11-0392 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QU.INTA, CALIFORNIA 92253
Tiht 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.
Licea Class: B -C10 -C36 N License No.: 811114
44i
Date:ntractor:
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 155001.:
(_ 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.).
(_) 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: 11 (�
Lender's Address: IBJ r
LQPERMIT
Owner:
JOHN LANGHANS
54785 FIRESTONE
LA QUINTA, CA 92253
VOICE (760) 777-7012.
FAX (760) 777-7011
777-7153
Contractor:
CALIFORNIA DELTA MECHNICAL INC
6052,E. BASELINE RD, #155
MESA, AZ 85206
(866)692-5273
LiC. No.: 811114
WORKER'S COMPENSATION DECLARATION
4/18/11
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 performanceofthe 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
��/ q� 3700 of the abor Code, I Ni-thJw(_ijt_h��a/0ympI .with those provisions.
/bate: / OBD pplicant: lit X
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 this inter upon he above-mentioned property fo inspection purposes.
ate. nature (Applicant or Agent):
Application Number:111-_0_0000392-x'
-
Property Address:
54785 FIRESTONE
APN:
775-051-072- -
Application description:
PLUMBING
Property. Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
2117
Tiht 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.
Licea Class: B -C10 -C36 N License No.: 811114
44i
Date:ntractor:
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 155001.:
(_ 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.).
(_) 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: 11 (�
Lender's Address: IBJ r
LQPERMIT
Owner:
JOHN LANGHANS
54785 FIRESTONE
LA QUINTA, CA 92253
VOICE (760) 777-7012.
FAX (760) 777-7011
777-7153
Contractor:
CALIFORNIA DELTA MECHNICAL INC
6052,E. BASELINE RD, #155
MESA, AZ 85206
(866)692-5273
LiC. No.: 811114
WORKER'S COMPENSATION DECLARATION
4/18/11
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 performanceofthe 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
��/ q� 3700 of the abor Code, I Ni-thJw(_ijt_h��a/0ympI .with those provisions.
/bate: / OBD pplicant: lit X
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 this inter upon he above-mentioned property fo inspection purposes.
ate. nature (Applicant or Agent):
Application Number . . . .'. 11-00000392
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 .
--------------------------------------------------=---------------------
Special Notes and
Comments
----
INSTALL NEW 50.GALLON GAS WATER
HEATER.
2010 CODES.
-----------------------7----------------------------------------------------
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
K
LQPERMIT
r
Prescrl five Certincute of Com lionce: Residential
WATER BEATER CP -IR -ALS'- Watar Heater
Date:
Enforcement Agency:
Clim Zone #
# of Stories
Permit #
Site Address:
8 5
NE
Building a kSimlile Family o Multi Pamil •
NOTE: rhis orui is not to be used ar Newly Constructed Buildings or Additions
WATER HEATING
List water- heaters and boilers for both dornesttc hot water (DHFP) heaters and hydronic space heating.
Individual dwelling DHW heoterOnust be gas orpropone, jsrea; and may not exceed 50 gallons. Hat water pipe
insulation from the DRWheater to the kltchen(s) and an all underground hot waterpipes is required in all
cam anenta* es in all climate zones.
Nater Heater Type/ ' Distdbutiou Type
Number Tank Energy Factor . Extemal
Puel Typo' (Standard,
in System Capaoity or Tank
Recirowating?
(gal) Thmmal Iasulatiou
Bfficien R -Value
Cwt / 5TAPPRILD
; 910
1. Indicate type (Storage Gas, Heat Pump, hwtantaneow, etc.)
Z. Recirculating systems serving multiple dwelling units 4hall meet the recirculation requirements of
S150(a). The Prescriptive requiremnis do ►wt allow installation of a reciroulating water heating system
for single dwelling units.
3. Ae external water heaft tanks and pipesvhall be insulated to meet the requirements o ISO .
• I cw* under penalty of perjury, under lite lavas of the; State Of Callfomia, the information p
and complete,
• , I certify that the enaW feahues and perfomrnnco specft:adans identitled ori this Ccrdfi ata
requiraments of Title 24, Peons 1 and S of the Callfbrnia Code oPReaulationB, .
Name: Qv)y)Q . ��eDEwcY- Signa
Address:
(005(0 E.
nriE CKQA
ISS
32 OL.v
on this form Is accurate
Pliance conform to the
License: Q t l
Phone: U
like)Lo25~L`13
For assistance or questions regarding the Energy Standards, contact the Energy Hotline at 1-800-772-3300.
l Zi L A 5E ''JN'
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City of La Qurnta
BWdfng• 8r Safety DbLslon
Box 1504, 78.495 Calle Tamplco
Perm►t #P.O.
3�1
1�
La Quinta, CA 92253 • (760) 777-7012
Building Permit .Application and Tracking Sheet
Pcojeat Addtws;�f
Owner's Name: J
A. P. Number:
Address: 611-745
Legal Description:
City, ST, Zip. 41*9 CR
91PQ
Contractor; ce�!hrrt
Telephone;
Address; 60s� �, v '}'�
SS'
Pro)ectDucaiption:
City, ST, Zip: Z
mw&xet- 5 . at
Arch., Eagn, Designer:
Address:
City,, ST, zip.
Telephone:
Construction Typo: Occupancy;
Stato Lir. #:
krojact type (alrele one):' New Add'a Alter ' ,
pair cmo
Name of Contact Person;
L Sq. Ft : f! stories; #Units;
Telephone # of Contact Person:
Estimated Value of Project
APPLICANT: 00 NOT WRITE BELOW THIS LINE
#
Submittal
Re 'd
linea
TRACKNO
?) MMrr FM
Plait gets
plan Check submitted
Iters
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calle.
Called Contact Pirsoa
Pion Check Balance,
TYtla 41 Cake.
Plane picked up
Construction
Flood plain plan
Plana resubmitted
Mechanical
Grading plan
a'! Review, ready Or corrcetlonsfissue
Zloctrleal
llubcontaotor Lint
Mich Contact Person
plumbing
Qrant Deed
Plans picked up
MO.& Approval
Plana reeabmitted
Gradlug
IN HOUSE!-
Rulew, ready for correctlane/fssue
Developer Impact Pee
planning Approval
Celled Cork act Person
A.LP.P.
Pub. Wks. Appr
Date of permit Issue
8chodl Fees
•
Total permit Bees
W
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n
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