12-0270 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
.. t --w
1000270 }
55070•RIVIERA
775 -153 -070 -
PLUMBING
LOW DENSITY RESIDENTIAL
1147
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
JEAN YUROSKO
55070 RIVIERA
LA QUINTA, CA 92253
Contractor:
CALIFORNIA DELTA ME
D
6052 E. BASELINE RD, {#{15
MESA, AZ 85206' I
(866) 692-5273 CIY'YO L-A QUINTA
/ -------------------------------------------------------------------------------------------
Lic•. 'No.: 811114 F).iayS't_}
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 C ss: C10 C20,,C3li[ 'ce a No.: 811114 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
ate: ntractor: 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 1697823-11
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 70001. of Division 3 of the Business and Professions Code) or 1 X700 of the)-abor Code, I shall hv✓ith 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 �7
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: D e: J pplicant: .
1 _ 1 1, 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: F IL E 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.). IAPPLICANT ACKNOWLEDGEMENT
(_) 1, 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 permit subject 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 at whose 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,
(_ 1 I am exempt under Sec. , B.&P.C. for this reason the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Ouinta, its officers, agents and employees for any act or omission related to the work being
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153 '
Date: 3/21/12
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:
LQPER.MIT
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 thi my'tb�';,rr:upon th above-mentioned property for ' tion purposes. ,
te:r?'�-F�"-"' gn re (Applicant or Agentl:
Application Number
.12-00000270
Permit . . .
PLUMBING
Additional desc .
Permit Fee
22.50
Plan Check
Fee
5.63
Issue Date . . . .
Valuation
. . .
0
Expiration Date
9/17/12
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.
:
------------------------------------
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
F
Prosect time Certificate of Com 11&aee: Residential Water 1-Teati12 CI'_IR_A-LT_FVh
General Information
Site Address: [j
�►'�/1 Climate Zone:
NO 7M, This ern is o)rly �rSed for a/terarrn. . ,.,ra:d: .. _p_.._._.
Dflte; � Z•1 /Z
WATEP, $EATING
List water heaters and botlent for both domestic hot water (DHWJ heaters and hydrontc space heating. )rdm. dual dwelling DXiW
heater s mum be gas or propane fired and may not exceed 50 gallons. Hot
euc,kenwater. pipe tr,,st{[mon
(s and on all tmdergrourtd hot waietpipes rs re iy ed in all co firom the DHW heater to the
component ackages in all climate cones.
Water Fisater Type / �Distributola e .S em Energy Factor or
1hael e' (Standard Number oz Tank Capacity Thcrmat l xtemal Tank
aft Standard l�p_ a Eficiew InsulerionR-Valuc'I
6
1. inatCate type (Storage Oros, Flsat pyo — -
2. Recurcu rrwdm+Ybt+eous, etc)
not rrltaw imtallmtio parr rrll dwelling units sha11 meet the recirculation r ubbemeppi o 150 n , e
rytxter ea ' e4 1 �) EYP sscriuit've requirements de
3. T §a water heAtvrg tank and pipes shall be theulated to meet she m uirem&ju o ISO ate,
q>r Gl-
Contractor (Documentation Aigthor's /R onsible Desi ex's Declaration Statement
Y certify that this Certifrcatr of Coawli nee documentation is accurate and c
• I am el'gt'hle under Division 3 of the C omple[e.
this Certiampliance,
cate of Co d= Bnsuiess and professions Code to accept tesponsrbrliry for the bwlding design identified on
• I certify that the energy feawrm and per!brn=co specifications for the building design idautiffed on this Certificate of Compliance conform
to the requirements of Tide 24, party 1 and 6 of the Califomis Code of Reffu arims.
• buil iagdtng design feather ppacfied o12eo this CertifiCata of Campliance are etrasisteat with the infornta8an pmVidad to documFnt this
bnildiug design ea the other applicable e
a ea for a rovgl WIC bttildm ompliance farms; wo;kaheets, calculations, plans and specifications submitted the
Mit a plication. cnforccAcnt
Name, /i(f
Comnauy Califomia Dalta Me anlcal
�ddxcss:8056 E. easellneRd., #155
Cirf/StaWZip:Mei AZ 85206
ties:dent:�l Co:npr�anca C',rnu
sigouare:
Date. . r l 2"
Liceasa:8 j 1114
phone:866-692-5273
600A00 'd 8L56-69E=ZOL 'ON Xdd AN—IVDINVH03W V113Q
March 201
Yid I E :10 QHM/Z I OZ/d zAvw
Bin #
ty ®f La Quinta .
Btl11d1ng 8r Safety piv/s/on
Permit #f P,O. Box 1504, 78-495 Calle Tampico
�r1 4 Qulrna, G4 92253 (760) 7777012
V Building Permit Application and Track ng Sheet
Pr*ct Address:e, ro
Owner's Name.. Git"t7 j k�
A. P. Number.
Address:
Legal Description: 'City, ST, Zip- �� �%ys, G) z
L)q rlw6 j
FO
M*
600/900'd USG -696 -ZOOM M
TOW Pdrmit Bees
AN—IHDINVH03W V113a Wd IO:IO QHA IOZ/IZ/M
Contfsbtor. (�(�1 l�� q GQ
MEME
Ad dross:
Projecibescaiption:
City. ST, Zip: / Le's Z gJ ZO6
Tolephone;
State iia. # : City QQ
Arch'., Sngr., Desigtler. :.
Address: >
City, ST, Zip:
Telephone:
Cotlsttuction *pe, Occupancy:
State
I ic. #: Project jape (circle one : Neµr Add'n Alt' - ,apeir Demo
Name of Contact P "
erson: V7 S Pt:
v
4- # 3tnfios: tl Units:
Telephone # of Concoct Person:
/
--------
----- Value of Project
APPLICANT! DO NOT WHITE WELOW THIS LINE
# Submittal Req'd IEiec'.d TRAC IG
PLRAIIT FEES
Plait Sets tPianheck
submittalItem
Amount
9trnet4ral Gales, avewc4 regdy for correedone
Plan Cheek Deposit
Truss Cabs.
Called CantaCEYcrson Plan Check 8alsnce
11([e 24 Gales. Plana piekC d up
CoUstruetion
Flood plain plan Panna resubmitted
- Mechanical
Qrading plan 2A1IZeview. ready for uorrcctipbg/tssue
. 1�lectrleal
Subeonisetorlaat Called ContactFereon
.
Plumbing
. GrantAxd
•
Plans picked up
s2KI.
11 -0 -AL Approval Pians resubmitted
Grading
Ii`l1;OUeE; '' RSview, ready for correctlons/Issue
Developer Impoetizee
Planning Approval
Called ContaetPerson A.LP.P.
Pub. Wks. Appr bate of permit issue
Scho6l fees
L)q rlw6 j
FO
M*
600/900'd USG -696 -ZOOM M
TOW Pdrmit Bees
AN—IHDINVH03W V113a Wd IO:IO QHA IOZ/IZ/M