11-1099 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
11-=`00001099
Property Address:
56505 RIVIERA
APN:
762 -022 -010 -
Application description:
PLUMBING
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
800
Tit!t444"
Applicant: Architect or Engineer:
LICENSED CONTRACTOR'S DECLARATION
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 of the Business and Professional ode, and my License is in full force and effect.
License Class: C36 D34 N 15215
CDae: 0' a • //Contractor.
OWNER ILDER 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 nbt more than -five hundred dollars ($500).:
(_) 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.).
(_ 1 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.).
( 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.I.
Lender's Name:
'Lender's•Address:
L.QPERMIT
Owner:
ALAN MARTIN
56505 RIVIERA
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/06/11
Contractor:
PLUMBING INSTALLERS t uri 0 6 2011
13400 SATICOY STREET #25' L3
NORTH HOLL700D, CA 91605
(818)9.82-6952 CITY OF QUINTA
LiC. No.: 915215
I
-
-------------I ------------ -------------------
WORKER'S COMPENSATION DECLARATION
I 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.
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 andpolicy number are:
Carrier TOWER SELECT IN Policy Number WCCO2130900
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 a workers' compensation provisions of Section
3700 of the Labor Code, I shall forthwi ly with thos isions.
Date: //Applicant: ---
WARNING: FAILURE TO SECURE WORKERS' COMPE_P ION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIE AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS 1$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 permitsubject 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. a to comply with all
city and county ordinances and state laws relating to building construction, and >eb�.eqjgj=tives
of this county to enter upon the above-mentioned property for inspection pur
Date: IV__!/Signature`(Applicant or Agent):
Application Number . . .
11-00001099
Permit . . . PLUMBING
Additional desc .
Permit Fee . . . . 30.00
Plan Check
Fee
7.50
Issue Date . . . .
Valuation
. . .
. 0
. Expiration Date 4/03/12
Qty Unit Charge Per
Extension
BASE
FEE
.15.00
2.00 7.5000 EA, PLB
WATER HEATER/VENT
15.00
----------------------------------------------------------------------------
Special Notes and Comments
INSTALL (2) 50 GALLON GAS WATER
HEATERS.
2010 CODES.
Fee summary Charged
--
Paid. Credited
---- - - - ---- - - -
- ----
Due
-- -----
- - - - - - - - - - - - - ------ - - - - --
Permit Fee Total 30.00
- --
.00
.00
-
30.00
Plan Check Total 7.50
.00
.00
7.50
Grand Total 37.50
.00
.00
37.50
LQPERMIT' �- "
Application Number
11-00001099
Permit PLUMING
Additional desc .
Permit Fee . . . . 30.00
Plan Check
Fee
7.50
Issue Date . . .
Valuation
. . .
. 0
Expiration Date 4/03/12
Qty Unit Charge Per
Extension
BASE FEE
.15.00
2.00 7.5000 EA. PLB
--------------------7-------------------------------------------------------
WATER HEATER/VENT
15.00
Special Notes and Comments
INSTALL (2) 50 GALLON GAS WATER
HEATERS.
2010 CODES.
Fee summary Charged
-----------------
Paid. Credited
Due
----------
Permit Fee Total 30.00
------------=-------
.00
----------
.00
30:00
Plan Check Total 7.50
.00
.00
7.50
Grand Total 37.50
.00
.0.0
37.50
Prescri tive Certificate of Comp • fiance: Residential CF-IR-ALT=DHW
Residential Alterations Page I of 2
Project Name: ,S'O IVI-Fg # Climate Zone: Permit #:
General Information
Site Address: Enforcement Agency: Date:
Building Type: ❑ Single Family ❑ Multi Family Project Type: ❑ Re lacettient or Chane Out of Water Heater
WATER HEATING
List newh installed water heaters and boilers for both domestic hot water heaters (DWH) and h►dronic space heating. Newly installed
DWH heaters and boilers mtust be gas, propamne, or use the existing it I type.
Distribution Type
Water Heater NumbiY to Tank Energy Factor or
(Standard,
TypdFi el Type . RecirrulatingS System Capacity (gal) TIHM al Efficiency
Extemal Tank
Insulation
R-Value3
1. Indicate Type (Storage Gas. Heat Ptunp. Instantaneous, etc.)
2. Recirculating systems serving multiple dwelling units shall meet the recirculation requirrinents of §/An).
The Prescriptive
requiretnents do not allow the installation of a recirculating water heating systetn for single dwelling units.
3. The external water heating tank and pipes shall be insulated to nteet thereuirrneents of § 1
Contractor or Homeowner (Documentation Author'sbResponsible Building Designer's Declaration Statement)
• I 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 for the building design
identified on this Certificate of Compliance.
• I certify that the energy features and performance specifications for the building design identified on this'Cenificate 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 Compliance are consistent with the information provided to document this
building design on the other applicable compliance forms, worksheets, calculations. plans and specifications submitted to the
enforcement agency for approval with this budding permit application.
Name: Signature:
C71/9 ->Z
Company: n te:
12
Address: License:
13
City/Statertip: Phone:
AFA
Bin. #
City of La Quina
BuNflog a Safety Division
Box 1504,78-495 Calle Tampico
14.Quinta, CA 92253 - (760) 777-7012
Building Permit Applicadon.and Tracking Sheet .
Permit #P.O.
- D0.
1�
Project Address: VY XTVJ?�:AO
Owner's Name:. , /
A P. Number
Address:
Legal Description: q,24Aalewv_City,
Contractor. GtJ �j
Address: 13 QQ Cp%• A2 Q—
ST, Zip: 9 � 1
�/T
Telephone: _ �
Project Description:
City, ST, Zip: Itl
Telephone:
State Lic. # : S City Lic #:
Arch, EW., Designer.
Address:
City., ST, Zip:
Telephone:
State Lie. #:
Construction Type:. Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.: # Stories: Unitp:
#
Telephone # of Contact Pelson: �p2
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
N Submittal Req'd Recd TRA CIaTVG PERMIT FEES -
Plan Sets Plan Cheek submitted Item Amount
Structural Calfa
Reviewed, ready for corrections Plan Check Deposit. .
Trow C*Ics•
Called Contact Person Plan Check Balance.
Title 24 Calm
Pians picked up Construction
Flood plain plan
Plans resubmitted Mechanical
Grading plea
21' Review, ready for correctionsroue Electrical
Subeontaetor List
Called Contact Person Plumbing
Grant Deed
Plans picked up SMI.
H-O.A. Approval
Plans resubmitted Grading
IN ROUSE:'
''` Rtview, ready for correctionslissucDeveloper Impact Fee
Planning Approval.
Called Contact Person A.I.P.P.
Pub. Wks. Appr
Date of permit Issue
Schodl Fees
Total Permit Fees