11-0388 (PLBG)P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIk92253, BUILDING & SAFETY DEPARTMENT. INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 4/18/11
Application Number: _17 0000 03 88 Owner:
Property Address: 48553 VIA AMISTAD VICTOR CATES ftA7PR2
APN: 646-122-008- - - 48553 VIA AMISTADa.
Application description: PLUMBING LA QUINTA, CA 92253 O
Property Zoning:. LOW DENSITY RESIDENTIAL nqy lApplication valuation: 912 ZU 11
Contractor:
CITY
n� r A C;i1iN TA
Applicant Architect or Engineer:. CALIFORNIA DELTA MECHNI L INCF�;�ft_ANX-E n- EpT.
(A- 6052 E. BASELINE RD, #155 ,
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 Class: B-C10-C3ct6 Li o.: 811114
(.;vDate•. Contraor•+' _ -
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 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.). '
1 _ I 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
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
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 b come subject to the workers' compensation provisions of Section
3700 of the Labor Co forthwith comply with those provisions.
Dater // �• 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, 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 buildin construction, and hereby authorize representatives.
of this county t enter upon the above-mentioned prope r i spection purposes.
fDate: . Signature (Applicant or Agem):
- -
Application Number
11-00000388
Permit PLUMBING
- Additional.desc.,
Permit Fee . . 22.50
Plan Check
Fee.
5.63
Issue Date
0
Expiration Date 10/15/11
.,valuation
Qty Unit`Charge Per
Extension
BASE
-FEE
15.00
1.00 7.5000 EA PLB
WATER HEATER/VENT
7.50
Special Notes and Comments
INSTALL NEW 40 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 .,
.,
men nve 'artmente of com
' Date; pfo r
Site Address:
�8 5 �Buildin aSin le NOTE: Thisornr !s 1tot
ca: Residendal WATER HEATER
lent Agency: Climate ne # I # of Stories
�i
ViA
or A
CF -I R -ALT- Watar
Permit #
'Decluratfoq Statement
• I certify under penalty of pepury, under the laws of the State of Callfbmhy the l
and complete. brmation provided on this form Is accarats
• . i certify that the oneW fcahms and performance specModane idend5ed ori this Ce MMte of Co fiance cal&rrn to tha
uirements ofTide 24 parts 1 and 6 ofthe Ca1lPotnie Cade oFR ladona
Name; pt1 a �n QR.EDr Signator • .
Company:
Address: 1 � m E K � �• y' l�'• /�
�-I� ISS License:
City/State/Zip: Pbtme;
For assistance or questions regarding the Energy Standards, contact the Energy Hotline at 1-800-772-3300.
WS 'd IOSVON 3A31S NV60 : 6 HOZ OZ '9 � 'a dy
Bin #
City Of La Quints
80d/ng 8r SaFery Division
Permlc p C6P.O,
Box 1504, 78-495 Calle Tampico
La Qulhra, CA 92253 - (760) 7777012
4
Building Permit Application and ?racking Sheet
Project Address:
% Owner's Nome:
A. P. Number:
I1 p
Address: 7 0 V'�
Legal Description:
� �
Contractor: O r l,w
City, ST, Zip: U
Telephone. ( _
Address: 60s6
ProJectbesoripdon:
-s
City, 3T, zip:
410.
Telephone: 266
State Lio # :
Ci Lia #;
_/0y00
Engr., Designer,s:T,
r
Zip:
;
Telephone:
Consttuctlon Type: Occupancy:
•
State Llo, {F;
Name of Contut Person:
Noot type (alrule otto): Nety Add'n Alter ' Demo
• --
Sq. Ft.:
Tel hone # of Contact Fersan: $6 6-6 Z — 3
# 3tori�: # iJt:
Bstlmeted Vslue of ProJecL U
APPLICANT; DO NOT MIM BELOW THIS LINT;
# su�talttal_ Req'd
Ado`d TRACKIIYQ
Mott sots
PIM Check submitted
PEMA4IT 81�E8
Structural Cales,
leveed, re >br corrections ecMons
Item
Amount
%Rn
Trues Cabe,
Plan Check Depaalt
Called ContactPcraaa
Plan Check balance,
Tufo 24 Ca1ce,
Plans pleked up
Flood pinln pian
Plana resubmitted
Construction
i
Grading plan
a•! Revlew, ready Por corrcctlonstissue
f4echanleal
Electrical
Subcontactor Llet
Called Contact Person
Grant Doed
Plans picked up
Plumbing
X.O.A. Approval
Plane resubmitted
1N IIOU81�:-
'^� Reyielvi ready for correctiona/Issue
Grading
Planning A,pproYal
Called Contact Person
Aeveloper Impact Fee
Pub, Wks. Appr
Date of pernplt Iesue
A.LP,P.
Schodl Fees
Total PermlMes
161ti 'd tiM "N.
3A31S NV 0:6 [10Z 8l 'a db