12-0272 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: J2 -0_6066272_ ---
Property Address:. 79828 OLYMPIA" FIELDS
APN: 775-051-029- -
Application description: PLUMBING
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 941
Applicant:
Architect or Engineer:
rIP(
4
BUILDING& SAFETY DEPARTMENT
BUILDING PERMIT
I
MAR 2 6 2012
CITY OF I.A
--------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that 1 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.
Licen a ass: C10 C20 C3 License No.: 811114 .
ate: Contractor.
- 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 contractors) 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:
Lender's Address:
LQPERMIT
Owner:
DOUG DICKINSON .
79828'OLYMPIA FIELDS
LA QUINTA, CA 92253
:ractor:. .
IFORNIA DELTA
2 E. BASELINE
A; AZ 85206
6)692-5273
. No.: 811114
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/21/12
MECHNICAL INC
RD, #155
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WORKER'S COMPENSATION DECLARATION
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
22 % 700 of the Labor Code, all orth 'th comply with those provisions.
ate:J N7pplicant:
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, indemnity 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
oI t/h�'a'c my to enter upon the above-mentioned property m pectin purposes.'
a(7 te215
:S' ature (Applicant or Ageritl:
Application Number
12-00000272
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 w l CunuueiiLs
spe
----------------
INSTALL NEW 48 GALLON
GAS WATER
HEATER.
2010 CODES.
-----------------------------------------------
Other 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`
Prescri Cive Certificate of Com BaCte: Residential Water Hearin-CF_1R :Ai,T;ti'(/
Genera! ZnPormarion '
Sire Address:
�i S 1 Climate Zone:Date; -m 75
--
]VOTE.- This ore is only used or rtltetation of ad?ition n w6ter h¢arin s steiiu.
WATER SEATING
Lisr water heaters zad boi!ers for• both domestic hot waxer .
.eaters must be gas or rro dere. r t�� heaters and hydl onic space heeling: �ncavidua! dwellingDHyy -
p P fi eta artd may trot exceed 50 galla, Hot water pipe insulation from lice DHW heater to the
', itchen(s) cmd on all undtrg�orard hot water p' es is required in all ra onentpaekages in all crimare acnes.
UNater Heater Type / DistributioEnergy Factor Or
n
iniel e' Standard? Nlmlber of Tank Capacity Thennel Ext -mal Tank
L� Standard
System 1) Efficiency 0nonR-Va1uc'
B 0,
1.Ittdkate Type Morav Gas. 13'eafpurnp. Xnrranrmreous, etc-)
Z Rectr=daaYw sy.Ptew serAI multiple dwellfr,
not trllaw tha outalTarion of a recircrrla8n g 1tAq sl. meet the reeircu/atton tetivv e�rer pf 1SO�ir). Tne Preset! lists. r u " en da
L w••rai heaptinv stem for? 111 Qwelltn utat
3. �.,� rvurer neartrrg ratrtr andPrpey shall be insulated to me
et t%e regmigmerrts of XSDG). ' -
Contractor (Docum.eatation Author's /Responsible besi
giier's Declaration Statement)
' I cetify that this CfttL6mte ofdoutpliauce dncumentatiotiis aecarate and complete.
• I am, eligible Under Divisinn 3 of tho California Buaincss and Pmfessians Code to eaccpt rr6 onar'bility forthe ��S design i dentified on
this Certificate of complierce.
• . l cemfy that the energy featares and performance apeeificatioas for the building design idanD.fied on this Certiftcale`af Comp]iance canfo�
!o the requirements of Title 24, Perls 1 and 6 of the Californiri Cada ofRegulaliona.
The draign features identified ori this C`-erQ cste of Compliance arc consistent
banding design on the other applicable con pliance with the infv�ation provided o doctimew thia
a cit Sr a roval wifii This b forms, v="hects, ealculatieaa, plans and epecificadona submitted m the �`oznemenY
wlding merit a olicatiori.
Name.' I
O/,^/tA a�,Jk Signatrtte: -
Coapan. ;California Defta MB anical
Dais: �1 ZDI'�• -
Addreas:5056 E. Baeellne:•Rd. :�15S -
- . License:811114 •
City/Statelzip:Nlesa, AZ 85208 .
Phone:866-692-5273
^J+� 2esiderrti.r: Ccn,?,?QncaFornts • .
• Alfarch 2010
•600/900 'd 9L56-6.99-ZOL 'ON Xdd AN—IVDINVH93N ME Yid K: 10 93AM.OUIZAM
Cin
OtY. of La C uln a
- Building 8z: Sal`eiy Division P0 '9 ...
Permit #P.O.
a /7 �
Box 1504, 78.495 Calle Tampico
! a Qu t'a, CA 92253 ��
� �
- (760) 777-71 #
BUIldtng Permit Appitcation and Tracking See
Project A ddtess: Z'
i'71
O Wner's Name: v ,
A- P. Number-
Address: / v
Legal Description; :�1,t�j j�aJ
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ST, Zip.
City, G'/'7TYj Z GJ
Contractor: l�t�l� v/`%�-1'
rjQ
Telephone: �'!S`►t S� jA s
Address:
ProjectD6scription,
'
City, ST, Zip: •
.
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Tafephone: ?66 -(q2 — 3
State Lie, # : `a l,
Ciry Lie. #;'0 y()[7
)rngr„ Designer:
.
f
IArch.,
ti
Address: '
City., ST, Zip:
Telephone:
Construction T e;
yP Occupancy:
State Lie. #: _
Project typo (circle one): 14w Add'n Pit repair Demo
`
Name of Contact Person: i
/' �O TI
/�� (M^l�.
Sq_ Ft:
�
#Stories: #Units
Tel ephone#of Contact Person X6 T1-61 7757--�3
Estimated Value of Project; -17y//, .
APPLICANT: DO NOT WRITS 13ELOW THIS LINE
#
submitral
Jlteq'd
Reced
TRA.C933iG
PFRAII�F S
Plan Sets
Plarx Check submitted
Item
Atnoant
Structural Crites.
Reviewed, ready for corrections
Plan CheckDepo.-,it
Truss Cates.
Called ContactPorsou
plan ClteekBslarse
Title Z4 Calcs.
Plans picked up
Consfrvetion
Flood plain plan
Plans resubmitted
Mechanical
Grading plan' .
r'R6--V(tw, readyfor corteetionatissue
tlectrlcal
Subcontactorlliat
Called Con(•aetporson
plumping
GraotDeed
Plana picked up
-
y M.I.
H.O.A. Approval
Plans resubmitted_
Grading
M Sov8PL:
ReAw, ready for correctiamilssue
Developer Tmpac: Hee
Planning Approval
Called ContaerPerson
Pub- Wks, Appr
Dafe orpermlt Issue
'
school Bees
Total permlt Peer
600/ 00 'd
HS6-696-ZOL 'OH Xdd AN-1VOINVH03W.V11311 Wd• 0£:1O 93MAIWIZAM