13-0469 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
13-00000469
Property Address:
45215 DESERT FOX DR
APN:
604-280-032-17 -23935
Application description:
PLUMBING
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
343
Applicant:
c�
T'd4f 4�
VOICE (760) 777-7012
FAX (760) 777-7011
BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
Architect or Engineer:
------------------
LICENSED CONTRACTOR'S DECLARATION
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 fessionals Code, and my License is in full force and effect.
License C /sss: C10 C20 C3 License No.: 811114
Date: ((0 3 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).:
(_ 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 _) 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: _
Lender's Address:
LQPERM IT
Date: 4/16/13
Owner:
FUJIO LARRY N
45215 DESERT FOX DR
LA QUINTA, CA 92253
DContractor:
UF�INANCEN)EpT
0 2093CALIFORNIA
DELTA MECHN6056
E. BASELINE RD,
#@UINiAMESA,
AZ 85206
(866)692-5273
Lic. No.: 811114
-----------------------------------------------
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 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
/ 702y0 of the Labor Code, 1 fbrthwi comply with those provisions.
Date: (� /J 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, 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 con�tion,ereby authorize representatives
of this cou ty/'to ntteer upon the above-mentioned property f s.
Date: I b IJSignature (Applicant or Agent):
Application Number . . . . . 13-00000469
Permit . . . PLUMBING
Additional desc .
Permit Fee . . . . 22.50 Plan Check Fee
5.63
Issue Date . . . . Valuation
0
Expiration Date 10/13/13
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 7.5000 EA PLB WATER HEATER/VENT
7.50
----------------------------------------------------------------------------
Special Notes and Comments
WATER HEATER CHANGE -OUT - 48 GALLON GAS
WATER HEATER. [2008 ENERGERY] CARBON
MONOXIDE ALARM(S) TO BE INSTALLED PRIOR
TO FINAL INSPECTION. 2010 CALIFORNIA
BUILDING 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
LQPERNI IT
APR/04/2013/THU 04:42 PM DELTA MECHANICAL -NV
FAX No. 702-369-957$ P.005
I
Prescriptive Certificate of Compliance:
ential Water Heating CF-
General Information
Site Address: Lisa i5 besecLf2s dr Climate Zone: Hate: /
.VOTE: Zhis fprnt is o«(y' «SetlJur (1(tcrafioa dr a[!d(ttar Of rv4tc�r lltu,i«gYysterxx
Contractor (Aocumentatiou Author's /Responsible Designer's Declaration Statement)
I certify that this Certificate of Compliance documentation is accurate and complete.
• (am eligible under Division -3 of the California Business and Professions Code to accept responsibility for the building design identified on
this Certificate of Compliance. .
I certify that the energy futures and performance specifications for the building design identified on this Certificate of Compliance conform
to the requirements of Title 24, Parts I and 6 of the California Code of Regulations.
• The building design features identified on this Certificate of Compliance are consistent with the information provided to document this
building design on the other applicable compliance forms, worksheets, calculations, plans and specifieatio submitted to the
enforrement agency o annrovnl with this building Permit 2onficadon,
Namc; I Signature:
Company:
Date: _
Address: License: 8 i i 114
6056 E Beuelifle Rd # 155
City!State:'Zip: Pltone.,�b6-692)
J
Mesa/AZ/85206
APR/04/2013/THU 04:42 PM DELTA MECHANICAL -NU
a
I
I
I .
FAX No,702-369-9578
P. 004
Bin #
city of /ted Quanta
Building 8r Safety Division
P.A Box 1504, •78-495 Calle Tampico
[a.Qulnta, CA 92253 -:(760) 777-7012
Building Permit Application and Tracidng Sheet
�,
—� % 1
Perry _41
ProjectAddress: Ll SA 15 besert Rx Owner's Namt:. Lar FiA
A. P. Plumber. Address: y5a15
Legal Description: City, ST, Zip: ( e>a aa5
33
Contractor:Ddla Telephone:
Address: ProJectDeocription: q(l0A
City, 5T, Zip: Az S1115ac � In ft4t_r
Telephone: a .5273
State Lic. # : City Lie', k;
Arch, Eng, Designer
Address
City, ST, Zip:
Telephone: Conon Type:. ' Occupattay
Stele Lic. #: Project type (circle one): New Add'n Alter Demo
Name of Coataot Pe zs w 4446�Sq. Ft.: #Stories✓ # Units:
Tcicpbom # of Contact Person: EAimatad Value of Project N13. 43
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Sobimlr al
xteq'd
-Reed
TRACKING
T=
Plan Sets
Plan Check suWned•
Item Amount
3trgctoral Coles-
,reviewed, ready for correctlone
PLm Check Deposit
Truss Calm
Called Contact Person
Pian Check S2220ce.
Title 14 CalcY,
Pians picked up
Cmtstmetioti
Flood plain plan
Plana resubmitted
Meehotileal
Grading plan
2'! Revitw, ready for correctlawlimue
E1eCb lcal
3ubcontactor Liat
Called ContactPeengn
Plu nb[ag
Grant Deed
Plans ptcked up
t 8.111.1.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE;-
" P.4*w; may for corrections%sue
Developer Impact Fee
PIanning Approval.
Called Contact Person
Pub. Wl(& Appr
Date o£permit isauc
school Fees
Total Permit Fees