11-0766 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number. 11 -00000766 --'--
Property Address: 48731 SAN-VICENTE ST
APN: 646-140-007- -
Application description: PLUMBING
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 809
c&44t 4 4 Q"
Architect or Engineer:
�lp
------------------
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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 lass: 10 C20 C3 license No.: 811114
tractor:
OWNER -BUILDER DECLARATION
1 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).:
(_ 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.).
(_) 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
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: A IA
Lender's Address:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
ROBERT BIRKLE
48731 SAN VICENTE STREET
LA QUINTA, CA 92253 t
Contractor:
CALIFORNIA DELTA MECHNICAL INC
6052 E. BASELINE RD, #155
MESA, AZ 85206
(866)692-5273
LiC. No.: 811114
U
JAN 1 � 201
r•Itat:�SGs: t�Fp�; ITY OF LA .4
------------- - ----
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.
Y -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
700 of the Labor Gall fo�hwith comply with those provisions.
ate: F-T -01 a Jam{
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 c mI t enter upon the above-mentioned property ins ecti ses.
Vate: I / ignature (Applicant or Agent):
11
Application Number .
. . . . 11-00000766
Permit
PLUMBING
Additional desc .
Permit•Fee
22.50 Plan'Check Fee
5.63
Issue Date
'Valuation . . .
. 0
Expiration Date
2/15/12
- Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 7.5000
EA PLB WATER HEATER/VENT
7.50.
Special Notes and Comments
REPLACE 38 GALLON GAS
WATER HEATER. 2010
CODES.
--------------------------------------------------------------------------
Other Fees . .
BLDG STDS ADMIN. (SB1473)
1.00
Fee summary Charged
Paid Credited
Due
Permit Fee Total
22.501 .00 .00
22.50 ;
Plan Check Total
5.63 11.00- .00
5 63
Other Fee Total
1.00 .00 .00
1.00
Grand Total
29.13 .00 .00
29.13
LQPERMIT
0
CkY Of ` La Quinta
Building &r Safety plvlslon
Permlc #P,O. Box 1504, 7&495 Calfe Tampico
U QulnU, CA 9,2253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Project Address; .
Owner's Nerve:
A: P. Numbor:
0 'd 56.88 'ON
Total permit reaq
1UAMIN H113a' NV60:1l l 101 '8l 'lei'..
Address: y 73
-
Legal Descri tion'
Contractor:'
,.
City, ST, Zip: [�
,
C� ul.
l,v�" LA Gl
� Ca
'Pelaphone;
Address:6CJS' , g�7
.S.'
. Project X)eacriptlon:
City, ST, zip: Z
�52PJ 6
2
Telephone:
State Lia # ;
City Lio, dk /0L07
Arch., Bngr., Designer,
Addrese:
City, ST, Zip:
Telephone:
Conatmation Type:
Occttpanoy;
State Lio. dA;
'
Namo of Contact person: �%
/�,, �
Project typo (circle one); New Add'n Alter �.epair I)edrle
•
A
Telephone # of Contact Person: p 6 6-6 --� J�Z� 3
#Units.
-------
.
Bstlrimsted value of project: ' � 3
,
A LICANT: DO NOT WRITE BELOW THIS LINE
# 'Submittal Re 'd
Rebta
I
TIUCMNG
Plan Seta
MR heck submitted
Y$Rl4IIT 8
Structural Cates,
RvAcwed, ready for corrections
Item
Amount
iYusa Cglea.
Plan Check Depaelt
Called ContactPersou
Platt Check 13alance•
Title 24 Cala,
Plane picked up
Blood plain plan
Plana resubmitted
Conatru don
Grading plan
Zed Review, ready for correctione/tssue
Mechanical
13<lecerlcal
Subcontactor U'st
Called Gbntact Persen
Grant Deed
Plana nicked up
•
Plumbing
Ti3O A. Approval
Plana resubmitted
8.M.1.
)lY HOU811;. '
'.r0 Review, ready for carver (fen
Grading •
Planning Approval
Celled Contact Person
Developer Impact Fee
.
Pub. Wks. Appr
Date of permit Issue
A.I.P.P,
Schodl Feel
0 'd 56.88 'ON
Total permit reaq
1UAMIN H113a' NV60:1l l 101 '8l 'lei'..
Prescri tine Certificate of COm fiance: Residential Water Heating
CF -1R -ALT -WI%
General information �.
Site Address;
C11matezone: 16,bate: l°+3 Zb�l
NOTE: This orm is only used r alteration or addition o water heatl s sletrzs.
WATER BZA '
List water heaters and boilers for both domestic hot water (DHS heaters and anic
heaters must he as or propane hydr space heating. Indtvfdual dwelling DHW
g P P fired, and stay. not exceed S0 gallons. Hot water pipe insulation ftom the AXE heater to the
kitchens a7td on.all underground hot water ias is requited in all coonent Pao CIS in all a/imalfs sones,
Water Heater e / Energy Ftactnr or
'P Distribution
Number of Tank Capacity Thermal gx Tank
I
Poet el S tem
qS Sisndard l O20 1 Afftoi Dv lataionR-Values
6.
1. Indicate 7ypa (S*rgge Gas, Xeat Pump1 lnstaataneous, eye)
3.90 affd10ttag �� ff at! wing mulHpla dwelNng units shall meet the recirculation regtriremahts of 1s0(t). h cr tr n
re ' utak Water heatht !hr aintr/e d►vsll o "Pay
°
3. The water haaBng lank and pipes shall he tratulated to meat the requirements of 1 i0q).
Contractor ocumezrtatlo>a Author's /Responsible Des1 ner's Denlaratiom Statement
• I certify that this Certificate of Compliance documentation is accurate and oomplate.
• I am eligible under Division 3 of the California Business
and professions Code to aecopt responsibility for the building design identified on
this Ceti floats of Compliance:
• I certify that the energy ftatnras and performancesPeciScations for the
bmVzg deslga identtfred on this Crrtifcate of Complimee conform.
to the requiremeWB oPTitlo 24, parts 1 and 6 of the CaUhmia Code oPlLagtilatlons.
The Wig design ibatures identified on this Cartigeate of Comppsnee an ransietent with the information provided to doctrma� this
building design on the other applicable eomplianoo forms, worksheets, calculations, plans and spaoifieationa submitted to the mens this t
a c fbr a roval witty thia buildin emiit appacation,
Nome: IL
)f 3ignatt>ra:
Compaay:Callf0mle Delta MeGhIidcaf
Date:
Address 1�
'8056 E, gaselln9 Rd., #465 License;
811114
Ci7/9tet0zip:Me13a., AZ 86206
Ph°ne:86113-882-5273
,2008 liesldenlial Co,npflarree Forms '
March 2010
S/S '.d S688 '4IN 1UINMD Villl
NV60:I1 -1 1.0Z '.81 lIP