11-0929 (PLBG)P.O. BOX 1504
78'-495.CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: j
11-00000929
Property Address:
52160 AVENIDA RUBIO
APN:
773-213-008-15 .-000000-
Application description:
PLUMBING
Property Zoning:
COVE RESIDENTIAL
Application valuation:
600
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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.
nseClass: C36 LicenseN0.: 618140
mracto
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
1, 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 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
Owner:
MARIA GARIBAN
52160 AVENIDA RUBIO
LA QUINTA, CA 92253
Contractor
CAMPESINOS� OILS , INC.
P.O. BOX 319
BRAWLEY, CA 92227
(760) 344 -4 500
Lic. NO.: 618140
WORKER'S COMPENSATI01
I hereby affirm'under penalty of perjury one of the following declara
_ 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
kfZVoinued.
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' CYPRESS INS Policy Number 3330058264
_ 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 Labor Cod
/e,,{�eFra} forthwith comply with those provisions.
Date:pticam:
WARNING: F LURE 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.
VOICE (760) 777-7012
FAX (760) 777=7011
INSPECTIONS (760) 777-7153
Date: 8/29/11
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 ac[ 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 ret pg.ie8dildia truction, and hereby authorize representatives
Aof is c unty to enter upon the abov - ntioned property for ins coon purposes.
te( -11
e: Signat (Applic e
M
LQPERMIT
Application Number
11-00000929
Permit . . .
PLUMBING
Additional.desc .
Permit Fee
22.50
Plan Check Fee
5.63
Issue Date
Valuation
0
Expiration Date
2/25/12
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
1.00 7.5000
EA PLB
WATER HEATER/VENT
7.50
----------------------------------------
Special Notes and Comments
-----------------------------_-------
CHANGE OUT 40 GALLON
GAS WATER
HEATER.
2010 CODES.
-------------------_--------------------------------------------
Other'Fees
BLDG STDS ADMIN.(SB1473)
1.00
Fee summary Charged
Paid Credited
------------------------------
Due
---------------------------
Permit Fee 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
Prescriptive Certificate of Compliance: Residential CF-IR-ALT-DHW
Residential Alterations Page I of 2
Project Name: iY1aY'-ti Gh-y-;b Climate Zone: Permit #:
General Information
Site Address: .P/(od ve-,; JC, w 'J
Enforcement A enc -25; Date: '�
BuildingT in le FamilyD Multi FamilyProject
T Re lacement o n e Out of Water Heater
WATER HEATING
• l certify that this Certificate of Compliance documentation is accurate and complete.
List new/Y installed water heaters and !oilers for loth domestic hot water heaters fDWH) and hYdronic space heating.
DWH heaters and boileis ►nnst be gas. propane, or use the esistin ueI h• e.
Newly installed
Water Heater DistnNaion Type Numb�v In Tank Enemy Factor
•TypdFuel Type:' (Standard = System Capacity (gal) Thermal Efficiency
R irculati )
External Tank
insulation
Value
• 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 agency for approval with this budding permit application.
Name:
Signature:
Company:
Date:
1. Indicate Type (Storage Gas. Heat Piunp. Instantaneous. etc.)
2. Recirculating systems serving multiple dwelling units shall meet the recirculation requirentents of §lAn).
requirements do not allow the installation of a recirculating water heating system for single dwelling units.
j. The e.vernal iewter hearing tank and pipes shall be insulated to meet the rc uiretnents of § 15
The Prescriptive
Contractor or Homeowner (Documentation Author's/Responsible Building Designer's Declaration Statement)
• l certify that this Certificate of Compliance documentation is accurate and complete.
• 1 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. Part l and 6 of the Cal ifomia 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 agency for approval with this budding permit application.
Name:
Signature:
Company:
Date:
Addrcss':f2 vo�
License:
Citylstate2ip:
l 9 Zz
Phone:
?60-3el 7 SdC)
P
Bin #
City of La Quint'a
Building 8f Safety Division
P.O. Box 1504, 78-495 Calle Tampico
la Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address:
A. P. Number:
Owner's Name: rn G Y"i bw
Address: l (, o A
Legal Description:
City, ST, Zip: b9z, Vit y\ ei c� a�
Contractor: �%/n O`0.S
�M�
'.;
Telephone:, ; .,; fix,:' ��`i,•
Address: O
Project Description:
City, ST, Zip: %� �J el iJ2iZ,
�j'� 1 n cry O
Telephone:/ .:d
State Lic. #: t `.
v`iiv �.:v;:d: :•)4M4:•iii 5:.�.Ci �:�+.<4?:::i:i%'v::
City Lic. #:
` l-i.a.. -Q.
Arch., Engr., Designer:
Address:
'City, ST, Zip:
Telephone:
P
State Lic. #:?
<:n?;" •; •.: k>00:-.0Tele
;: ,.. •.# ,..: Y ,.,. �
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: C
Sq. Ft.:
#Stories.
#Units:
Telephone # of Contact Person: '26O -ay7-9,7
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
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 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