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13-1014 (PLBG)
'I. P.O. BOX 1504 4 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Application Number: 13-00001014 Owner: Property Address: 79635 CETRINO KELLY DOBBS APN: 772-330-034- - - 79635 CETRINO Application description: PLUMBING LA QUINTA, CA 92253 Property Zoning: LOW DENSITY RESIDENTIAL ( Application valuation: 1067 Contractor: Applicant: Architect or Engineer: CALIFORNIA DELTA MECHNI 6056 E. BASELINE RD, #1 MESA, AZ 85206 (866)692-5273 LiC. No.: 811114 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. License � lases: ASB , C10, 16 License No.: 811114 Date:4 (,3 /3 Contractor: qi*_ �T 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 ($500): (_) 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.). (_ 1 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.). (_ 1 I am exempt under Sec. , B.&P.C. for this reason Date: Owner: CONSTRUCTION LENDING AGENCY 1 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: I,QPERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 8/13/13 1PA 0 1 _-) AUG 13 2013 CL NC 5 CITY OF LA QUINTA FINANCE r)FPT. WORKER'S COMPENSATION DECLARATION 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 performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier STATE FUND Policy Number 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' compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Section a370 0 of the LaborCoe,all forthwith comply with those provisions. Date:Applicant: 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 c9unty tj enter upon the above-mentioned property f action urposes. Date: ignature (Applicant or Agent): ' 01 Application Number . . . . . 13-00001014 Permit . . . PLUMBING 2013 Additional desc . . Permit Fee . . . . 11.92 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 0 Expiration Date 2/09/14 Qty Unit Charge Per Extension 1.00 11.9200 EA PLBG WATER HEATER/VENT 11.92 ---------------------------------------------------------------------------- Special Notes and Comments WATER HEATER CHANGE OUT - 48GALLON/GAS [2008 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL ' INSPECTION. 2010 CALIFORNIA BUILDING CODES. --------------------------------------------- Other Fees . . . . . . . . . PERMIT ------------------------------- ISSUANCE M/P/E 90.57 PLAN CHECK, PLUMBING 7.15 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 97.72 .00 .00 97.72 Grand Total 109.64 .00 .00 _ 109.64 LQPERMIT MR Din # P rmit # Project Address:–r(A5 Cek Qty Of ,La QUinta Building &r Safety Division P.O. Box 1504,18-495 Calle Tampico La.Quinta, CA 92253 • (760) 777-7012 Building Permit Application and Tracking Sheet • nn Owner's Name: W I Do b A. P. Number: Address: (03 a r' ne --.._........_..._......._..._-......._.._.._.._........_........-........................_...._................_........._._.._...._.._.._....__:__.._..:.—� Legal Descnpnon:.._,.......,........ Contractor: we - -------_ City, ST, Zip: (,,a QWok& aas Telephone: -: . Address: 6p% E egL%jirw. R© Project Description: PC P, gat 6) City, ST, Zip: Telephone: a910'(dV - `x'73 „ = i^:z . "1' '� State Lic. # : City Lie. S: 16#400y Arch., Engr., Designer: Address: City., ST, Zip: Telephone: State Lie. #: (� :�, .. s.` £>u .., a ' 't' Construction Type: C 3(o Occupancy: Project type (circle one): New Add'n Alter a a' Demo Name of Contact Person: Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: &(.-vqq-W'73 Estimated Value of Project: S APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACICTNG PERMIT FEES Pfau Sets Plan Check submitted Item Amount Structural Cases. Reviewed, ready for corrections Plan Check Deposit Truss talcs. Called Contact Person Plan Check Balance, Title 24 Cales. Pians picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2`a Review, ready for correctionsrssue Electrical Subcontactor List Called ContactPerson Plumbing Grant Deed Plans picked up 5.11�.L ILO.A. Approval Plans resubmitted Grading IN ROUSE: '^' Review, ready for correctionsflssue Developer Impact Fee Planning Approval Called Contact Person A.LP.P. Pub. Wks. Appr ' Date of permit issue school Fees Total Permit Fees Prescriptive Certificate of Couipliance: Residential 'A'ater heating CF -117-:1[, General Informatimi Site Addrc.is: -Mas ce4uino Zone: 15 Date: q .VOTE: This form 4% anlY used fiff alteration or addition ofivater heathjti �rsttentv. WATF.'R If F,'ATING and hoi fiw it `,j tvajei ii -w Individual d1vt,111)1t., W -11V 11, 1 bolif cfimwslic it,)[ ttawr ;D[PUj heater.; cmd i'll cal. ha u!cr.i allisl kic u), propaw lhvd, and mar nw E'vctavd 51) vahlons. Hot Wirtt:T pipe M.vdation fi*0111 the DHfV hemer to the hichewsy and on ,-I!/ undej-1vound but.archer Pipes is requii-ed to al/ con't-ponew parka vs.in all climate _-6)1eS, E'neruy !"actor or co -the requirernews of [,itic 24, Rartt:; I and bofthe California Code o(R.-IlLikififIll..". W-p-cr 1+ w- 'Yvt,ti M I'. (• Thtmn-fl Fvorn.-)l T!,111k Fuel T`ine i F. fficiencv 111SUIAtion R- `• GAS ST> 1 LIS J-Aln Salltoe Indicate Z'V!?(f 6101-a".2 Gas. Heea Puma butfintalle(31IS: 51;V0H.;A!/,'!/W m1drip"", &I e - /1.)wfis .4111'11. MLV! 11VC1_6 6pnis ofitjol i. The Prescriptive I rentel its do not 71 "IC IVC' vliPeMe a//Olt, the installation 01,14 recirculating water heathig, Y)vem 10r sin to divellin", 1111it'1. Contractor (Docufflenta*Uion AL11th.ors "Responsible Designer's Declaration Statement) 0 1 i.:t:rtify that this LS 3CCUracc jild Complete. 0 1 d1l) ell"'i0le Under Di -;Sion 3 of the California BuSines, 1110 n< (Node vi acc-CI)l 1'eSI)O11;ibih(.V tor d1C !)UikFndesipi idennOcd -.in this Cerliticale ol'Compliance. 0 1 cvrfif.v that the Lmergy fc;iujrQ.s iind perforniancc 5peciNcaomis f6r the builchm, de.;i-an Wentifi-ied tin ihi; Ceri:itica're ofCtiniplif.111ce COM' atilt co -the requirernews of [,itic 24, Rartt:; I and bofthe California Code o(R.-IlLikififIll..". With cllc int" [!kill r..! c • The bUildin-2 desi,-ni l'eaturcs identified on t11's Cervi.ficatc of Coniplimi%:ere, con -isiew 0!111� 'd d fo ch"Cumen( this bt.fildilh'. kill !11%: Q(hCr ill)PliCiII)IC CQ111pli InCe torm, �.vork., -111S -ind Nui)l litic Aleet.S. OdIC1.11,Uit)(1-1. DL -pccit k: d to the )k -jm1ro,:--.iI kvith this !1crnm ion. Name: Si."MItUrc: J-Aln Salltoe Company: Date: „''z3 Delta N"Iech"allical Inc liq Addi-c3s: License: S I 1114 6006 E Baseline Rd = 1_iti cky-sila(e-zill: Phonc:Nbo-092-D2 i3 X; 1'� c q. A 7 ; 12 ; I i) K �.� ! .�t..l..� l t(►,\ (. 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