12-0702 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 12-00000702
Property Address: 52110 DUNLEVIE CT
APN: 770-240-020- -
Appiication description: PLUMBING
Property Zoning: LOW_ DENSITY RESIDENTIAL
Application valuation: 1016
ii ant: /�' ! 'II Architect or Engineer:.
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LICENSED CONTRACTOR'S DECLARATION
0
BUILDING & SAFETY DEPARTMENT
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 he Business and Professionals Code, and my, License is in full force and effect:
Uc se:C ss: C10 C C3 License No.: 811114
ate Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that 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 7030.5 by
any applicant for a permit subjects the applicant to a civil penalty of, not more than five hundred dollars (8500).1
(_) 1,. as owner of, the property; or my employees with wages as their sole compensation; will do the work; and 40
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 burdenof 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 whocontractsforrthe projects wit_ h -a contractor(s) licensed
pursuant to the Contractors' State. License Law.l.
1 _) I`am exempt under Sec. , B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY -
I hereby affirm,under penalty of,perjury'thet thereis,a construction lending agency for the performance of the
work: for which this permit is issued ISec. 3097, Civ. C.).
LendeKs Name:
Lender's. Address:
LQPBRMrr
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/25/12
Owner:
MAGLICH MICHAEL
16500: GRAYS DAY BLV
WAYZATA, MN 55391
Contractor:
CALIFORNIA DELTA MECHNICAL INC
6052 R. BASELINE RD, #155
MESA, AZ 85206
(866) 692-5273
Lic. No.: 811114
WORKER'S COMPENSAY10N DECLARATION
I hereby affirm under penalty of perjuryone of the following declarations:'
1 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.performonce.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 permitis issued: My workers' compensation
insurancecarrier, and policy number are: -
Carrier STATE FUND -Policy Number 1697823-11
_ I certify that, in the..perfonnance of the work for which this permit is issued, I shall not employ any
person in manner so as.to become•subjectto the workers' compensation lawwof California,
and agree that, if I should' become subject to'the workers' compensation provisions of Section
3700 of the Labor Code, I shal nit mply with those provisions.
ate 2 pplicant: �-
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 Buildingand Safety fora 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 Quints, Its officers, agents and employees for any actor 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'wiltsubject
permitto cancellation.
I certify that.l haveread this application andstate that theabove information is correct. I spree to comply with all
city and county ordinances and state laws relating to building construction, and hereby euthorize:representatives
of this coyntty7�ootentterupon the above-mentioned property for on
Pe:gg / fSature (Applicant or Agent),
Application Number .. . . . . 12-00000702
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
1-60 7.5000 EA PLB WATER HEATER/VENT
7.50
--------- ---------------------
Special Notes and
--
Comments
REPLACE 38 GALLON
GAS WATER HEATER. 2010
CODES.
--------------------------------------I---------------:--------------
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
JUN/25/2012/MON 02:17 PM DELTA MECHANICAL—NV
FAX No.702-369-9576
P. 009/009
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JUN/25/2012/MON .02,:17 PM DELTA MECHANICAL -NV
FAX No; 702-369-9578
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PO# 64 b6t&:
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City of ' La QuInta
BuIldil7g BT Safety DMSIOD
Pennit
P.O. Box f 904, 78-495 Calle Tamptw
jo�
La QLdrfta, CA 92253 - (760) 777-7012
Building Pemilt Application and ?'racking , Sheet
Prqj--tAd*eM.D PVh,4VAP—
b-Own'r's 14amm 6 reAkv, Y /I
A- P- Number.Addreoe
11-D A,% mc
City, Sp, z4p: Z,,, Qo�,A-A 92 7 53
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Pim ad -Deswkdon
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gas
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CRY LIC,
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Addia
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hvjcdVpe, (*via one). NOW M&n /Z� :Wpgr DMO
Sq Ft: #
Stac Lim #
Nam of ClWaut Par M
Triepitwe# of cauwA person:
jB&=xt;adValue -afM=t
APPUCAN-T' DO NOT WRTM BELOW THIS LM
Awd
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TRAC=Q
Plan gets
PtAnCh"kaubadded
Itsm
Amount
Str=tursl CMOs,
Rtvtesred, ready for tonwoons
Elan CLeekpeposit
Troas Calei.
Wed ContactTenm
PIM Cht4* bdd"e@.
'Liffe 24 Calm
plane PjtkW up
CAmsbrote$oa
7100d plain RIAU
Plates roubw1w
Grading V"
V!PAWew, resoforLearnrOQUEOU06
Elaafricai
Subcontactor Vat
Called Contact Pomit
PluxaWff
GrAwDecd
1p'lillis picked up
&KL
X0.0- AppraftE
Piano ruubml*A
Ratcwt ready for torritodonshme
Dadaper bavadpft
Planning Approval
CaUed CoubactIlanw
ALIP2.
Pub. WIcs-Appr
Date of permit Issue
3cl:oai Bees
TotdremJtFsw
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PO# 64 b6t&:
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