12-0699 (PLBG)r
P.O. BOX 1504 VOICE (760) 777-7012
78-495 CA LLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
*I2=0400
9,
48633 V�A TIERRA
._646-081-017- - -
PLUMBING
LOW DENSITY RESIDENTIAL
1021
Architect or Engineer:
pJA
5
v
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
Cllasss: C10 C20 C3 ense No.: 811114
/te: to / � / C tractor.
/ - . 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 asigned 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 1, 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, 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.).
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
Date: 6/25/12
Owner:
GALE RUMMEL
48633 VISTA TIERRA
LA QUINTA, CA 92253
(,PRNIA DELTA MECHNICAL INC
�y } p �f�4ry 60,1 1 BASELINE RD, #155
°(r1£ ME��S,�1/j�AZ 85206
�t (8'6.6;692-5273
F, a :r�Q�;• c.�No. : 811114
------------------
WORKER'S COMPENSATION DECLARATION
1 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.
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
0:V7
Codp�,�Shallforthwith comply with those provisions.
ate: :
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.
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 construction, and hereby authorize representatives
of this cou ty to enter upon the above-mentioned property -pecti n u
Da-� ature (Applicant or Agent):
Application Number . . . . .
12-00000699
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
1.00 .'7.50Q0 EA PLB
WATER HEATER/VENT
7.5'0
---------------
-----Speciai Notes and Comments
--------------------------
--------------
REPLACE 50 GALLON WATER HEATER.
2010
CODES,
-----------------_-_--------------------------------------------------------
Other Fees . .
BLDG STDS"ADMIN (SB1473).
1. 0.0
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
r
LQPERMIT .. ..
,
JUN/25/2012/MON 02:16 PM DELTA MECHANICAL -NV
C10 I jj 1
J ::".,I e I It-'. I, TER E 'E. T
X' ' '
EI'T,E,iT
En'tvi-caw-It .1 —wey. Dara:
VZ15
F3,M;i-t C -V -j; F c rn: r I Cir --:t; uie Front or.vniatiom N. H, 5. ::r
C
!-:VA_ R_naicncn; )r 'c;! 0 LD-uct R, ;cc.
T j.. !jut _111.jw�" Cn"Vr.-1c-'cd 3-ri-irding,; .7r.,1ddNutLj
LO 7 E.
WATER
!'
itv-aL rz nfitv
Nalm. Hall YN NUJI)Imur :r.T CM r
3v!wn 'pi: T`c=at
0.4.7— 1 Z4
illai=c 1:71m, Ia ?1111p.
Pr_,-,!%'pdvj
.1ZIM
-fin �-Ifdl Ine:!! fila
.1 7�tv, rilquirzown,'s f1d
... :mint
nal thm' 'fif
CG=nctDr`s,(Dacu =Wi Hi Author!S/Respor)fibleBuildin- Desi-ner'v*0wror'*
D
ftrify thl s-. taraticn5catement
am SJZ!�,!
-;CS: i1a
nr !:Iis C0MP;:v:v-_�.
f—V
—A.UtS
:,e r 3
_�t tL"dilg te;;=Tn
Stez: w;f"
pjar,.i
:C
ile
r.--- C M
A A S'z:!aE-_ra,.
1,
Z E :7a; 5:,7::_'2 '-S. i; I
JUN/25/2012/MON 02:15 PM-
DELTA MECHANICAL -NV FAX No.702-369-9578 'P:002/009
;fin
0ty of La Quanta
!Building er Sarerj Division
Permit pQl
P.O. Box 1504, 78-495 Catle Tampico
La Quints, CA 92253 - (760) 777.7012
Building Permit Appiicado,n and Track n a ShEet
Project ,address: S3
r l airi� Owner's Name:+, % ,vim
A. P. Number:
Address -g �i�`A Perm
rm
Legal Description-
City, ST, Zip: d
Contractor. (yet C)M1 i q
Q �%1,�/L/ czI Telephone:
Address: COS6 at
H2 �SSproject Description:
Z
City, ST, Zip: /`/
��ZQJ 6C(�Cs� J / '
Ca �
vv+iy+'1/( a,3vV
/�
Talaphonc:O(J '�qZ
�r
State Lie. # :
City Lie, IO YOO L j
i
Arch., Eugr„ Designer
Address:
City., ST, Zip:
TeLephotte:
Coasttuction Type' Occu ao_.
Staab Lic_ #:
1'roject type (circle one): New Add'u AftBX ~epair D=o
(
1 Came of Contact Person:
.#Stories:
-
# Units: .
'
Telephone # of Contact Person: p 6 6-6 Z —:J Z� 3 E d Value Z% %�a 1
oPPtoJeot
APPLICANT: DO NOT WRITE BELOW THIS LINE
# 3ubm(ttal
Reqd
Xtec°.d
TMCKMG
pTt14iIT FTsFAS .
Plan Sets
Plato Check submitted
11sm
,Amount
Structural Cafes.
Iteviemed, ready for corrections
Plan CheclOeposit
Truss Cels.
Called CoutactPersorz
pta0. Chedk Balance
Title 24 Calcs.
!?leas Backed up .
Construction
Food plain ply)a
plans resnlimltted •
lYfechaplcal
f
Grading pleb
2"a ReA w, ready for rorrectionallssue
Electrical*
Called Cantic4peraon
Plumbing
d
plans picked ap
.
proval,
Plans resubmitted '
Grsding
VSubcomsclurctorLI'O
E:
r"' Review, ready for eorreetions/issue
I3cveloper Impact Fe
pproval
Called ContactPerson
Appr
Dateorpermitissue
s
Toral Permit Fees
��pp �7 n
�.
store # �~