13-0449 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
13-00000449
Property Address:
.80659 CHERRY HILLS
APN:
775-132-008- -
Application description:
'PLUMBING
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
2075
<V4,4t 4 4v Q" -
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Applicant: Architect or Engineer:
LICENSE) CONTRACTOR'S DECLARATION
Thereby affirm under penalty of perjury that 1, em licensed;under provisions of Chapter 9 (commencingwith
Section 70001 of Division 3 o the Busineseand Professionals Code, and my License is'in full force and effect.
License Class: C36 Lioense No.: 880269
Date. - Contractor: - -
OWNER -BUILDER DECLARATION
I"hereby affirm under penalty of perjury that I am exempt from the Contractor's State'Llcemse Law for the
following reason (Sec. 703.1 .5, Business and, Professions Code:. Any city or county that requires a permit to
constructalter,, improve, demolish, orrspair 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 taw (Chapter,9 (commencing with Section 7000) of Division '3,of the Business.ereProfessions Code) or
that he or she 1s exampttherefrom.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 (9500)::
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 Imended'or offered for sale (Sec. 7044;.Susiness and Professions., Code: The
Contractors' State License Law does notapply to an owner of property who bullds or Improves thereon,
and who does the. work himself or herself through his or her own employees, provided tharthe
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 o(oshe did not build or
improve•forthe purpose of sale.).
(_ 1 l,.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 em exempt.underSec. B'.&P.C. for this reason
Date: Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there Isis construction lending agency for the performance of the
work for which this permit Is issued (Sec. 3097, CIv:,CJ.
Lender's Name:
Lender's Address:.
LQPERMIT
VOICE (760) 777-7012
i� 'FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date' 4/10/13
Owner: a
CALVERT HENRT & BSTTTA
80.659. CHERRY HILLS
FF
LA QUINTA, CA 92253MR 1110
O 2 13
Contractor: C�QU"'TA
FRANKLIN PLUMBING,,BE J FINANCE.DEPG
2712 B. LA CADENA DRIVE
RIVERSIDE, CA 92.507
(800) 600-0'675
Lic. No.: 880269
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
_ I have and will maintain a certificate of consent to self4risure 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 INS -CO OF WEST Policy Number WVE802966100
_ I certify that, in the performance of the work for which this'permitds.1asued; 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 Labor Code, I shall forthwith comply with those provisions.
Date: q—JO' Applicant: (+
WARNING: FAILURE T.0 SECURE WORKERS''COMPEN ION 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 Applicatiorris 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 requestsand 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 Quints, 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 applicationbecomes null and void If work Is not commenced
within 180 daysfrom date of Issuance of such permit orcessatiomof 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. 1 agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of this county to enter upon the above-mentioned props gins Ion purposes.
ou
Date:. r�'Aignature (Applicant or Agent).
Application Number . . . . . 13-00000449
Permit. . . PLUMBING
Additional desc . .
Permit Fee . . . .
22.50 Plan Check Fee
5.63
Issue Date
Valuation . . .
. 0
Expiration Date
10/07/13
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 7.5000
EA PLB WATER HEATER/VENT
7.50
-----------------------------------------------------------------------------
Special Notes and Comments
REPLACE 50 GALLON GAS
WATER HEATER IN
THE GARAGE 2,010 CODES.
-----•----------------------------•
Other Fees
--------------------------
BLDG STDS ADMIN (3B1473)
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
General Information
Site Address: SkNo5q cuffAClimate Zone: Date: ..
NOTE: Thisform is on& used or alteration or adildon of water headmir sotems.
WATER HEATING
List water heaters and boilers for both domestic hot water (DHW) heaters and hydronic space heating Individual, dwelling DHW
heaters must be gas or propane fired, and may not exceed30 gallons. Hot water pipe insulation from the DHW heater to the
kitchen(s) and on all underground "hot water pipes is required .in all component packages in all climate zones.
• I 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, Parts I and 6 of the California Code of Regulations.
• The building design features identified on this Certificate of Compliance are consistent with the information provided to document this
building design on the other applicable_ compliance forms, worksheets„calculations, plans and specifications.submitted to the enforcement
Energy Factor or
Name:
Water Heater Type /
Distribution Type
Number of
Tank Capacity
Thermal
External Tank
Fuel Type'
(Standard)'
System
a!
Efficiency
solation R -Value
1. Indicate Type (Storage=Gas,-Heat Pump, Instantaneous, etc.)
2. Recirculating systems serving multiple dwelling units shall meet the recirculation requirements of 150(n). The Prescriotive requirements do
not allow the installation of a recirculating water headnr,,system for sinrle dwelling units.
3. The water heating tank and pipes shall be insulated: to meet therequirements of 1506).
Contractor (Documentation Author's /Responsible Designer's Declaration Statement).
• I certifythat 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.
• I 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, Parts I and 6 of the California Code of Regulations.
• The building design features identified on this Certificate of Compliance are consistent with the information provided to document this
building design on the other applicable_ compliance forms, worksheets„calculations, plans and specifications.submitted to the enforcement
agency1or approval with this building permit application.
Name:
Signature:
Company:`�
54
ate: ..,
Address:
License:.
City/State/Zip: n
CPik
Phone
2008 Residential Compliance Forms March 2010
Bin.
City of La Quina
Btdkgng ar Safety Division
P.Q: Box 1504,"7B495 Calle Tampico
f a.Qtdnta, CA 92233 -:(760) 777^.7012
Building Permit Application and Tracking Sheet
Perinft #
ProjectAddtess: Ownees Nwne:..
A P..Nunba:_nAddress. .
Legal Description: City, ST, Zip:
Contractor. h , Telephone:
Address: Pmject Description:
City. ST, tip: "t 'Q\
TelephowAS5
State L.ia {City Lic. iR •
Atr�.. i3ngr., Dosiscet: :`� � • •• •. . '. .
Address:.
City' ST. Zip:
Telephone: Construction Type: Ocaepaacy:
State iia. C Project type (circle one):' New Add'n Alter Repair Demo
Name of.Contim PersonSq Ft : # Stories:
AA# ��Uniw
Telephone # of Contact Pelson: Eat;mated Value of Project: 94S W
APPLICANT: DO NOT WRITE BELOW THIS UNE
Y
Submittal
Revd
Reed
TRACXNG PERwr FEFB
Plan Sets
Pian Check submitted item Amount
St w u u[ Cale,
Reviewed, ready for corrections Pian Check Deposit, .
Truss Gales.
Called Cornet person Plan Check Balance.
'nue Zt Caics.
Plane picked up Construction
Flood plain plan
Plass- resubmitted, . Mechadcal
Grading plan
2" Review, ready for correctionsfissue Elec6ieal
Subeoataetor I.ist
Called Coutact Person Plumbing
Grant Deed
Plaus picked up S.McI.
H.O,A. Approval
Plans resubmitted Grading
iN HOUSE -
''� Ilttvlcw; ready fbr eorrewnwissae Developer Impact k'ee
PLindng Approval.
Called Contact Person
Pub. Wb. Appr -
Date of permit Issue
School Fees
Total Permit Fees