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11-0389 (PLBG)P.O. BOX 1504' VOICE-(760).777-7012 78-495 CALLE TAMPICO- FAX (760) 777-7011 LA"-QUINTA, CALIFORNIA 92253BUILDING &SAFETY DEPARTMENT " INSPECTIONS (760) 777-71-D BUILDING PERMIT ' A ate: 8/11 Application Number:. 11-00,0,00-389 _ Owner: U` Property Address: 78685 VIA CORRIDO MARK PEDERSON APN: - 646-300-.0477 - - 78655 VIA • CORRIDO i APR* 2 G .2011 Application description: PLUMBING LA QUINTA, CA 92253 t Property Zoning: LOW DENSITY RESIDENTIAL is Cir�,{j=(_�r•,�rtN7` Application valuation: 759 Contractor. Applicant: Architect or Engineer: 'CALIFORNIA DELTA MECHNICAL INC- 6052 NC_6052 E. BASELINE RD, #155 MESA, AZ 85206 (/ 1/ (86i5)(552-5213 Lic. No.: 811114 ' -----------------'------------------- - - - - -- 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 and Professionals 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: -C10-C36 - License No.i 811114 - - - for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Coo tr r: _ 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 I ollowing reason (Sec. 7031..5, Business and Professions Code: Any city or county that requires, a permit to _ 1 certify that, in the performance of the work for which this permit is issued, I shall'nbt 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 1 shout orae 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 .n - 700 of the Labor C shall forthwith comply with those provisions. that he or she is exempt therefrom. and the basis for the alleged exemption. Any violation of Section,.7031.5 by !-� J od any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred -dollars ($500)•: Date:. APPIic 1 _ 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.). APPLICANT ACKNOWLEDGEMENT 1 _ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permiusubject to the 7044, Business and Professions Code: The Contractors' State License Law does not•apply to an owner of conditions and restrictions set forth on this application. property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed 1. Each person upon whose behalf this application is made, each person atwhose request and for - - pursuant to the Contractors'. State License Law.). whose benefit work.is performed under or pursuant to any permit issued as a result of this application,- ( ' ) .I am exempt under Sec. , BAP.C. for this reason 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. Date: Owner: - -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 CONSTRUCTION LENDING AGENCY - permit to cancellation. - I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the - I certify that I have read this application and state that the above information is correct. I agree to comply with all. work. for which this permit is. issued (Sec. 3097, Civ. C.). - - city and county. ordinances and state laws relating to building construction, and hereby authorize representatives ' r - of this co oty t enter upon the above-mentioned property for ' e tion rposes. Lender's Name: :- f--- . -- ,.. _ _.Date: V'/ Signature(Applicant or,Agentl: - Lender's Address: Application Number 11-00000389 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 ------------------------------------------------------------ Other Fees . . . . . . ------ BLDG STM ADMIN (SB1473) - -- 1.00 7 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 Prescrl Hue Certificate of Com lionce; Residentinj WATER HEATER CF -IR -ALT- Water Haater bete: Enforcement Agency;Climate ne # At of Stories Permit # Site Address: � Huildin a Sin le Femil Mu]ti Famil NOTE:. chis ornt /s not to be used or relply Calutructed Bu►ldin s ar Additions .-i- --- - .. �..'... .... -rw�raincrria au urll lnmNl m.vrnllnnnn nen ,-.."......•.l.•u..0......-.. l..�L..� +...� dor srngte dwelling units. 3. 77ta crlc7 71ul w"t-er heullyW lanits 24 i eSt shatl be tnsi►(ated to meet thereui ementa"o T1 S0 acclnration Ututawcul _ t'—:.,sS- --:, •� • - r----l��—r�--J— j N ....4.�� w6.. Iowa v� Ulu owk�s u� t,. - n ormenon provided on dhi6 form fs uca¢rate . and Complete. • , i certify that the energy features and peArmanre sPecificadons identified ori this Cerdficoto of C011MR,nca Conform to the mijiTirmmontc efTitla 24 Pn to l Cad 6 of tha Califwuiu Cuda OrItegUlgdons. EltIIC: Signator Noma T��6,1)MCJY- Company; ate: Addmss: I'V1 E y / • �� V� E• Awe (ZL {SS .License: C�� I ty City/State/Zip: Phone: 1 • For assistance or gvestions regarding the Energy Standardi, contact the Energy Hotline at 1-8p0-772 300. 4- . cis! ,d Hr.9 '`ON3A31S W�+!9 6' 11Ul 'Sl 'a da Bin $ CILY Or.La QuInta Du1fdln9 8r Safety plvisfon Permit # �O� P.O. Box 1504, 76-495 Calle Tampico La QuIl'U, CA 92253 • (760) 777-7012 PIJIlding Permit Applrn;Hnn and Tracking Shcct n_ ..... P U Owner'B mama: M A. P. Number; Address: �t V f Ct. ( � z.ese! MacnIgUQµ. Contractor. f .i{��-l`yyi A City K 1'�r�t�Lrii�n �F.,i.r� - Address; 6056 g .•�. (. �a y , 5jr Project Dewiption: wry, �'r, zip: Z �.5 � {� 966 State Lia # ; City Llc, #. �� y00 Arrh . RerDr., Llcelgnsn '• .. Address; City, ST, zip: Telephone: State Lir- A. Name of Contact Person; Projectt7po (eirole ouo); New Add'n A-Ja ' �ppair DOme+ j� s Telephone # of Contact Person; 86 6-6 1` Y stvrtts: a units ? Z —, 2,-7,3 Estimated Value of Prgjeot; `I 7' —Otret.lc:Ann : uu NOT WRITE BELOW THIS LINE 4 Submittal Re 'd ReetdACIDTIG Plan sets P1anrr FEFB Plan Check eubfilaea Itofi —-afbnelarat Oalae. Truss Calls. u.vf.,..•a,-...,y. ..... ....�...y.oe Orme LAcak Dppeea Amount Called Contact Person Plan Chevk Dalgn" Title 24 Wes. Plana plake$ up PI—aNt"�� I+tMn Construction plana resubmitted Grading plan � 11'Iechsnlcal 2 . "e' w reaAy R,r c'rrootiono/1lstre Subaontactor List 1�InCtrlCal Called ContactPcraon Plumbing Plans picked up H.O A. Approval Plans resubmitted ' Ciradiu� ' -a, rv, wrrecponsrtasge Developer Impact Fee plan°Utbr Fdwral Called Contaethrson Pub; Wks.A•ppr Date cePermit lssae Sehodl Peet 1 U9 'd tiOS8 '6N 3A31S NVLO:6 l l OZ 8l 'add