10-0924 (PLBG)iz.1. _ 4,
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
.10-00000924
Property Address:
54405 AVENIDA HERRERA
APN:
774-245-020-8 -000000-
Application description:
PLUMBING
Property Zoning:
COVE RESIDENTIAL
Application valuation:
925
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
HAUGEN LINDA A
54-405 AVENIDA
LA QUINTA, CA
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/16/10
R ERA +f
5 SEP 2 0 2010
CTYOF 1.,4 �%i!rrJYa
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, 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. , 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: /,n�
Lender's Address: Y -
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 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
gf this county to enter up n the above-mentioned propertyspection purposes.
Date: �� ignature (Applicant or Agent):
Contractor:
Applicant: Architect or Engineer:
CALIFORNIA DELTA MECHNICAL INCA
6052 E. BASELINE RD, #155
MESA, AZ 85206
)�
(480) 898-0007
LiC. No.: 811114
(/
---------------------------------------------------------------------7---------------------------
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 arWXjofessionals 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
License Class: B -C10 -C icense No.: 811114 -
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
I
issued.
/L1ate: O ontractor:
'W�
/
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
OWNER -BUILDER DECLARATION
insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
Carrier STATE FUND Policy Number 1697823
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 th�Labor��rthwi with those provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
77��
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
Date: tJ pplicant:
(_ 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
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, 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. , 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: /,n�
Lender's Address: Y -
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 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
gf this county to enter up n the above-mentioned propertyspection purposes.
Date: �� ignature (Applicant or Agent):
Application Number . . . . . 10-00000924
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
----------------------------------------------------------------------------
Special.Notes and
Comments
REPLACE 50 GALLON
ELECTRIC 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
1.00
.00
.00
1.00
Grand Total
29.13
.00
.00
29.13
LQPERMIT
Sep -15. 2010. 3:53PM STEVE
No. 4904 P. 3
[Prescriptive Certificate of Compliance: Residential 'Vater Heating
t; egeraI In forro
Ion
Site addes:S4ko5-,1 V�d Amage Zone: /S
Date:
r
• I certify that this Certificate of Compliance docomeatation is aeomate and complete,
• I am eligible undit Division 3 of the C difornk Bu&esa and professions Code to accept responsibility for the building design identified on
We Certificate of Compliaam
• I certify that the energy features and performance spoeificatioms for the building design identdicd an this Ccrtificate of Camplisaee conform
to the requirements of Title 24, Parts I and 6 of the California Code of Regulations.
• The building dcsiga features idea ified on this Certificate of Compliance are consistent with the infbznm4au provided to docutnent title
building demiga on the other applicable compliance forms, worksheets, calculations, plans and epccifi one submitted to the enfvraement
aeencv fat atroroval with this building tMit avalimtion
NE{ena Johnson
CoVW-Calffornia Delta Mechanical
44d"08 3056 E. Baseline Rd„ #155
Citymt `jz'p'Mesa, AZ 85206
sigmtorz:
Liwm.811114
ph09e:866-692-5273
e
a
2008 Residen/idl Compliance Forms March 2010
Sep.15. 2010 3:52PM STEVE No. 4904 P. 2
Un #
City of La QuInta
8w1ding 8c Safety DWan
Petrnit # I �,
P.O. Box 1504, 78-495 Calle Tampico
.'[
La Qulnta, CA 92253 • (760) 777-7012
,Building Permit Application and Tracldng Sheet
Pro}ect Address: � Q,�j
� � Owner's Nerve: L �
A. P. Number.
,/ ,,,
Address: E 05 Piyl,r'd a
Legal Description:
/� 2
City, ST, Zip: ZA - t,� J.4 CX 7'Z Z.S,3
Contractor. ca44 ptl f Q
Telephoner ��
Address:�QL6 �•�j
'jam �5-j �rojectDeaeription:
City, ST, Zip:
CitL &t Z&moi
-
Telephone: 36A '9172
State Lie, #:
/0 q oo �(
Arch, Engn, Designer.
Address:
City, 87Zip-
Telephone:
Co Ist ucdon Typot occupancy:
State Lia #:
Project type (circle one): New Add'n After • : ,epefr Demo
Name of Contact P=, ' &�)i!F-1
Sq. FL: # Stogies: # Units.
Telephone # of Contact Person: Fatimated Value of Project 2 S.
APPLICANT: DO NOT WRITE BELOW TWS LINE
M Submittal Req'd
Rec'4 T1tAC43NG P1�13k*l KBPS
Plan Sets
Pian Check submitted Item AM=
Stmetuml Coles.
Revhwed, ready for corrections Plan Check Deposit
Tr'usa Catcs.
Called Contact Persou Plan Check Satance,
Titto 24 Calve.
Plana picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Gradinwplan
21" Review, ready forcorreetiousPusue
Electrical
SubcoutactorList
Called Contact Person
Piambing
GrantDccd
Plans picked up
S ML
IMA, Approval
Plans resabmltted
Grading
IN HOUSE:-
''i RSvigw, ready for correetionsfiesue
Developer Impact Tree
planning Approval
Called ContactPerson
A.LP.P.
Yub, Wks. Appr
bate of permit issue
Schodl Fees
Total Permit Fees