13-1013 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 13-00001013
Property Address: 78670 BOTTLE BRUSH DR
APN: 646-311-034-34 -000000-
Application description: PLUMBING
Property Zoning: MEDIUM DENSITY RES
Application valuation: 776
Applicant:
so
L
Tit!t
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Architect or Engineer:
. . �I
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 lasss: IASB,C10,16 cense No.: 811114
Date::3]_13 —3Contractor:
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 1$500).:
(_ 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.).
(_ 1 1, 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:
Lender's Address:
LQPERMIT
Owner:
GILBERT UNGER
78670 BOTTLE BRUSH
LA QUINTA, CA 92253
(
Contractor: D
CALIFORNIA DELTA MECHNIC
6056 E. BASELINE RD, 4155
MESA, AZ 85206
(866) 692 - 52 73
LiC. No.: 811114
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/13/13
AUG 132013 , L
CITY OF LA QUINTA
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
I issued.
y, I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
-r 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
700 of the Labor Code, I shh-those provisions.
Dater7
J 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
ofthis c unty enter upon the above-mentioned property f speeltion pu oses.
Date: l Signature (Applicant or Agent):
Application Number . . . . . 13-00001013
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 -
50GALLON/ELECTRIC (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
Permit Fee Total 11.92
Plan Check Total .00
Other. Fee Total 97.72
Grand Total 109.64
LQPERMTT
Paid Credited Due
.00 .00 11..92
.00 .00 .00
.00 .00 97.72
.00 .00 109.64
f3fn #
City of La Qu,lnta
Building &r Safety.Division
P.O. Box 1504,78-495 Calle Tampico
La.Quinta, CA 92253 • (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
6
Project Address: �g(p''Q ���Cbrtt4i aLr
Owner's Name: Ci 16grk
A. P. Number.
Address: . 7 (a 70
Legal Description:
City, ST, Zip: 6.c A 6Z53
Contractor:
Telephone: ,
Beita :a, n
Address: 6056 E Baseline Road
Project Description:
City, ST, Zip: Suite 155
mus
Telephone:
State Lie. # : 13 ( I 1114 City}Lic. #: 10400q,
Arch., Engr., Designer:
Address:
City, ST, zip:
Telephone:,':� µ y
State Lie. #c
Name of Contact Person: S '
Construction Type:. C 3(O Occupancy;
Project type (circle one): New Add'n Alter a air Demo
Sq.:Ft.: # Stories: # Units:
Estimated Value of Project: -77(p.60
Telephone # of Contact Person:%k
APPLICANT: DO NOT WRITE BELOW THIS LINE
9
Submittal
Req'd
Recd
TRACMG
PERMIT FEES'
Plan Sets
Plan Check submitted
Item Amount
Structural Calcs.
Reviewed; ready for corrections
Plan Check Deposit
Truss Cates.
Called Contact Person.
Plan Check Balance
Title 24 Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2id Review, ready for correctionslissueElectrical
Subcontactor List
Called ContactP.erson
Plumbing
Grant Deed
pians picked up
ILO.A. Approval
Plans resubmitted
Grading
M i10USE:-
'Review, ready for correetioosAssue
Developer impact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr '
Date of permit issue
School Fees
Total Permit Fees
I Pr-escripike Certificate ofCum pliance: Residential Vx`atet ljeatirle', CF -112 \[. f' -\t fl
General
F-111-
Geiieral Information
Site Address: -N(D%6 bAe bet.,tsh brushdc Firi-te Zone: 7195113
Ao"Th": This form is wity used for ulierwidit or addition ofit,wer hewin't, sYwenis.
Coutractor (Doctimentation Author's -Responsible Designer -'s Declaration Statement)
Liv -water hwter/ aml hodery fi)r borh hof 'i -we")' hl.'61601; 11ild hl-d;.!)i?iCS1W1-V Ift'ittin- Adividtfol dwelh;l� I
heuwr5 rmist he ms w- vropmw fired, wid rn-m- nw ;1.-,Av(-_vd .)0 Hij; -a-awl. Pipe insulution fi'o),t the DHIF 10 1114,
kitche-Wsj emd on till uride)-grouml hofs ityzle/- p! pes t I s required in all cumponew pewkages in u 1 dinicue :vies.
0 1 :ertit'v that the. Ciel d;: fc;Irures and oerformarlcL- riecifica;1on,, 1'()r the bUildillif desi-m i&nTit'icd on ihi, C:miiiiate of Compliance conf:(Irill
to rhe reqUil-MICII(S OCTidC -14. Parts I and 6 of!he Culitbrniu Code of Regulation;.
S identified on this Ccrtificate ot'Coniplianee.jire .�Ow;isrem with rhe information pr( -_-Y Wed to document this
*'(he building desioll fcanlrc . i -
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el"r,on:cIllent fr_,el1C,-v v*or *Woro%fl with `Ile bttildiP2 Det -Mi!
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Dkn;htriop Tvn;-
Numhrc..of .-i 'ti
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veqm•'fl Tank
Fuel Noe
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Insulation R -Valle
6056 E Baseline Rd #- 1.55
SO I
o. qb
L
Imbeam, 7'vpe 6wragO Gua, kfecu Pliny). hisuintolic.10lis, el(:%)
nitiltiole &telf "lig- wths Shg,,U file recir'. fdralon of I `.Otw. 771i' Prts-criprive requirenteiii.v do not
allow the iustullation of u. rech-culatiji,- water hewin,.v)!St0l1 fiw sin, Ie dwellina-units;
Coutractor (Doctimentation Author's -Responsible Designer -'s Declaration Statement)
0 1 ccrtiN that.ih;s Cmificaw of (.,omplianee documentation is accuraw and con)
-Win
* I :till cliz.!ibl,' undcr Division ' or"rhe Calil,).rnio BLis;twss Gild Prof`e�iolls Codle to accept nz,,sp6n.iibil is torthe buil : g dc.sign idcpaificj oil
this Cervificaic (?I C011tpiltln�c`.
0 1 :ertit'v that the. Ciel d;: fc;Irures and oerformarlcL- riecifica;1on,, 1'()r the bUildillif desi-m i&nTit'icd on ihi, C:miiiiate of Compliance conf:(Irill
to rhe reqUil-MICII(S OCTidC -14. Parts I and 6 of!he Culitbrniu Code of Regulation;.
S identified on this Ccrtificate ot'Coniplianee.jire .�Ow;isrem with rhe information pr( -_-Y Wed to document this
*'(he building desioll fcanlrc . i -
.building desi.gq on the other apphcabl.e coniplimice i . Orms, .vorksheets. calculations, plaili ill Np---'1ficat;ons iubmitud to ilic
el"r,on:cIllent fr_,el1C,-v v*or *Woro%fl with `Ile bttildiP2 Det -Mi!
N, a ill e:
S iun a ft! re: L
John Si nto;
Company:
Date:
Delta Mechanical In,:C
Address:
11 14
6056 E Baseline Rd #- 1.55
Cir;- state 71st:
Pitone:666-692-;2 /3
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