PLBG (13-0176)Twit 4
` P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 2/19/13
Application Number: 13-00000176 Owner:
Property Address: 54020 AVENIDA MENDOZA CHRISTINA DOBBLINGS
APN: 774-223-002-21 -000000- 54020 AVENIDA MENDOZA
Application description: PLUMBING LA QUINTA, CA 92253
Property Zoning: COVE RESIDENTIAL (310) 971-6377
Application valuation: 600
Contractor: D O
Applicant: Architect or Engineer: VALLEY PLUMBING CO
�If en 78886 AVENUE 41
BERMUDA DUNES, CA 92203
1✓p`J
.(760)347-3629 CIS® CEDEDT•
Lic. No.: 273088 FMpNCEDEP
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.
License Class: Q36 Lice ee I 273088
f Date: (�/ Contractor• �--
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.).
(_) 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 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:
LQPERMIT
---------------------------7-------------------
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 SELF-INSURED Policy Number 2246
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' c pensation provisions of Section
3700 of the Labor Code, I shat forth i ffc' mply with tho a ovisi ns.
Date: Applicant:
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 and state laws relating to buildin constru .1;on, and hereby authorize representatives
of this county to enter upon the above-mentioned property -r ins ion purposes.
Date: Signature (Applicant or Agent): -
I
Application Number . . . . . 13-00000176
Permit" . . . PLUMBING
Additional desc .
Permit Fee . . . . 18.00 Plan Check Fee
4.50
Issue Date" Valuation
0
Expiration Date 8/18/13
Qty Unit Charge Per'
Extension
BASE FEE
15.00
1.00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS
3.00
----------------------------------------------------------------------------
Special Notes and Comments
EXPOSE AND REPLACE APPROXIMATELY 15 FEET
OF THE CORODED (LP)YARD PIPING FROM THE
EXDISTING (LP) TANK REGULATOR TO THE
ENTRY OF THE STRUCTURE. PIPING WILL BE
RAN UNDERGROUND. NO WORK WILL BE DONE TO
OR INSIDE OF THE STRUCTURE.BOTH THE
STRUCTURE AND THE YARD LINE HAVE BEEN
PRESSURE TESTED INDIVIDUALLY WITH THE
YARD PIPPINGFAILING TO HOLD 30 PSI FOR
15 MINUTES.2010 CODES APPROVED AJ.
----------------------------------------------------------------------"------
Other Fees . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
-------------------------------
Due
--------------------------
Permit Fee Total 18.00 .00 .00
18.00
Plan Check Total 4.50 .00 .00
4.50
Other Fee Total 1.00 .00 .00
1.00 "
Grand Total 23.50 .00 .00
23.50
LQPERMIT
Bin #
City of La Quinta
Building U Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit l
3
Project Address: 54-020 Avcncda Martinez
Owner's Name: Christina Dobbings
A. P. Number:
Address: 54-020 Avcncda U.*inw tq4 l(l O0 2Lri
Legal Description:
Contractor: Valley Plumbing Company
City, ST, Zip: La Quinta, Ca. 92253
Telephone: 310-971-6377
Project Description: Expose and replace approximately 15 feet of the
Address: 78886 Avenue 41
City, ST, Zip: Bermuda Dunes, Ca. 92203
corroded (LP) yard piping from the existing (LP)
Telephone: 760-347-3629
tank regulator to the entry of the structure. Piping
State Lic. # : 273088
City Lic. #:
will be ran underground. NO work will be done to
Arch., Engr., Designer:
or inside of the structure. Both the structure and the
Address:
and line have been pressure tested induvidually with
City, ST, Zip:
the yard piping failing to hold 30 psi for 15 minutes.
Telephone:
Construction Type: Plumbing Occupancy: Yes
State Lic. #:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: D. Troup
Sq. Ft.: # Stories:
#Units:
Telephone # of Contact Person: 760-3464695 Ext: 115
Estimated Value of Project: $600.00
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
Submittal
Req'd
Recd
TRACKING
PERMIT FEFS
Plan Sets
Plan Check submitted
Item
Amount
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2e0 Review, ready for correctionsfissue
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 correctionsrssue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
Valley Plumbing Company
Replace the LP yard line from the propane tank to the structure. The structure
has been pressure tested 02/24/2013 and held 30 psi for 1/- hour. No work
will be done to the propane line inside the structure. Amerigas is the local
provider.
A8 �iVCI _
iionHiS
®3AOH1 114
'1dAQ AJ:14W(Z V J1Vln
merigas Regulator and line to the LP. tank
3/4" X PE Socket Reducer
3/4" PE Transition Sweep
a
Grade 18 s
Christina Dobbings
54-020 Aveneda Martinez
La Quinta, Ca. 92253
310-971-6377
78886 Avenue 41 Bermuda Dunes, Ca. 92203 (760)346-4695