PLBG (13-1336)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
13-00001336
Property Address:
43580 MILAN CT
APN:
609-552-013-32 -28458 -
Application description:
PLUMBING
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
800
Applicant: Architect or Engineer:
V .
--------------- - -
LICENSED CONTRACTOR'S DECLARATION
4
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 Professionals Code and my Lice full force and effect.
License Class: C36 894
Date(/-- 21 —/ Contracto
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).:
(_) 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 contractors) licensed
pursuant to the Contractors' State License Law.).
( ) 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:.
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/21/13
Owner:
CAROL OSTROM
43580 MILAN COURT
LA QUINTA, CA 92253
(760)200-5213
Contractor:
WDHEA R. °30300IN
ALL STAR PUERTOEVALLA WAY6CT 2 12013
MENIFEE, CA 92584
(95,1)301-0067 CITY OF LA QUINTA
Lic. No.: 812894 FINANCE DEPT.
WORKER'S COMPENSATION DECLARATION
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.
,A
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 OAK RIVER INS Policy Number 2200062086121
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 becom lett to orkers' ansa ' provisions of Section
�/- 3700 of the Labor Code, I s 1 wi those provisions.
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 it 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 infor is cor�alize
comply with all
city and county ordinances. and state laws relating to building c uction, and hepresentatives
of this county to enter upon the above-mentioned propertyAlYr inspection pur _
Date Signature (Applicant or Agent)'
Application Number . . . . 13-00001336
Permit . . . PLUMBING 2013
Additional desc
Permit Fee 11.92
Plan Check Fee
.00
Issue Date . .
Valuation . . .
. 0
Expiration Date'. 4/19/14
Qty Unit Charge Per
Extension
1.00 11.9200 EA PLBG WATER
HEATER/VENT
11.92
------------------------------------------------------------------------------
Special Notes and Comments
WATER HEATER CHANGE OUT - 40GALLON/GAS
[2008 ENERGY] CARBON MONOXIDE ALARM(S)
TO BE INSTALLED PRIOR TO FINAL
INSPECTION. 2010 CALIFORNIA BUILDING
CODES.
- ----------------------------------------------------------------------------
Other Fees . . . . . . . . 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 97.72
.00 .00
97.72
Grand Total 109.64
.00 .00
109.64
LQPERMIT
Bin #
Qty of La QUinta
Building 8T Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #.
,
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Project Address: U
Owner's Name: ate:
A. P. Number:
Address:
Legal Description:
City, ST, Zip: t
Contractor: 41Tele
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Address:
Project Description: k4fC
City, ST, Zip:
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Telepho
State Lic. # :
City Lie. #;
Arch., Engr., Designer:
Address:
City, ST,, Zip:
Telephone:
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Construction Type: Occupancy:
State Lic. #:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone #,of Contact Person:
Estimated Value of Project: eFm do
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calls.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
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
• � i
WIM REM
stw iter earerw SP4 &WMjbrW &ijewe- kV Wier #* a $goes say sj,'
Asawrw Nara k lm prRnq� . #gprr, 4NOW Not -caved $0: jauw, •Aria VWsrp W LwWi la jm o alts AfW kWff If ile VO (s)
OW on It rmd in an Is 4U.4UMMOU,
Yater Neater ettibution Type ,.fhisber In tank Energy, octet or External Tank
Type./fuel'Type' (Stgndprd. System Ctpseity (01) Thermal Efficiency Insulation R-Yaluel
Reaisat�latin )_ '
Storage Gas•tan ar
50 .62
: Unfired storage tanks. such. a; storage treks.er backup links for solar wrstsr- eating sjites, or
E13
other indirect hot water tanks have R-lZ extorrsl insulation or R-16 internal insulation whore the.
intiriie3 isoulstieAih-value is i+�diaated on tMa exterior et the tank;
First b feet of het Md. cold. water pipes ehar#t to water heater tank, ndn-recircdlatfng systess, and
9. 'Wave rype Nims , awrxaw, JAMW4Miow. we,
2. Red?=191me syslelll,TttnrGtt wsbip/i i�srlurg rnlrs thQit suet tNy rreiMalW/on rt4uirwMsyt�t it flleM). !hs Prwserlptirw
htquin wxO ate sea 4&w oke bWalWlon Oe rndncrr/otbrg water egliaf�s�v "for dqk ehwluej w1Gr.
3..Yhe ear .O wrtH h t shall be inwAatol tp as 5 noeaati. .. IJO .
e I cert ;tout tilt Caetlilfagb'sf Cam iesaaid
Naar Jeff Sprague F,�' Qrner th
Company : All Star Water Heater
Address: 30300 Puerto Vallarta Wa
City/State Zip: Menifee CA 92584
uuu�.
agent
Contractor license 0: 812894
u
Rater heaters. dMcertified by the Ener awe moon.
: maws haat nt see revlatien loops sirvin' �u t plc daalling.units and Nigh -Rosa residential
ocoupsnoies meet the sir.,rtlease valve, backflow prevention, puny isolation valve, and ricireulgti..oa.
A: Storage jet water hooter# rated with en nera<yaeter no greater than the federal sinlsel standard
are ex• frnsll or# ed. with.dnaalatioo havin en installed thermal resistance of R-19 er eater.
: Unfired storage tanks. such. a; storage treks.er backup links for solar wrstsr- eating sjites, or
E13
other indirect hot water tanks have R-lZ extorrsl insulation or R-16 internal insulation whore the.
intiriie3 isoulstieAih-value is i+�diaated on tMa exterior et the tank;
First b feet of het Md. cold. water pipes ehar#t to water heater tank, ndn-recircdlatfng systess, and
entire length of recirculating emotions of het water i s are insulated r.Standards Takl 150-E.
Cooling system piping ' auction, chil ed wste>r. er rine lines ,and'pipinj insulated between heating
source and indireat hot wstor tank .he> bf lnsalstpd to able Iatf-8..and ties 160-A.
Pipi insulation for ttau hydronie hating :yttess or hot water sgrtems >15. i, accts the
.repuirseents of itererds Table 1232.
150 (J) W Insulation is protected frac, dotage, one u n; t st due: to sualight, eaii:cur., epuipmsnt
FlAintsmanse, and wind
e I cert ;tout tilt Caetlilfagb'sf Cam iesaaid
Naar Jeff Sprague F,�' Qrner th
Company : All Star Water Heater
Address: 30300 Puerto Vallarta Wa
City/State Zip: Menifee CA 92584
uuu�.
agent
Contractor license 0: 812894
u