13-0385 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA; CALIFORNIA 92253
Application Number: 13-00000-385
Property Address: 56365 RIVIERA
APN: 762-022-003- -
Application description: PLUMBING
Property Zoning: LOW- DENSITY RESIDENTIAL,
Application valuation: 700
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty ofperjury th t I am licensed under provisions of Chapter 9 (commencing with
Section 7000). of Division 3 of the Bus)pl and Professionals Code, and my License is in full force and effect.
License lass: C36 License No.: 936147
Date: Contracto
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.).
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:. d `
LQPERI%I IT
Owner;
RANDY GRAY
56365 RIVIERA
LA QUINTA, CA 92253
(912)961-84.08
Contractor: .
STATEWIDE SERVICES INC
40244 CATANIA CT /
BERMUDA DUNES, CA 9220
(760)636-0315
Lic. No.: 936147
U
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/01/13
WORKER'S COMPENSATION DECLARATION / -
I hereby affirm under penalty of perjury one of the following declarations: J/
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 1948371
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 be me subject to the workers' compensation provisions of Section
3700 of the Labor Code, I forthwith
comply with those provisions.
Dater Applicant:
ARNING: 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 (5100,000). IN ADDITION TO THE COST bF 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. 1 agree to comply with all.
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of thisgnty to enter upon the above-mentioned property nspection purposes.
Date: / / - Signature (Applicant or Agen )
-Application Number . . . . . 13-00000385
Permit . . . PLUMBING
Additional desc .
Permit Fee 21.00 Plan Check Fee
5.25
Issue -Date - . . . . Valuation . . .
. 0
Expiration Date 9/28/13
Qty Unit Charge Per
Extension
BASE FEE
15:00
1.00 3,000Q EA PLB WATER INST/ALT/REP
3.00
1.0.0 3.0000 EA PLB GAS PIPE.1-4 OUTLETS
3.00
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Special Notes and Comments
WATER HEATER CHANGE OUT - 50GALLON/GAS
WATER HEATER CHANGE OUT (2008 ENERGY]
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 21.00 .00 .00
21.00
Plan Check Total 5.25 .00 .00
5.25
Other Fee Total 1.00 .00 .00
1.00
Grand.Total.: 27.25 .00 .00
27.25
Prescri Ove Gerfifi6te of
Residential Alterations
Pro'ect. Name:
OF- 1R-ALT-DgiW
Page 1 of 2
Climate Zone: Permit #:
General Information ,
Site Address: �(U Enforcement etxi : Date:
Buildin T Mingle Family D -Multi Family Project T e lacetnent or Change Out of Water.Heater
WATER HEATING
List neu4'Y installed %water heaters and boilers for both domestic hot anter heaters-(DWH) and Mttrottic space heating. Nrw�ly installed
D.VVH heaters and boilers must be gas, propane. or use the existing el ")PC.
Waterer
Tytd� Tree,
Distribution Type Numbs In Tank Energy Factor or
R (St d System Capacity (gal) Thermal Efficiency
External Tank
Wsubdim
L Indicate Type (Storage Gas, Heat Pump: instantaneous, etc.)
2. Recirculating systems serving multiple dwelling 'units shall meet the recirculation requimnents of ¢ISA(n).
requirements do not allow the installation of a recirculating water heating system for single dwelling srnits.
3. The a vernal xnter heating tank and pipes shall be. insulated to meet the requirements of § i50%
The Prescriptive.,
Contractor or Homeowner (Documentation Author's/Responsible Building Designer's Declaration Statement)
• 1 certify that this Certificate of Compliance documentation is accurate and complete.
• I am eligible under Division 3 of the California Business and Professions Code to accept responsibility foi the building design
identifted on this Certificate of Compliance.
• 1 certify that the energy features and performance specifications for the building design identified on this Certificate of Compliance
conform to the requirements of Title 24, Part I and 6 of the California Code of Regulations.
The building design features identified on this Certificate of Cornplianoc arc consistent with the information provided to document this
building design on the other applicable Compliance forms, woridteets, calartatiotts.' plans and specifications submitted to the
enforceman for approval with this building permit licatio L
Name: Si
V V`
Caparry:
mDate:
City/StatdTp: ` Phone:
Bin.#
city.,Of ici Quir�ta
Building 8i Safety Division
P.O. Box 1504,78-495 Calle Tampico
(a.Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address:
Owner's Name: . OLA
A. P. Number.
Address: S
Legal Description:
Contractor. `
City, ST, Zip:
Telephone -
Address: (j a ` Vl'►'b�
Project Description: - -�
�-
City, ST, Zip:
l4A
Cl-
Telephone-,�,� 6
State Lie. # :
CityLic. #,
Arch., Engr., Designer.
Address:
City., ST, Zip:
Telephone: Y..
Stats Lic. #: ;w jam» ".
Construction Type:. Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft : #Stories: #Units:
Name of Contact Person: t LL't.
``
Telephone # of Contact Pelson: �b 1
Estimated Value of Project V -�
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Rec'd
TRACKNG
PERMIT FEES
Plan Sets
Pian Check submitted
Item Amount
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Cates.
Called Contact Person
Plan Check Balance
Title 24 Cala.
Pians picked up
Construction
Flood plain plan
Pians resubmitted..
Mechariical
Grading plan
2if Review, ready for correctlonsliissue
Electrical
Subcontactor List
Called Contact Person .
Plumbing
Grant Deed
Plans picked up
SALL
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
3d Review; ready for correctionsirssue
Developer Impact Fee
Planning Approval
Called Contact PersonA.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees