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13-0243 (PLBG)P.O. BOX 1504 VOICE (760) 777-7012: 78-495 CALLE TAMPICO C `' ��. FAX (760) 777-7011 LA QUINTA, CALIFORNIA. 92253 BUILDING .&' SAFETY DEPARTMENT �� INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 3/06/13. Application Number:. 13-00000243 Owner: Property Address: " 528.65 AVENIDA VILLA MC CUNE SUSAN APN: 773-333-020-7 -000000- 52865 AVENIDA VILLA- • Application description: PLUMBING LA QUINTA, CA 92253 Property Zoning: COVE RESIDENTIAL (760)238-1`333 ri j Application valuation: 1075 �1 � f +�afc 0J 2 Contractor. Applicant: Architect or Engineer: CALIFORNIA DELTA MECHNICAL IN 6056 E. BASELINE RD, #155 C��OF�QUIJyTA f� �r MESA, AZ 85206 ANCEpEP-r (866)692-5273 Lic. No.: 811114 LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION - I hereby affirm under penalty of perjury -that I am licensed under provisions of Chapter 9 (commencing 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 C20 C3 'cense No.: 811114 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued., Date:- Contractor:. _ 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 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 1697823-11 ,.. 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, I,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 tobecome subject to the workers' compensationlawsof 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, he I for with comply. with 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).: Date: Applicant: 1 _ 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 - 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,A as nwner of the nrnnarty. am P.xrIi iivaly contracting with IIgen5eQ g4nn.,,i rs 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 appy'to an owner of; conditions and id3tiidti6AS Sot t6Rr1 an tnls appncauun. - 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 whose request 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, (_ 1 I am exempt under Sec. B.&P.C. for this reason the owner, and the applicant, each agrees to, and shall defend, indemnity and hold harmless the City' of La Ouinta, 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.1• - City and county ordinances and state laws relating to mbuSildiconst,uct,on, and hereby authorize representatives - of this co y o enter upon the above-mentioned propenspect purposes. Lender's Name: • , Date: 0 Signature (Applicant or Agent): .Lender's Address: - LQPERMIT Application Number 13-00000243 Permit PLUMBING Additional desc . Permit Fee 22.50 Plan Check Fee 5.63 Issue Date- Valuation . . . 0 Expiration Date 9/02/13 Qty Unit Charge Per, Extension BASE FEE 15.00 1.00 7.5000 EA PLB WATER HEATER/VENT 7.50 ---------------------------------------------------------------------------- Special Notes and Comments REMOVE AND REPLACE 40 GALLON GAS WATER HEATER CHANGE OUT IN GARAGE. 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 - o- eFn #City of La Quinta Building a Safety Division P.O. Box 1504,78-495 Calle Tampico La.Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # Project Address: rJ• ola(05 Avent-aa.Vik- Owner's Name:. S USc1t1 McCune A. P. Number. Address: SaM Avtn iJA Vd Q Legal Description: City, ST, Zip: La QU i A&,Yaa Telephone: p ��u a ► Contractor: Ut: Address: net RD Project Description: ace_ 40 ag oas r, City, ST, Zip:X(p ..sx . . Telephone: P State Lic. # : 1 CityLie. #.- Arch., Engr., Designer: Address: City, ST, Zip: ..a Telephoner .� State Lic. #:Yl Construction Type: C occupancy: Project type (circle one): New Adc'n Alter Repair Demo Name of Contact Person: Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: Estimated Value of Project: 075. • 13 APPLICANT: DO NOT WRITE BELOW THIS LINE tl Submittal. Req'd Recd TRACMG PERMPT FEES Plan Sets Plan Check submitted Item Amount Structural-Cales. Reviewed, ready for corrections Plan Ch=k Deposit Truss Cales. Called Contact Person Plan Check;8alance Title 14 Caice. Plans picked up Construction Flood plain plan Plans resubmitted :Mechariial Grading plan r' Review, ready for correctionsfssue Electricdl Subcontactor list Called Contact Person 'Flumbirig Grant Deed Plans picked up S.M.h H.O.A. Approval Plans resubmitted Grading IN HOUSE:- '^' Review, ready for correctionslissue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue - School Fees Total Ecrmit Fees FEB/2$/2013/THU 09:03 AM DELTA MECHANICAL-NV FAX -No,702-369-957, P. 003 Prt:scciptivd certitirat� of Compliance: Rz,i(lentiaJ CF IR -A Ur OHtiti R�,r_[,,.•r!if .-t.:^^��r4.t1:•�tt; (C Sita .at�l re'i3: �� 5 Cn day a• �i,«:t'r_� ,zt,(,�.—�1:��,: i D�t�: a� 3•Ji l :f?+r [.,�'' d C'1'tr I r .� 1(?.' t:'-1(tr `v-k TER F1FKATLNI- i n✓•.tr.:n:1rtli!J .,:ir,r :realer, .;rtJ ;,:r.'er; •'i)r h.1rlt jr:Nre:!:C k1r rt' ;r!!I,�.; : JX�I:.u!J r ;(r•:nie ;u!:Ce � .`ieul•, O NH t"1•e'S a •I ilrn4! ylrr"r ;l✓ ••rJ Jrn7,rn� .rr y llr. �Cr Y:n7 'rel .•.�✓ i ! l e.r!etnal Ttnk Dlitr hut:cn i •?C �run:n�::n T3r.k I e^tri; �•1L;',Or :r ! N,!er F e::icf I _ r..ivhuun T,7v:'idfT,�e I sanduU.C1o:cir 4'111 Tiernul=rt:c:enc. R;ytlue' ' • �._:rc•al7r:n i i Wil. /ndic`.re T':pe !Iwroge es. He'll ?:rmp• ln;tttnrunelus. _'..4!ci!!':rlulrn3 ^:�1Cr ! idrvin9• rrtlil('ple J,vei!ing wii:3 ;hull meet (ItC re:';lculvnvn r'�uiry nen/; ?1 �<J:(!t). T%rt Prr:C':g!t':e i r�•1!Nr��,rgnL:Jv.•tc)r.,irt,,w:he 'tiller 4131."". r.:5,e,n'Orsrn�!••('.•'!!in!'an•(s. e.r(er`t(71 •tater :cztvA ]nJ ?;cei ;hull he ;1uuIo:2-J:u rn;e' 'hs ro;!ri! we.nL' •71 j!ji�l'i• CO0tructor 9r Homeowner (Docamenta[ioo Author'V'Respunsible Buildin) Desi-ner*3 Declar3ti0❑ Statement) a I :'"•" }Ciftie `�3.^,i!�C',]:- •; r'].T.�lilfll <)rJC1R:Q^!dL;U!l 15 :CCU.21:! and curnple'e. • I am ell jAte ur.4er Division 3 of he C11i omit Buaicees nd Proets5;ons,Cade t0 acti:7t e3po-sibii:ty i_9r i e 5uiiding design , "'e.nE;-!v1 -Jni,i;s Cer:iCCat:.Jr Ccrnpi'.avc;. ! 1 _ • I :d:'..[-i ;Pat in, :nez'-;I ie1(::.ei and pe"Crilarcz ip!'aP;CaCpn3 For Lie 'au:ld°n--design '_n :h:3 Cv!!Oc itz. 7f`C•]tT.011:L'.C. i _uri,' to :7a :e{uirtmear of Tule 24. Par i and 3 of the Caiifomia Cade of Regulat:ons. • T.% b!l;Winl Je:iip featurl:5 identir.ed in .-his Cer6('c3(t o(Cprnpli:u:ce lr: :onSisteit wii�7 ti.e in.-,)rnarion gr•OvYsed t0 lQCUR;e'I1C i5i5 Ir hunting ae5i,t.'i an :!7e )(her applicable comphirc, forms. wurkstee'3, 3: ell pians and.ipcctvicaGOr75 iubmiced to iUf 1 'r'lI '•ViL�I itii5 `r:!Id;n2 ?enni( 300licaCct \ ^. 1. iignatr t::, % %;' Conclmr j Qvc: ! /9-7 /13 Lctnw , A Jr;,3: /Lj,-^Z,,• � Ian :�_�;;;:�_ �./ .f r�-� � � •