11-1020 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 11-00001020
Property Address: 54120 AVENIDA MONTEZUMA
APN: 774-191-005-5 -000000-
Application description: PLUMBING
Property Zoning: COVE RESIDENTIAL
Application valuation: 229
Applicant:
T4ht 4 4 Q"
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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.
Licen a Clla)ss: C36 License No.: 557026
Date- _I Contractor•
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that 1 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).:
(_) 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.).
I—) 1 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: 1
Lender's Address:
r
LQPERMIT
Owner:
JUNA ROWLAND
54120 AVENIDA MONTEZUMA
LA QUINTA, CA 92253
Contractor: I@
ALL INTERCITY PLUMBIN
255 N. EL CIELO DRIVE;II,r
PALM SPRINGS, CA 92262
(760)323-3455
Lic. No.: 557026
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
J f Y 0 F. 5 A.
A
Date: 2/09/12
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 CASLETPOINT Policy Number WSLTHCO0583506
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
3700 of theXabor Code, I shall forthwith comply with those provisions.
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.
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 aro state laws relating to building construction, and hereby authorize representatives
of this unty to ter upo he above-mentioned property for inspection -p rposes.
/r
ate: _ � nature (Applicant or Agent)
Application Number . . . . . 11-00001020
Permit . . PLUMBING
Additional desc .
' Permit Fee . . . .
22.50
Plan Check Fee
5.63
Issue DateValuation
. . .
. 0
Expiration Date . .
8/07/12
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
INSTALL NEW 40 GALLON
ELECTRIC 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
Prescr 't'ive-Certificaie of Coen .l
Residential Alterotions
Pm'ect Name:T
r
General Informationn
Site Address:
Building Type: 0 Single Family 0 Multi
'sidential CF -1R ALT-DHW ,
Page l o(2 4
Climate Zone: Permit q:
Enforcement Agency:
!}ate=
Pro ect T Re lacement or Change Out of Water Heater
WATER HEATING
• 1 certify that this Certificate of Compliance documentation is accurate and complete.
List new4y installed water heaters and boilers for 66th domestic hot water heaters (DWH) and lndronic space heating.
Ne%4Y, installed
D.WH heaters and boilers must be gas. propane. or use the existin . el tl
conform to the requirements of Title 24. Part I and 6 of the California Code of Regulations.
Water Huta Distribution Type
Nun*x.-r In Tank F—By Factor �r .
External Tank
Imulatim
TYI Type' R tsw��'
ircuiatiiigy
System Capacity (gal) nxnnal Effici ncy
R-Vakw'
VOfrDFWp W 4111�
406
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1. Indicate Type (Storage Gas. Heat Puntp. Instantaneous. etc.)
2. Recirculating systems serving multiple dwelling whits shall meet the recirculation requirements of §150(n).
The Prescriptive..
requirnmem(s do not allow the installation of a mcirrulating water heating system for single dwelling emits.
2. The enema/ voter heating tank and pipes shall be insulated to meet the requirements of ¢_150(7)
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 for the building design
identified 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 feataes identified on this Certificate of Compliance am consistent with die information provided to document this
building design on the otfner applicable compliance fortis, worksheets, caleulainon& plans and specifications submitted to the
enforcement for approval with this budding u application.
Name: Sig"t
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Irl
Company: 1/iNt_VJ\I N Date �
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ALL - INTERCITY PLUMBING
4th GENERATION OF PLUMBING EXCELLENCE
255 N. EL CIELO RD. # 411 a PALM SPRINGS, CA 92262
Phone (760) 323-3455 - Fax (760) 328-0692
Calif. State Contractors' License No. 557026
er
Name G'I ✓I R. ii v1 r^n ❑Tenant Bili.To r A/
Job at �l) 1 li ✓ E >7 "e I� o �, - "-e z u m of At I,�/ /.it -� 2 3 2ti Gl .
city L Gc (,tE d N � .� "t c, CA zip: city do 7" ij ii-� 1 i�S Zip-
371989
ip
391989
DATE
WORKMAN��
Customer 004d ONew
Classification
Telephone
WORKA ffHOPEAMN-IMleherebyauttameftworkdescriiedabngwilhfrteneoessary
maoetialsandparls
WORK ORDERED:
Time
From
To
Hours
MATERIAL USED
AMOUNT
Mon.
%A
✓ iw '9 it ",;A4 -y l C4 k I /►. Gr � o.n, c- ri %,
Tues.
16(n
A r
Gi. W G! 't 7 / !'l Z/�
Wed.
I / /'
✓✓1 L �9 � I V-
Thurs.
C n, ./,
.h
i
Fn.
Sat.
UIV 1 Fr<'
Sun.
ym I I(Atl�
Taal
ENTERED
i
Invoice
Journal
Ledger
Canis
G
WAIVER OF RKiiMT TO CANCEL
Having Ini fated a contract In connection with emergency repairs or service:
for thaimmediate protection of persons or real and personal property, I hereby
state that the followingemergencysituation exists, requiring immediate
auarieon:
Pursuant to Section 1689.13 of the California Civil Code, I acknowledge,
and hereby waive all rights to cancel the sale within three days.
Dated Buyers Signature
IF (11
G r t 2 1
'1 I
Cyr /a/,, Z- 2,n d
,J L , ,� �. / t%l �{ t I 1 (/ G
TO OUR CUSTOMERS: Service men are required to have work slip signed. This is done
in order to protect you, the workmen, and ourselves, and to enable us to give you absolute
satisfactory service. You are respedhdlyy requested to examine material and labor state -
sent before workmen leave the job, and if you find everything satisfactory, okay this ticket.
It service is urtsatistactory, in any way, please phone our office immediately.
"I find the time and material charged above satisfactory and agree to pay for same on
presentation of invoice, and further agree to y reasonable charges forcoAection, indud•
ing attorneys fees in the event of my defauR.'
A PENALTY WILL BE CHARGED AT THE RATDOF t v2% PER MONTH ON UNPAID
BALANCES AFTER 30 DAYS OF INVOICE TE ANVU L PERCENTAGE RATE 18%.
Signed 4 atto
Total Material
OMraCtOfS are required law to licensed an
4 y
regulated by the Contractors' State License Board
which.has jurisdiction to investigate complaints against
contractors if a complaint regarding a patent act or
omission is filed within four years of the date of the
alleged violation. A complaint regarding a latent act or
omission pertaining to structural defects must be filed
within 10 years of the date of the alleged violation.
Any questions concerning a contractor may be referred
to the Registrar, Contractors' State License Board, P.O.
Box 26000 Sacramento CA 95826.
Tax
Service
Permits - Insurance
T - Eouioment
TOTAL
91
Bin. #
Of Quinta
Building at Safety Division
P.O. Box 1504,78-495 Calle Tampico
La.Quinta, CA 92253 -:(760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
`O
Project Address: � /--20, AVON/,. 4 l cWlCity,ST,
Omer's Nam:. • (� /
e7,1 o (.l jlLA.71
A. P. Number.
Address:a
Legal Description:
Contactor.
Zip:
Telephone: O, ko
Address:
Project Description:
Ciry, ST, Zip:
/ r/—
Telephone:
City Lic.
State Lic. # :
Arch., Engr., Designer.
Address:
City., ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person:
Construction Type:. Occupancy:
Project type (circle one): New Add'n Alte Repair Demo
Sq. Ft.:# Stories: # Units:
Telephone # of Contact Person:
Estimated Value of Project:.
APPLICANT: DO NOT WRITE BELOW THIS UNE
H
Submittal
Req'd
Reed
TRACKING PERMITFEES
Plan Sets
Plan Check submitted
Item Amount
Structural Cake.
Reviewed, ready for corrections
Plan Check Deposit, .
Truss Calce•
Called Contact Person
Plan Check Balance
Mile 24 CsI
'Plans picked up
Construction
Flood plain plan
Plans resubmitted'.
Mechanical
Grading plan
Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.L
H.O.A. Approval
Plans resubmitted
Grading
Ik IiOIISE:-
'`` Review; ready for correetionVIssue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P'.
Pub. Wks. Appr
Date of permit Issue
School Fees
Total Permit Fees