12-1021 (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: 9/06/12
Application Number: X2O 0:0 1- 0 .2 1 Owner:
Property Address: 52050 AVENIDA OBREGON MCCUNE DONNA
APN: 773-215-003-3 -000000- 52050 AVENIDA OBREGON
Application description: PLUMBING LA QUINTA, CA 92253
Property Zoning: COVE RESIDENTIAL (760) 347-.2385 D
Application valuation: 250 9
Contractor: CEP 0 6 20 i2
Applicant: Architect or -Engineer:, PLUMBING INSTALLERS "`
134'00 SATICOY STREET #25 CIT`LOFLAQu1 A,,
NORTH HOLLYWOOD, . CA 91605 FIBA�C��EP�'
(818)982-6952
Lic. No.: 915215
.a
UCENSED'CONTRACTOR'S DECLARATION
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 P fessionals'Code, and my Licenseis in full'force and effect.
License:Cla s:' IISCe6611_Q3,_. License No.: 915215 _
Date:_ .' r G–Contrac
OWNER -BUILDER DECLARATION
I hereby affirm underpenaltyof. perjury'_hat I am,ezempt from the.Contractor's State License Law for the
following'reason (Sec. 7031 .5;.Busihd'ss and Professions Code: Any city or county that requires aper6t1to
construct;'alter,'improve, demolish; or,repair. 'any structure, prior to its issuance, also requires the applicant for the
permitdto file a signed statement that,he or, she is licensed pursuant to the provisions.of the Contractor's State
Licems 4:L w IChapter9-(commencing with Section 7000) of Division'3-of the Business and Professions Code) or
that heor 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).:
(_ Ptl, 'ds.owner of.the property, or my employees with wages astheir 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�wfio does thework himself or herself through -his: ,or her own'employees, provided that the
improvements aie'riot intended or offered for sale. If, however, the building or,improvement is sold withiri
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.). - - .
(_) 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 theireon,'and who contracts for the projects with a contractors) 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 (Seo. 3097, Civ. C.).
Lender's Name:
Lender's Address: _
LQPERMIT
- - WORKER'S.COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury. one of the following declarations:
I.hay. -and'will maintains certificate of consent�to self -insure f workers' compensation, as provided
L....: .
for by Section 3700 of the Labor Code, for: the performan �` 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 oarrierand policy number are:
Carrier TOWER `SELECT 'IN Policy Number . WCCO2130900
I certify,that, in the performance of the work for which' thispermit is issued; I shall not employ any
person in any manner so as to become subjectjo the workers' compensation laws of California,
and. agree that, if. sh I orae subject to the workers' compensation'provisions of. Section
. ,]00 of the Labor Co I sh rthwith comply with those provisions.
—Date,:— p�(/ App plioyr <;
oe
WAR ING: FAILURE TO SEC WORK ERS`COMPENSATIONCOVERAGE IS UNLAWFUL, AND SHALL
'SUBJECT AN EMPLOYER T. CRIMINAL PENALTIES AND CIVIL FINES UP TQbNE 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 totfie Director of Building and Safety for a permit subject to the
conditions and restiictions'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 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. 1.80 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 ilding construction, and hereby authorize representatives
ofth��ntyXt,55er�upo�n,,t�he a�bow�e-mentioned pro y for'F�rpos
DateSignet' ure:(Applicant or Agent):
Application Number . . . . . 12-00001021
Permit
PLUMBING
Additional desc .
.
Permit Fee . . .
. 22.50
Plan Check
Fee
5.63
Issue Date . . .
.
Valuation
. . .
. 0
Expiration Date .
. 3/05/13
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 7.5000 EA PLB WATER
HEATER/VENT
7.50
----------------------------------------------------------------------------
Special Notes and
Comments
INSTALL NEW WATER
HEATER 40 GALLON
ELECTRIC 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
Prescri tive Certificate.of Com liatice:,Residential
Residential Al
terdtions
Pm'ect Name: ,BALM, nI Climate
CF -
;IR -ALT -Pa -Page I 0172
Permit t1:
General Information
Site Address: Enforcement Agency: 9. Date:
Building Type: 0 Single Family 0 MultiFamily ProjedT : 0 Re lacement or.Chan a Out of Water Heater
I
WATER HEATING
List newa<c installed .later heaters and boilers for. both domestic hot water heaters. (t)WH) and 7tydronic space heating. NeuAc installed
DIM heaters and boilers ntusi be gas. prqgane. or tut the'existing el I)re.
Water Heater
TYpI� TYpe'
Distribution Type NumbLr In Tank F-� gy tFactor
R tstard?td. Seckculai6wYystem Capacity (gal) Tttetmat Efficiency .
Erttxnal Tank
�ula(ion
R -Values
sit, n CI AD
1.OGc,
1. Indicate Type (Storage Gas. Heat Pimp. Instanwneous. etc.)
2. Recirculating systems serving multiple dw+rlling units shag inert_ he, recircWation requirements of §150(n).
requirements do not allow the hwallotion of a recirculating .waterlieanmg'spsretn for single dwaelling units.
J. The external water heatingtank and s shall be insulated to meet the rt uirements o f
The Prescriptive.
Contractor or Homeowner (Doc amentatlon Author'stResponsible Building Desigmes Declaration Statement)
• 1 certify that this Certificate of Compliance documentation is accurate and complete.
• 1 a eligible under Division 3 of the California Business and Professions Code to accept responsibility for the building design
identified on this Cenifuutte of Comp,!Wsce.
• 1 certify that the energy features and pesforrnance,-specifications for the building design ,identified on this Certificate of Compliance
conform to. the requirements of Title 24, Part .l and 6 of the California Code of Regulations.
The building acsign features identified on this Certificate of Compliarstx ane cauistent with the information provided to document this
building design•on the other applicable compliance fortns;-worlcshoem calculations. plans and spe-F"toac submitted to the
enforcement agency, foravat with this buildin itapplication.
Name Signantse:
Cir• Date: �
CSU �� J/ CQ Cl
CirylstatoZp:M7 7 L
Sin. #
Cit}/ Of Quiilta
Bulfding 8L Safety Division
P.O. Box 1504,78-495 Calle Tampico
La.Quinfa, CA 92253 - (760) 777-7012
Building Permit Application`and Tracking Sheet
Permit #
Project Address: �( l
Owner's Name:.
A- P. Number.
Address: k �
Legal Description:
Contractor. N IM.)il
City, ST, Zip: nn nn
1:17
Telephone: -34r7— 23t�
Address:
Project Description:
City. ST, Zip: Wo �N.
Telephon .
�1
'c. V
State Lic. # : City Lic fl;
�
Arch, Engr.,.Designer.
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Construction Type:. Occupancy:
Project type (circle one): New Add'a Alter Repair Demo
Sq. Ft.: # Stories: # Units:
Name of Contact Person:
Telephone # of Contact Person: Estimatod Value of Project: S
APPLICANT: DO NOT WRITE BELOW THIS LINE
M
Submittal
Req'd'-
Recd .
TRACICTIVG•
PERMIT FEES
Plan•Sets
Plan Check submitted
itemAmoaut
Strnctnra! Cala
Reviewed, ready for cortectloas
Plan Check Deposit. .
Truss Cala.
Called Contact Person
Plan Cheek Balance. .
Title" talcs.
Plans picked np
Caastractlon
Flood plain plan
Plans resubmitted..
Mechanical
Grading plan'
Z`! Review, ready for correctionsfissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plaus picked up
SALL
H.O.A. Approval
Plans resubmitted
Grading
IM HOUSE:-
''a Review; ready for- corrections/issue
Developer Impact Fee
Planning Approval.
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees