13-0865 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
13-00000865
Property Address:
52610 AVENIDA OBREGON
APN:
773-285-006-5 -000000-
Application description:
PLUMBING
Property Zoning:
COVE RESIDENTIAL
Application valuation:
1136
c&ht 4,.4 Qubm r-"\
BUILDING'& SAFETY DEPARTMENT
BUILDING. PERMIT
Owner:
NANCY JAVITCH
526,10 AVENIDA OBREGON
LA QUINTA, CA 92253 ffD
(774)000-6063 r
Applicant: Architect or Engineer.
LICENSED CONTRACTOR'S DECLARATION
I -hereby affirm under penalty of perjury that -1 am licensed underprovisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professionals -Code, andmy:License is in full force and effect.
License_asss/:- SB, C10, 16 Lic nse-No:: 811114
Date:4• 4 3 Contractor:
OWNER -BUILDER -DECLARATION
hereby affirmunder penalty of perjury that I am exemptfrom the Contractor's State Liceme,Law for the
.following reason (Seo. 7031.5, Business and Professions Code: 'Any:city-or,county thatrequires 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 siatement.thai he or she is licensed pursuant to the provisions of the Contractor's State
."Pcense Law (Chapter -9 (commencing -with Section 7000) of, Division 3:o0the'Business and Professions'Code) or -
4ihat he or she is exempt therefrom and the basis for the alleged ezempti6n. Any violation of Section 7031.5 by
?any applicant for apeeTit subjects theapplicant to a civil penalty -of not more than five hundred dollars ($500).:
I,.as owner ofthe property, or my employees with wages as their sole compensation, will do the work, and
the structure is not infended•or offered for, sale (Sec° 7044, Business and Professions`Code: The
nt,
Coractors'. State License Law does.not applyto an.ownerof property who builds or.improves thereon,'
and wtio'does the -work himself or her through his or her own employees, provided that the
improvemare not intended or offered for sale. If, however, the building or,m
.improveent issold-within
one year_ ents
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
puisuant 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
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (160) 777-7153
Date: 7/11/13
Contractor:
U JUL 16 2013 U
CALIFORNIA DELTA'MECHN{CAlawO.FLAQUINTA
6056.E;. BASELINE RD, #155 FINANCEDEPT.,
MESA,. AZ 85206 -
(866)692-5273. }
Lic.."No.: 811114
WORKER'S COMPENSATION DECLARATION -_
I hereby affirm under penalty of perjury one of the following declarations:
I have and willmaintain 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 numberare: <
Carrier STATE FUND +.- P.olicyNumber `: 1697823-11
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' compensatiomlaws of California,
and agree that, if I should become subject to the workers' compensation. provisions of Section
700 of the Labor Code,Ia al . forthwith comply with those provisions. -
D atee711Applicant
`
r � w / u Applica�, r .
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 1$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 forthon 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, eatih- grees 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 cou y to a ter upon the above-mentioned propec(�tv/111_II/n1 n'sp/ection purposes.
Date ignature (Applicant or
Application Number . . . . . 13-00000865
Permit PLUMBING 2013
Additional desc .
Permit Fee . . . . 11.92
Plan Check Fee
.00
Issue Date . . . .
Valuation . . .
. 0
Expiration Date 1/07/14
Qty Unit Charge Per
Extension
1.00 11.9200 EA PLBG WATER
INST/ALT/REP
11.92
----------------------------------------------------------------------------
Special Notes and Comments
WATER HEATER CHANGE OUT - 40GALLON/GAS
(2008 ENERGY) CARBON MONOXIDE ALARM(S)
TO BE INSTALLED PRIOR TO FINAL
INSPECTION. 2010 CALIFORNIA BUILDING
CODES.
----------------------------------------------------------------------------
Other Fees . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
.PERMIT
ISSUANCE M/P/E
90.57
Fee summary. Charged Paid
-------------------------------------
Credited
--------------------
Due
Permit Fee.Total 11.92
.00 .00
11.92
Plan Check Total .00
.00 .00
.00
Other Fee Total 91.57
.00 .00
91.57
Grand Total 103.49
.00 .00
103.49
LQPERMIT
JUL/11/2013MU 11:00. AM DELTA MECHANICAL -NU FAX No.7027369-95TE F.002/003 '
Bltr #
City of La -0a ita
Bullding ff Safety-Pylslon
P:O: Box 1-504, T8 495 Calle Tampico
CA 9,2253'- (T60) 7777012 .
Building Permit.Applicadon'and Tracking Sheet
Permit #
�La.Quinia,
' Q
Project Address; 5,%16
�Owher'sNama:
A. P. Number:
Address: �jei(O(G iCJ[Q. A
Legal Description_
Contractor:
City; ST, Zip: a
Telephone:
Address: PPS
Project Description:
City, ST, Zip: A 2 g5a0(o
Telephone:
State Lic..# : 19,11liq City Lie #;
Arch., .Engr., Designer:
Addross:
City, ST, Zip:
Telephone:
C6n5huction'Type: • Occupancy:
Prgject type (circlo one): Ncty Add'n Alter a air Demo
State Llc. #:
Name of Contact Fersott:
Sq.'Ft.: #Stories: td Tlnit�:
Telephone # of Contact Person: 4 13 '
£stlmatcd 'Value of Project:
APPLICANT; DO NOT WRITE BELOW THIS EINE
d SobmidAl Re 'd Reed TRACIaNG PERMIT FEES
Flga Sets
Flan. Check submitted
Item Amount
Structural Cala.
Revlewed, ready Tor correcdlons
Plan Check Deposit
Truss Calm
Called. Contact Person
Plan Cheek Balance
Tide 24 Cala.
Planta plcked'up
ConstrucooR
Flood plain plan
Flans resubmitted
Tvfecharilcal
Grading plan
Z°aRevlew, ready for corirections/issue
Electrical
$nDLontAGlUr Liat
Called C0UtUCtPer6an
Plv nmb!ng
Grant Decd
Plans picked up
S.M.I.
IMA. Approval
Plans resabruitted
Grading
IN IIOUSR;-
Jd 1hvlew, ready for corrcctlonstttsue
Developer Impact dee
Planning Approval.
Called Contact Pcrson
Pub. Wks. Appr
Date o{petwit issue
Scho l Fees
Total Permit Fees
JUL/11/20-13-VTHU 11:01 AM DELTA -MECHANICAL -NV FAX N,,,.702-369-957E�i P.003100131
Prescriwive Certificate ')f Con a w; CF -IR -ALT -MI
n0ance: Residential Water t -le ti -
Gericrul Information
Site -\d(IrL,,.S:% . 610 10 6E r\ Urnace Zone: Date;
NO TL; This fwwi i80111): 11-Y-1fiP- (11tel'(16w, /,, tt�odidwt nf-urer heutiliz vj vrellis.
NVATER
Lie/ u utr A.,,alvri 41rd
[he DHW Cha'tlan" (11141 l7lu". ri'll L,
I . . . . .
k�rchL�alil and on (W twelel-I uund hot plpt!.5 t.Y re(jull""d in all t all dillicit,!
Every,, Factor --�r
T h -r --,l I Ferrmit I T*
Fuel Tvue ( S tandard i- I Val) _EffLLj n (, v InSUlaciori R-Vakh!*
GRS SZp 1 46 0, sct
du "llill; wilu Shall i7levi tile The Preyeriptive reflilipelileilits do nut
alt,),v the installution of a reeireulating it-uter heittiliz 5L N:re'llt �nrsbnile divelling fillits.
Con -S tatLIment)
Contractor (L)ocumexitadon :Moes /Responsible Designer's Declara clon
ccrtic,,- that this CertiCivate oVChjnpjjjtnk;C I1)CLl111fnt;ktjOrl i.i accurate und z(1n1p1C-,,-.
-)t for the hl.lildill-V deSi2ll IdePlifict.1 ('11
and Prcj(k:��ions Cod,: to accept under Di,. i�ion I oftie Cjlit�,Mi.l BLL,4t-,' i
this Ccrtiricuw eieCornpli-ancz.
1 ;crtjjr, That th,: co-ler2-1 eaacttr=s ava pel-Ti)rm-UnL;: ;Pecificotivni Cor the buildkv� dc-3ivi idelltificd on (bi, cdri,-ICUE,� ofcompi;.in,:. ;L)11,orm
to the requir--n-ftents of iric 1-4. Kiri t Ind 6 of the C;lfifomia Codc or Re'julations.
'The bUildirhZ dSi2n fCUtU(eS idl;ntitlej oil dik ccl-rificale of complia(jCe -Irc with dle infor-nddt.10 P'-O;idcd it) d'Nument t1117
oil 6t: (slier IppjjCt1111C tbrnizs. work.hcci,. calculat:,xis. pldu6 and ip 1i0n5* iubinic(CO to
the
Qe=
Si-:!.mkture�
JA Sante,
Company::
—11 .'711
Li-cns�: LS I I 114
6056 E Baseline Rd -- 15-5 Phone
ciry sckice-zip:
Mesa, AZ 85206
n
1UL/11/2013/THU 11:0-0 ASI DELTA MECHANICAL—NU
FAX No: 702-369—'3578
California D, Oita
60.56.E B�os.ejine Rd -#155
Mesa, AZ.8�5206c
Facsimile Transmittal
TO: City of Xaa Qu.iuta DATE 07/1.1/13
FAX NUMBER: 760-777-70 11
P. 0011/003 .
NUMBER OF PAGES 3 (including this page)
❑ URGENT ❑ FOR REVIEW 0 PLEASE COMMENT ❑ PLEASE REPLY ❑ PLEASE RECYCLE
Please Adv when. ready so I can adv runner
Thank you,
John Santos
California Delta Mechanical, Inc.
Nevada Delta Mechanical, Inc.
1-866-692-5273 Ext 236
Johns@deltamechanical.com