- a
Address: q3140 &1004
Legal Description;
Contractor a4 m, vi
VV ' 17
ON
Cily. ST, Zip: LA A;oN 44�Z-
Telephone; '
Address!'605-6 �, 629,LVAP, /sr
PMleetDascription;
City, ST, Zip:
Telephone;366 -6` Z Jr2.�
pe*o,,u-3 o's
Qtr
State lie. !#
,Arch., Engr., Designer;
AAdress:
.
City., ST, Zip:
Telephone:
State Lic,#:
Name of Contact Person;
Construeton *K, Oaaupsboy;
Project typo (circleone); New Add'ntat ,epair Demo
Sq. Pt.: # 5tcta4: 0 units;
Telephone # of Contact Pemo JRsdnmt,,dVaWeofFM8ot Ivr1,13
APPLICANT: ao NOT WRITE BELOW THIS LINE
9
Submittal
Platt Sets
Req'd
Red
TRACIMG
Plan Check submlttefl aN ii
PrMT FEES
Item Amount
Structural Calei.
Reviewed, ready for corritedoes
Plan Cheok Deposit
Truss Cala,
Called ContactPiraon
Plan Cheekidalanea.
Title 14 Calci.
Plane pidtid up
Cunetruatlon
Fidod plain plan
plans resubmitted
1kLechauleal
Giradlog plan
r Review, ready fir correctionsllesue
Electrtcol
8ubcontactor Ti,lst
Called ContactPorson
Xlumbing
GlrantDeed
Plane plcked up
9,O.A, Approval
Place raiabmitted
GradiaQ
YKHO{157��-
Reviety,ready ibrcorrectlont/lieue
Developer Impact Fee
Plaaaing Approval
Pub, Wks. Appr
Called Contact Person
Ditto otpermit lesua
School Fees
Total Permit Bees
1d�INdN�3W d113a`
6
NVE0:6 ILOZ dog'