12-0382 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
r
Application Number:
Property Address':
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
12-00000382
78740 CASTLE PINES DR
770-080-010-10 -25389 -
PLUMBING
MEDIUM DENSITY RES
700
Tityl 4 4 "
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Architect or Engineer:
PIA
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 70001 of Division 3 of the Bu ess and Professionals Code, and my License is in full force and effect.
License Class: C36 License No.: 731855
Date/LT/Contr
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.).
(_ 1 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 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 _ 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:
LQPERMIT
Owner:
SMITH RESIDENCE
78740 CASTLE PINES DR.
LA QUINTA, CA 92253
in -D
Contractor:
STATE WIDE PLUMBING
40244 CATANIA COURT
INDIO, CA 92203--0
(760)636-0315
Lic. No.: 731855
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
APR 10 2012
LA
Date: 4/10/12
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 SOUTHER INS CO Policy Number WSIO047530-01
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 shou become subject to the workers' compensation provisions of Section
3700 of the Labor I shall forthwith comply with those provisions. .
Dat ••/�(�^Applic
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 1 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 build' construction, and hereby authorize representatives
of this county to enter upon the above-mentioned pope r inspection purposes.
Date ignature (Applicant or Age
Application Number . . . . . 12-00000382
Permit ... . PLUMBING
Additional desc .
Permit Fee . . . . 22.50 Plan Check Fee
5.63
Issue Date . . . . Valuation . . .
. 0
Expiration Date 10/07/12
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 7.5000 EA PLB WATER HEATER/VENT
7.50
----------------------------------------------------------------------------
Special Notes and Comments
REMOVE & REPLACE 50 GALLON NG WH. 2010
CODES.
i
---------------------------------------------
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
r
Prescri tiye Certificate of Com Bance: Residential ..... CF-IR-ALT-D11W j`
Residential Alterations age t of z
Project Name: Climate Zone: Permit q:
General Inforrnatain
Site Address: _ Enforcement C,-Ky.. Date:EE�
(�~
Buiidine Tvoe: Sinele Family O Multi Family I Proiect Tvoe:`•XReolacement or Change Out of Water Heater.
WATER HEATING
List newh• installed water heaters and boilers for both doanestic hot water heaters (DWH) and h?dronic space heating. Ne%4. installed
DWH heaters and boilers mustbe gax e. or use the existing el
Wats Ficarer
Typa+Fi+et Type
( Numbs In Tank atiy F°r
System Capacity (gal) lbamst Bfficiarcy
F�ctemal Teak
hsutataoa
R-Vatud
1. Indicate Type (Storage Gas. Heat Amp. Instantaneous. etc.)
2. Recirculating systems serving n khWe dwelling units shall inlet the recirculation requirements of §1504
requirements do not allow the batathvion of a recirrularing water heating system for single dwelling units.
J. The eaernal water heat' tank and - s shall be insulated to meet the requirements o !
The Prcscriptivr .
Contractor or Homeowner'(Documentation Author'stResponsi Ae Building Desigmes Dedaratbn Statement)
• F certify that this Certificate of Compliance documentation is acartme and complete.
• I am eligible under Division 3 of the California Business and Professions Code to soap, responsibility for the building design
identified on this Certificate of Compliance.
• I certify that the energy features and performatnce specifications for dne building design identified on this Certificate of Corrnpl'iartoi:
conform 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 am conrshMent with the information provided to document this
building design on the other applicable compliance -forms, wo calculainotu plans and spociGcaGons submitted to the
enforcement agency for approval with this budding itapplication.
Name: S'
��'� U\ .
A4�7tom:
CFty/S
Bin.#
Q ®f Qutnta
Budding 8i: Safety Division �
P.O.. Box 1504,78-4 95 Calle Tampico
La.Quinta, CA 92253 -:(760) 777-7012
Building Permit Application and Tracking Sheet
Permit #' ':
I�
�Ul •
ProjectAddress- f(� 1 r
Owner's Name:.
A. P. Number.
Address,:' f-7 L/ 8 C&�41 S y
Legal Description:City,
ST, Zip:(-f4-
Contracto . l 1
Telephone _
ati?'
w sem,
Address: ; a C4Proyje�ctDescription:
City, ST, Zip:-1
Telephone'Z
r:``
:•z ��«?
State Lic. # : l`' S
City Lic. #•
Arch., Engr., Designer. 1 0061 Dg
Address:
City., ST, Zip:
Telephone:
State �;w/y%� ” ,�
Name of Contact Person'—,r-r r C
Construction Type: . Occupancy:
Project We (circle one): New Add'n Alter Repair Demo
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:. 3
Estimated Value of Project: .0 •Q
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Reed
TRACKNG
PERMIT FEES'
Plan Sets
Plan Check submitted
"
item Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit,
Truss Cates.
Called Contact Person
Plan Check Balance •
Tide 24 Cal&
Pians picked up
Construction
Flood plain plan
Plans resubmitted..
Mechanical
Grading plan
21" Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
SALL
13.0.4- Approval
Plans resubmitted
Grading
N HOUSE:-
'^` Review.' ready for correctionslissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees