10-1334 (PLBG)P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
� Date: 12/07/10
Application Number: 10:-00001334:' Owner:
Property Address: 48548 VIA AMISTAD KOSSOFF HERBERT W .
APN: 646-122-042- - - 48548 VIA AMISTAD .
Application description: PLUMBING LA QUINTA, CA .92253
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 1085
Contractor:
Applicant: Architect or Engineer: CALIFORNIA DELTA MECHNI d
6052 E. BASELINE RD, #15
° MESA, AZ 85206
(866).692-5273 Q8
Lic. No.: 811114
`.fir � ®�o •/ �
----------------------------------------------------------------------------------- -- -----!----
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 Icommencing with
I hereby affirm under penalty of perjury one of the following declarations:
. Section 7000) of Division 3 of the Business and Professionals Code, and.my License is in full force and effect.
_ I have and will maintain a certificate of consent to self -insure for workers'. compensation, as provided
- - License Class: -C10-C36 . - License No.: 811114
for by Section 3700 of the Labor Code,-forthe performance of the work for which this permit is
/
/Date: (O Contractor.
issued.
I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
J/
Code, for the performance of the work for which this permit is issued: My workers' compensation
OWNER -BUILDER DECLARATION
insurance carrier and policy number are: -
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
Carrier STATE FUND Policy Number 1697823
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to
_ I certify that, in the performance of the work for which this permit is issued, l shall not employ any
construct, alter, improve; demolish, or repair any structure, prior to its issuance, also requires the applicant for the
person in any manner so as to become subject to the workers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
and agree that, if I should become subject to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
3700 of the Labor Code, I short with c th those provisions..
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).:
j '
Date:) O (%icant: /"`•"
(_ ) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
- the structureis not intended or offered for sale (Sec. 7044, Business and Professions Code: The
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon_,
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the •
DOLLARS ($100,000)• IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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.).
APPLICANT ACKNOWLEDGEMENT
1 _ 1 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
conditions and restrictions set forth on this application.
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
1 . Each person upon whose behalf this application is made, each person at whoserequest and for
pursuant to the Contractors' State License Law.)•
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
.. (_) I am exempt under Sec. , B.&P.C. for this reason
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.
Date: Owner:
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
CONSTRUCTION LENDING AGENCY
. permit to cancellation. -
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
I certify that I have read this application and state that the above information is correct. I agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.).
city and county ordinances and tate laws relating to building construction, and hereby authorize representatives
of thi cou ty enter upon t above-mentioned propett r ins ecti purposes.
Lender's Name:
'
at S' ature (Applicant or Agent): i
Lender's Address:
LQPERMIT
Application Number
10-00001334
Permit . . .
PLUMBING
Additional desc .
Permit Fee . . . .
22.50 Plan Check
Fee
5.63
Issue Date . .
Valuation
0
Expiration Date
6/05/11
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.'2007
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
2D1ii 105 ?AM DELTA MECHANICAL -No. 4017 F. 13
R to
ILe a.t�i
Clir atezone: /Z -
Only 1,
'fdfl)n oj aL
t
i2l
both do,
hydM
nia space heati7tg, lndijjdv,7j
"s C71 01* PrOP0710 fired '.a77d may not exceed 50 gallons. Hot domestic hot wafe7-heaters
I'd
r')? all underground-hot-m)a Waterf'P` '"SW11760hfto, the 1).U7jzhv--2
—LL1-1t--PiPPs 4V required in all component a c7
ipc0ges in all climate zones
'110mer Type
nistributiort 113n
St tto y Ener Factor Ox
N=ber of Tank item Ca acity
U-1 rype 7�pc
(Standard Exteriv.1
St JL.IX
all Standard
C.
Standard ffiLicncy
5',j -020 — I
L
7Z.4
�'JPc (81 --age Gas, 1jeatp
th C i zlyJ'am'; "rvi"g Mlli )7g In tj
ple dw 71i
f1S11?1LrrL1�Ojj ;hQ71)"cet the recimulation regO
_qLa 7 rromenyx OfI50(n').
19 tonk andpf�,&Jj be insirl
ed io meet the reguhement'? 0
]S imp
7 7 -----:-
not L:1c01- Mqct
A, �tl�
LT"Iltntiolo. Anno,;3 /.R
esigMex
les�IPD-1—�
'.-:J-tjfy that'sinexs Declaration statelme]]Lt) — ------
,his Cnflifioate; of Coco
91:ee documentation 13 gCCnylte EMd Complete.
Hin cligibic Undert)
iv's'on 3 of the Cdjftnia B,si,,,,
of Coln and 11rofe&9ions Code to ter
'OPt T&VOnaihaity for the btuldmg design
[""'hn c"19Y features and petfman,, specifications
of Title 24, P" 1 and 6 o for the
building design --dcntified on this Certificate of Compliance CO'Elf...
features iticntifiod on this ,(�,9rtjfca C
bUildmg de3jgc f of CaliforniaCufCode OfRagulations.
6ilsio", on the Other &PPEr4ble eqn3pli... I to a ocvlianvo are con
folk, wo;rkshr
-.111CLI-y fn, with f110 infb=ati ed to document thi-e
this annlicxtion.,ts, . caIcWatiouz, 'PIRTs
JUuUM t ani ep
4ciffigOtted to the etiforceni'
v ew
r
""'""'!'California )elta, Mechanica
-----------
-6056, E. Baseline Rd., #155
ivIesa,AZ86206
Date
4
Phon
'1866-692-527,3
D -1c. 7. 2010 10:57AM DELTA MECHANICAL
No. 4017 P. 12
Bill #
City of La Quinta •
Building 8i Safety Division
Permit #
P.O. Box 1504, 78.495 Calle Tampico
La Quinra, CA 92253 - (760) 7717012
I� 133`
Building Permit Application and Tracking Sheet
Project Address: ! 5
Owner'sNamv:
A. P. Number.
Address: 4?S-
Legal Description:
City, ST, Zip: �Z2 Cv?
Contractor a41 m'4,
,,
Address: 6oS� . �j�'i �.s„ j Project Description:
City, ST, Zip: Z
�,52� 6�q
a
Telephone:
State Lic; # - I 1
!'
City Lio. #(; /D IOD y
Arch., Eugr., Designer:
Address:
'
City., ST, Zip:
Telephone:
Consavetion Type: ()ccupauay;
State Lia #:
Project type (circle one): New Add'n t repair Demo
Name of Contact Parson:1n
1 u Sq- Ft.: # StArles: # Units:
Telephone * of Contact Person: 86 6-6.q Estunafed value of Project
APPLICANT; 00 NOT WFUTE BELOW THIS LINE
# gnbmtiial ire Od
Ree'•d TRACKING EMIT FEES
Plan Seta
Plan Check submitted
Item
Amount
Structural Cake-
Reviewed, ready for corrections
Plan CheckDeposit
Truss CaleL
Called Contact Person
Plan Check Balance.
Title 24 Cales.
Plans picked up
Construction
Flood plain plan
Pans resubmitted
Mechanical
Grading plan
2'"Revlew, ready for correctionstissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plana picked up
S,M.I-
H.O-A. Approval
Plans resubmitted
Grading
IN HOUSE:-
''" Reylew, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact person
A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Bees
Total Permit Fees