PLBG (14-0136)79355 Mandarina
14-0136
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
14-00000136
79355 MANDARINA
772-350-014- -
PLUMBING
LOW DENSITY RESIDENTIAL
1790
Architect or Engineer:
4
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
DEREK ISLES
79355 MANDARINA
LA QUINTA, CA 92253
(760)698-8549
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.
LicenseClass: A C36 C42 UILDERDNECLAR'ATION
65155
Dat€: — ' Contractor: '
OWNER-
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 _ 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 solo 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, 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 town 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 _ 1 I am exempt under Sec. , BAP.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:
LQPFPMIT
Contractor:
RESCUE ROOTER
1520 W. LINDEN STREET
RIVERSIDE, CA 92507
(951)341-9371
Lic. No.: 765155
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 2/11/14
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 LIBERTY INS Policy Number WC7631508631
_ 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 the bor Cod I Ilfwith comply with th se provisions. .
✓ _
Date:a I1-ly Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPEN ATION 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 an unty ordinances and sta a laws relating to building construction, and hereby authorize representatives
oft county/to enter upon th ove-mentioned property for inspection purposes.
Date: a' "f — (' Signature (Applicant or Agent): C.
Application Number . . . . . 14-00000136
Permit PLUMBING 2013
Additional desc .
Permit Fee11.92 Plan Check Fee
.00
Issue Date . . . . Valuation . . .
. 0
Expiration Date.. 8/10/14
Qty Unit Charge Per--
Extension
1.00 11.9200 EA PLBG WATER HEATER/VENT
11.92
----------------------------------------- ---------------------------
Special Notes and Comments
WATER HEATER CHANGE OUT - (1) 48
GALLON/GAS WATER HEATER(S) [2008 ENERGY]
CARBON MONOXIDE ALARM(S) TO BE INSTALLED
PRIOR TO FINAL INSPECTION. 2013
CALIFORNIA BUILDING CODES.
-------------------------------------------------------------
Other Fees . . . . . . . BLDG STDS ADMIN (SB1473)
--------------
1.00
PERMIT ISSUANCE M/P/E
90.57
PLAN CHECK, PLUMBING
7.15
Fee summary Charged Paid Credited
Due
Permit Fee Total 11.92 .00 .00
11.92
Plan Check Total .00 .00 .00
00
Other Fee Total, 98.72 .00 .00
98.72
Grand Total 110.64 .00 .00
110.64
LQPERM IT
Bin #
Cityof La Quinta
Building &r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
I
Project Address: 79 3SS M h da r ).Vxa
Owner's Name: Oe ,•c !L 1 S'!e 5,
A. P. Number:
Address: 793 5 Nlot rto(a. i ^. a
Legal Description:
City, ST, Zip:
Contractor: esc
Telephone: ?Gc 6R8- S
mom=
Address: is w t_i-,,,c ,c
Project Description: UJC } 't
City, ST, Zip: 12i`ve ✓Si c<< C Ql,- S—U7r
Q Gin -
Telephone:
State Lic. # : % 5 I S S City Lie. #•:
Arch., Engr., Designer:
Address:
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City., ST, Zip:.
Telephone:
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Construction Type: ✓ Occupancy:
State Lic. # •
Project a circle one): New Add'n Alter e
J type ) Pair Demo
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone #,of Contact Person:
Estimated Value of Project -7 ,
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cales.
Called Contact Person
Plan Check Balance
Title 24 Cales.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'"' Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
Prescriptiye. Certificate of Compliance: Residential CF-1R-A.LT-DHW-
Residential AlterationsPage 1 ot'-
Project Name: Climate zone: / Permit I(:
General Information
Site Address:-1`x3S 5 Enforcement Agency:
Building T Sin le Family 0 ultiFamily I Project Type: PRelace"nt or Change Out of Water Heater.
WATER HEATING
List neu4It• installed water heaters and boilers for built domestic hot eater hearers (DWH) and h.Wrottic space heating. Nev44Y installed
DWH heaters and boilers must be gas. propane. or use the existing eel h
D&ribution Type
Water h{ ter Numbs M Tank8YOf
TYpdq Type R(StarAacdsystem Capacity (gal) Mxrtnal Efficiency
External Tank
Insulatiaa
R-Vakx
(res $ ► ti ck,, . o 56
O
I. Indicate rve (Storage Gas, Hear Pump: Instantaneous, etc.)
2. Recirculating systems serving multiple . dwelling units shalt meet the recirculation requirements of V SO(n).
requi-ments do nor allow the installation of a rrcirculating water heating system for single dwrlling units.
J. The a aernal water heating tank and poes shall be insulated to meet the rrquirements of § 15M.
The Prrscriptivr,
Contractor or Homeowner (Documentation Author's/Responsible Building Designee'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 nxponsibility for the building design
identified on this Certificate of Compliance.
• t certify that the energy features and perfotmanxx specifications for the building design identified on this Certificate of Compliance
confortn 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 nue consistent with the information provided to document this
building design on the other applicable co plianee forms, worksheets, calculation& plans and spociGcaflons submitted to the
enforccrsxnt agency for appmval with this building a licazion
Name: Signanvr e:
C—V-Y: Wee.
Address: License:
Z. a w vm A -e -1 l0 5 i S S
City/Stata?ip: Phone:
Qt c ✓S:cQt G( a507 ci37