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12-0701 (PLBG)-41 P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: G12 X0.0.0.00.7.0.1: Property Address: •54945 AVENIDA VALLEJO APN: 774-301-020-10 -000000- Application description: PLUMBING Property Zoning: COVE RESIDENTIAL Application valuation: 1025 T4:tit 44Q*rw BUILDING & SAFETY DEPARTMENT BUILDING PERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760).777-7153 Date: 6/25/12 Owner: MARY LOU PORTOLESI 54945 AVENIDA VALLEJO LA QUINTA, CA 92253 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. Lic nse Class: ' 10 C20 3 License No.: 811114 ' Date: L96/tractor: 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).: 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 - 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 theburdenof 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.). (_ I I am exempt under Sec. , B.&P.C. for this reason Date: Owner: CONSTRUCTIOWLENDING AGENCY I hereby affirm under penalty of perjury that there is a coristruction 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 Lic. NO.: 811114 MECHNICAL INC RD, #155 ------------------ 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 IPolicy 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 shall Jayfffi-with comply with those provisions. ate: pplicant: 6V 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 anypermit 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 s couQty to ter upon the above-mentioned property for 'r action urposes. >r�� / "g ure (Applicant or Agent): Contractor: • Architect or Engineer: CALIFORNIA DELTA 6052 E. BASELINE MESA, AZ 85206 . Pi (866)692-5273 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. Lic nse Class: ' 10 C20 3 License No.: 811114 ' Date: L96/tractor: 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).: 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 - 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 theburdenof 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.). (_ I I am exempt under Sec. , B.&P.C. for this reason Date: Owner: CONSTRUCTIOWLENDING AGENCY I hereby affirm under penalty of perjury that there is a coristruction 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 Lic. NO.: 811114 MECHNICAL INC RD, #155 ------------------ 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 IPolicy 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 shall Jayfffi-with comply with those provisions. ate: pplicant: 6V 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 anypermit 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 s couQty to ter upon the above-mentioned property for 'r action urposes. >r�� / "g ure (Applicant or Agent): Application Number . . . . . 12-00000701 Permit . . . PLUMBING Additional desc . Permit Fee 22.50 Plan Check Fee 5.63 Issue Date Valuation' . . . . 0 Expiration Date 12/22/12 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 50 GALLON ELECTRIC 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 JUN/25/2012/MON 02:17 PM DELTA MECHANICAL—NU FAX No,702-369=9578 P,007/009 tt%. 'I: r:l i:•1: _It'_ i,'" t_'/ft1 !illattli. �_' t-I*k-! r-` !n tl ull �t� :�4 /: i:._t _1 ,'r.�r •: ',"iV a...� t.l .1 •�.-�. r' f J�' ; _. r' r, 7 ,,• �. R �v lilfl c ' �iC'"/ r / �• lv '%� �/ Ai �" I Lrt.o - tiltlert c�,�t:nC}°; �� [);tt2: 1 7 It -- r �: I f^_;c _:I� ^f^.C; („r:Co.�al.fr ti. j• '.4, �r _� rr t_ �,..,:�:,. 1•�i:0; l '�' ''p-• .r .:!_.':LIC.^... .:1V';i.;rC f...' Fr'::7;::7::gin \— �'0:•"l;: w";rr;;; 1/:11 ix ir�r:�. yc erect: fyr;`;,:.�•1:' �"!Jn�'Ir�rC'CJ FJ„ildirl; .�r !'f' r � ' :IJ:<tut.r Contractor's, (DOcul--crtabon Author's/Responsible 13uild'i--12 Uasi;r.e:'s%lj:vner's); Declaration Statement v !-- �.; 3 CfE�=Ca; i--cmiu 3U3i1t$3 7C� ��._ Cne C'cdL :., C".��.t.-CSr ns! C;; Ca";::c„� C i71, ” c'iiz r^__: _ i i .s.: ..3 . •rLid Ll . �S:a^ �„t:::�_ Jn t`I; y' P,=5 aad 5 ••_f s,e Ca:!;or^.;� Ccdo of Rego!^_::�r.�. .�^ :� ':-- _ �Cc'J., d.1::1;:� Cu •r.,12'.i1 '; rL;. -7 11 .�� ^_rc canolS:C'i " ;::1 1::d ir,:^,r��:i•:" r:�':i(:3G :C y pian,; _ a,:"Ic, I.: JUN/25/2012/MON 02:16 PM DELTA MECHANICAL -NV Itin Permit #� 01 Projcct Address: A. P. Number PAX No,702-369-9578 P. 006/009 a t , Y Of La Quinta Building 8r Safe C/ Divislon P,O. Box 1504, 76-495 Calle Tampico 0 Quinra, CA 9225.T - (760),777-7012 Building Permit Application and Tracking Sheet d Owner's Mamer) OA J f . L, �— Address: '-I c i•(� . .0 i, �'t �. �,3 � 1.7� 11 City, ST, Zip: / y l �ul>. / 4 Total Permit Fee3 Contractor: /�,, l�livl @ l �� / J I / - I (jam(iJlLGT �-""1 -> TelephotLe: Addr ss: ProjectDescription: Ciry, ST, Zip: / Z �15�w� 6 Ovu,611L Ie Telephone: 966 -oz State Lic. I 1 City Lic, #,. /0 00 Arcb., Engr., Designer, " Add=s: Ciry., ST, Zip: v� Telcphane; Comstmction'Type, Occupancy: P cY: State Lic, Project typs (circle oae : New Add'n rAxte� repair Demo Name of ContactPerson :" '�', I/ �✓!V iY+.• f %��W�; Sq. Ft: ��#Units # Stones:• Telephone # of Con -act Person: 96 6-6L? Z —� 5Z� 3 Estimated Value of Project_ 'Submittal APPL(DANT: DO NOT WR(TE 13ELOW THIS UNE Re 'd Rec?d TRA.CIfIIVG F.ERMT FEES Plan Sets . Plan Check submitted I ' .Amount Structural Calcs. }Yavletyed, ready for corrections Plan Cheek Deposit Truss Calcs. Called ContactPersoxt Plan Check R.alanee. Title 24 Calcs. Plana pkked up CoAsh•ttctian . Plood plain plan Pla>'s resubmitted Mechanical Grading plan 21� Rev(eW, ready for corrections/Issue Electrlcel. Subcontaetor List Called Contact person Plumbing , ' Grant Decd Plana pfeked up S.yA f 5,O.A. Approval Plans resubmitted Grading 1N HOUSE:- '"' Revtew, ready for corrections/issue Developer xMp0.ct.Pee Planking Approval Called ContaetPerson A.T.P P• Pub. Wks. Appr Date of permit Issue School Feel Total Permit Fee3