12-1272 (PLBG)79759 America Ct
12-1272
IIIIIIIIIIIDIIIVIIIIIII 46
- IE
P.O. BOX 1504 - - • - -
'*495 CALLE TAMPICO
L kQUINTA, CALIFORNIA 92253
Tay/ 4 4 Q"
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
1 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.
ZI.t,nseClass- C36 LicenseNo.: 731855
j oractor.
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 Codel 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.).
(_ 1 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 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
1 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
Owner:
HOFF DAVID A
79759 AMERICA COURT
LA QUINTA, CA 92253
Contractor:
STATE WIDE PLU
40244 CATANIA
INDIO, CA 9220
(760)636-0315
LiC. No.: 7318
VOICE (760) 77
FAX (760) 777-70 1
INSPECTIONS (760) 777-7153
Date: 10/25/12
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 and policy number are:,
Carrier MARKEL INS CO Policy Number MWC00329801-01
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 s uld become subject to the workers' compensation provisions of Section
/ 3700 of the Labordple, I shall forthwith comply with those provisions.
Dal/.
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.
APPUCANT 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. I agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of this
county
CtoJenter upon he above-mentioned propert or inspection purposes.
1.109 ,I7, ' nature (Applicant or Agen*- c
Application Number:
12-00001272,
Property Address:
79759 AMERICA CT
APN:
604=502-025-3.0 -24197 -
Application description:
PLUMBING
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
700
Tay/ 4 4 Q"
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
1 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.
ZI.t,nseClass- C36 LicenseNo.: 731855
j oractor.
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 Codel 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.).
(_ 1 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 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
1 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
Owner:
HOFF DAVID A
79759 AMERICA COURT
LA QUINTA, CA 92253
Contractor:
STATE WIDE PLU
40244 CATANIA
INDIO, CA 9220
(760)636-0315
LiC. No.: 7318
VOICE (760) 77
FAX (760) 777-70 1
INSPECTIONS (760) 777-7153
Date: 10/25/12
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 and policy number are:,
Carrier MARKEL INS CO Policy Number MWC00329801-01
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 s uld become subject to the workers' compensation provisions of Section
/ 3700 of the Labordple, I shall forthwith comply with those provisions.
Dal/.
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.
APPUCANT 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. I agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of this
county
CtoJenter upon he above-mentioned propert or inspection purposes.
1.109 ,I7, ' nature (Applicant or Agen*- c
Application Number . . . . . 12-00001272
Permit . . . PLUMBING
Additional desc .
Permit'Fee . . . . 22.50
Plan Check
Fee
5.63
Issue Date . . . .
Valuation
. . .
. 0
Expiration Date 4/23/13
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 7.5000 EA PLB WATER
HEATER/VENT
7.50
7 --------------------------------------------------------------------
Special Notes and Comments
REMOVE & REPLACE 40 GALLON GAS WATER
HEATER. 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
Prescriptive Certificate of
rResidential Alterqtions
Climate Zone:
Permit M
1
=1R-ALT7DHW : .
Page t of 3
General Informatkm
Site Address: Enforcement em:y- Date:
Buildin T in le Famil ❑Multi
Family] Project T e lac ement or ChangeOut of Water Heater
WATER HEATING
List newh• installed water heaters and boilers for bwh domestic hot water heaters (DWH) and hytbottic space heating. Newt)• installed
MH heaters and boilers mast be gas, e, or use the existing l qre-
Water Fieitcs
Typdfroet Type
Dattmb raton T ' Number In Tank ABY factor err
(Stimmd+md. System Capacity (gall llmerstmal E(ficictscy R-Vahtem
1. Indicate Type (Storage Cas. Heat PmW /nrtantatrtous etcJ
2. Rerirctdatmg systems serving multiple dwelling units shall inert the recirculation requirements of VARA The Prescriptive
requirm-nts do not allow the bwallation of a recirculating wnterheating j wem for single dwelling units.
J. flee esternal stater heating rant and pApq shall be insulated to meet the rrquirenients of J !
mtractor or Homeowner (Doasmentatfon Author'stResponsi Ae Building Designees Dedaration Statement)
• i certify that this Certificate of Compliance doc umenta6m is amurate and complete.
• i am eligible under Division 3 of the California Business and Professions Code to adapt responsibility for the building design
identified on this Certificate of Compliatsce_
• i certify dial the energy features and performance specifications for the building design identified on this Certificate of Complianoi:
conform to the requirements of Title 24, Part 1 and 6 of the California Code of Regulations.
• The building design features identified on this Oertirate of conviancc m consistent with the information provided to tiowmtmt this
building design on the other appliabk,00mplianee forms, wotimbeem cakulatiotm plans aro speciation shed to the
enformaxx t asency for approval with this build" is km
ntpaty: n _
bl /_ 1-0-12&
k— __ r -
Vo Hq-
` K_du0 ' a , v Z OO
-'r
Bin # jt
1 {
Permit #
Buitdlin,
AAA -
City of La QUinta
pe14 ding 8L Safety Division
P.D. Box 1504, 78-495 Calle Tampico
La Qllinta, CA 92253 - (760) 777-7012
ermit Application and Tracking Sheet
Id
Owner's Name:
.. ,------- - ,
A. P. Number.
;
Address:
Legal Description:
A,
City, ST, Zip:
Contractor: /
% /)
Telephone:
Project Desc/riptrion:
b•
w.<..
v
Address:
City, ST, Zip:
!
C
Telephoneri
State Lic. # :
City IWD 9
Arch., Engr., Designer.
I
Address:
City, ST, Zip:
Telephone:
State Lic. #:
r' > ,
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
I
Sq. FL •
# Stories:
# Units:
Telephone # of Contact Person:
(
Estimated Value of Project:
APPUCANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Rec'd
I TRACMG
PERMIT FEES
Plan Sets
I
Pian Check submitted
Item
'
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
CalledlContact Person
Plan Check Balance.
Title 24 Cales.
Pians picked up
Contraction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2n4 Review, ready for correctionsfissue
Electrical
Subcontactor List
Calledi Contact Person
Plumbing
Grant Deed
Plan picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
''& Review, ready for correcdonsfissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wls. Appr
Date of permit issue
School Fees
Total Permit Fees