11-0390 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 11-000 003 90,
Property Address: 52725 AVENIDA HERRERA.
APN: 773-293-024-11 -000000-
Application description: PLUMBING
Property Zoning: COVE RESIDENTIAL
Application valuation: 759
Applicant: J Architect or Engineer:
Op
---------------
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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 Cl ss: B -C10 -C36 License No.: 811114
ate: mractor.
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that 1 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 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: OE
Lender's Address:
LQPERMIT
Owner:
DUNCAN JOSEPH C
82725 AVENIDA'HERRERA
LA QUINTA, CA 92253 t
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
O'f® 11 A 8 / 11
APR 20 2011
GttyOF �;,
Contractor: .
CALIFORNIA DELTA MECHNICAL INC
6052 E., BASELINE RD,#155
MESA, AZ 85206
(866)692-5273
LiC. No.: 811114
WORKER'S COMPENSATION DECLARATION
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.
1 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
_ 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
700 of the Labor Code II fort ith comply with those provisions.
/^. 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 an county ordinances and state laws relating to building construction, and hereby authorize representatives
of co my Jo enter upon the above-mentioned propertysection ur ses.
Date: Signature (Applicant or Agent):
Application Number
. . . .
11-00000390
Permit
PLUMBING
Additional desc .
Permit Fee . . . .
22.50
Plan Check
Fee
5.63
Issue Date
Valuation
0
Expiration Date
10/15/11
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 50 GALLON
GAS WATER
HEATER.
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
Preaurl ttve CertifieatB Of Conmallo W STzr.0 IM=V A•i' IL or tri :.rlr--n1..1... •*....,...
w Unforconacut Agtuty . Caltutale ne ff if of aiorle9 Permit #
Site Address:
)Building a in le Family ti Multi Farad
NOTE: T ids. orns is not to be used Lor Newly Constructed Buildh s or Additions
WATER HEATING.
List wale- heaters and boilers for both domestic hot water (DHW) heaters and hydronit: space heating.,
IndNidual dwe111ngDHW heater s'mtrst be gas or propane}ired and may not exceed 50 gallons. Hot waterApe
insulation from tha DHW heater to the kitchen(s) and an all underground hot water pipes Is required in all
component packages in all climate zones;
Water Aeatar Type/
Distn''Wou Type
Ntunber Tank Buorgy Factor
External
Fuol Type)
(Standard,
in System Capaoity or
Tank
Address: 05( 6 • ` t �) ISS
Re*cWating)Z
(gal) Thermal
Insulation
' 52
(Oq2 _ 5215
Bfftdeuc
R Vaiud
T NDi��.D
� 15
•
1. .ln case type (Storage Gas, Heat Pump, Instantaneous, etc.)
2. Recirculating systems serving multiple dwelling units shall meet the recirculation requirements of
§150(n). The Prescript)ve requirements do not allow installation of a recirculating water heatingsystern
for single dwelling traits.
3. The external water heating tanks and i es shall be insulated to meet the re ult•ements o 1 SO .
-Declaration Statement
• ' i oardfy underpenalty of perjury, under the laws of the State of Collfomia, the lnfanmnation provided on this form is ecearate
and complete.
r rwrtify. tttII! thv onuey fncfu+nn ..,It �, .R,..�_ :_ c��-''A=csi:ffarftllf:a v�iiiia voi1I11L71iE1 OfC�0 Itonce conform to the
me uirements of Title 2 Parts I and 6 of the Califomio.Code ofRegulafins.
Name-1�1 Q Y1Y1 Q �GZ-r✓D EG4�
1
,
Company:
ate
Address: 05( 6 • ` t �) ISS
L,toet]Ae, ��� j t t'i
city/staee/zip:
Phone:
' 52
(Oq2 _ 5215
For assistance or questions regarding the Energy Standarde, contnet the Energy Hotline at 1-800-772-3300.
WSJd ti058 °N 3A31S Wo 6 1106.'8[ ,dV
Din �f
Qty of La Quinta
Buifdby 8r Safety Dh4slon
P.O. Box 1504, 70.495 Calle Tampfco
La Qurnta, CA 92253 -.(7-60) 777-7012
Building Permit Applicadon and Tracking Sheet .
Permit #
'
Project Addtoss.
Owner's Name:Poh
A. P. Numbor:
Address-
Legel Dcscri tion:
Contractor: ejrytj
Cid, ST, Zip:'knA,, io�ll 00
Tolo hone
Address: bq"t/ s- j
City, 3T, ZIP: Z. 95W6
Telcpbone;
State Lic 1i ; j9 City LI,. #; /0 q00 y
Arch., Engn, Designer
Address:
Project Dewdption:
.a! '
� aaS
r
City,, ST, Zip:
Telephone:
State Llo. #:
Cowtrued,on Type: Occupancy:
Project typo (cirole one): New Add'n Alter ' p ' bemo
Name of Contact Person: �wjSq.
Ft:
# 3torita: # Units:
Tela hone # of Contact Person: & tnatad varve of Prgjeot: 5.Oi7
APPLICANT, 110 NOT WRITE BELOW THIS LINE
0, Submittal Re ld xaa�d TRAaKiNG 7'IB1tA11 FEKS
Plan Sets
Plan Cheekeubmltted
Item
Amount
Structural Calle.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cafes,
Called. Contact rimn
Plan Cheek Balance•
T'itfo 24 Calls.
Flood plain plan
Plane pird" up
Plans resubmitted
Const ractlan
Meehanleal
Oreding plan
2^° Revlew, ready for correctloneAssue
Electrical
Subcontactor Llai
Called Contact Person
Plumbing
Grant Deed
Piling ptcked.np
9.M.I.
H.O.A. Approval
IN HODS$;-
plans resubmitted
'"' Reylew, ready for eorrectlonsRssue
Grading
Developer Impact Fee
Planning Approval
Called Contaet Person
Pub. Wks. Appr
Date of permit Issue
Schodl Hees
Total PermftFees
()Z8 dd
tOSS-'IN 3n31S ' Wd90:6 l l [ 'a