BPLB2015-008678-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
COMM UNITY'DEVELOPMENT DEPARTMENT
BUILDINGVERMIT
Application Number:
BPLB201S-0086 . .
Property Address:
526,55. AVENIDA RUBIO
APN:.
773282020
Application Description:
40 GALLON WATER HEATER CHANGE
Property Zoning:
Contractor:
Application Valuation:
$800.00
Applicant:
RETO KAUFMANN
13486 AMBROSIA. DRIVE d
12486 AMBROSIO DRIVE
DESERT HOT SPRINGS, CA
92240
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/25/2015
Owner:
JEFFREY HORGER
52655 AVENIDA RUBIO
LA QUINTA, CA 92253 I L_!=iI
LICENSED CONTRACTOR'S.DECLARATION
I hereby affirm under penalty of perjury that l;am licensed under provisions of Chapter'
9 (commencing with Section 7000) of Division'3 of the Business and ProfessionsCode, .
and my License is in full force and effect.
License Class: C36 License No.: �941122�37
Date: C' � CIn tractoc'
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, orrepair
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 the7work
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 owrier 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. 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:
Len
(760)78474095
Llc. No.: 941237
WORKER'S COMPENSATION DECLARATION
I hereby affirm under.penalty of perjury one of the following declarations:
I have and will rriaintain 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. Nly workers' compensation insurance carrier and policy number are:
Carrier: _ ' Policy{Number:
Icertifythat• in the performance.of the work for which this permit is issued, I
shall not employ anypersonin 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.
. .
Dat Z _Appli{ cantr�`
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALLSUBJECT 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'Building Official for a permit subject to
the conditions'and restrictions set forth on this application..
1. Each p' rsdn 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 resultof 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 bf 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 building
construction, and hereby authorize representatives of this city to enter upon the above-
mentioned property for -inspection purposes.
_:. -..: -
Signature (Applicarit.or-Agentjc—=�
a
17=
O
2a
Contractor:
�
� w
g
RETO KAUFMANN
J
o>
13486 AMBROSIA. DRIVE d
DESERT HOT SPRINGS, CA 92240"
LICENSED CONTRACTOR'S.DECLARATION
I hereby affirm under penalty of perjury that l;am licensed under provisions of Chapter'
9 (commencing with Section 7000) of Division'3 of the Business and ProfessionsCode, .
and my License is in full force and effect.
License Class: C36 License No.: �941122�37
Date: C' � CIn tractoc'
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, orrepair
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 the7work
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 owrier 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. 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:
Len
(760)78474095
Llc. No.: 941237
WORKER'S COMPENSATION DECLARATION
I hereby affirm under.penalty of perjury one of the following declarations:
I have and will rriaintain 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. Nly workers' compensation insurance carrier and policy number are:
Carrier: _ ' Policy{Number:
Icertifythat• in the performance.of the work for which this permit is issued, I
shall not employ anypersonin 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.
. .
Dat Z _Appli{ cantr�`
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALLSUBJECT AN EMPLOYER,TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS'($100,000). IN ADDITION TO THE COST OF .
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,.
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT:Application is hereby made to the'Building Official for a permit subject to
the conditions'and restrictions set forth on this application..
1. Each p' rsdn upon whose behalf this application is made, each person at whose
request and for whose benefit work is performed under or pursuant to any permit
issued as a resultof this application , the owner, and the applicant, each agrees to, and
shall defend, indemnify and.hold•harmless the City of La Quinta, its officers, agents, and
employees for any act or omission related to the work being performed under or
following issuance of this permit.
2. Any permit issued as a result bf this application becomes null and void if work is
not commenced within 180 days from date of issuance of such permit, or cessation of
work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is correct.
I agree to;comply with all.city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter upon the above-
mentioned property for -inspection purposes.
_:. -..: -
Signature (Applicarit.or-Agentjc—=�
'.y: "a:. .'•.a .S e�T, D 7a F ..r4:.;, daS+`$� E,- U.�%a ANN
x DESCRIPTION ��ACCQUNT QTY
-.',y.ra�iSi�'=i'.E�S'".vbf;'�i
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AMOUNT - �P,.AID
b»•.`;.<::'`.:i.o<..a4"usa.:m.r;§.4'"s.'��,.,.a�S`c
kPAIDDATE
....BSA SBl'473!FEE 101 0000:20306 0
$1.00 $0:00
np. .6',cv''"��!r4;,::a3i�i$' vF°'.l=ih'.u-"a`€;,�',
"::.011"I
�PAIO BY r -? g � METFIOD " py:: sSRECEIPT.#_ CHECKr#� CLTD'BY 3
£iA�i_..
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:w�c -rt ,i Ea,,.=.r.i w:.i.. .it, TY`:.,'..0 um4 u3dxas': ,'�!.Lsy7X :.Lv 4i:�'"'4S."a i3x'3�:U., fkxi�`u�;:..v."S.' .,�P�.i��s^?d, :...iit%S �-. �v�C.�Y,^. �`w°-.S�S'..`�-"�[�,'ds,.
TotM'Paid forBUILDING STANDARDS ADMINISTRATION BSa .1. $S'00 $0.00
Yhnj.ySCRIYuPT.,AI}"O^'�•t
sA�CCiOU.��NTg,✓12��Ee
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WMAQ'AMOU"NT;
PaIDE
'rDaATRE:t�'
?=a`'Y
, .�$
�
�ID
PERMIT ISSUANCE
rt 101 0000;42404"
0 $91 85,
.$0.:00
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���PAIDBY'�''�METHOD�k
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RECEIPT#
a2 a.'s +,�rF-.£�f.,
"
.CHECK#
eCLT.DnBY''
Total PaidforPERIVIIT ISSUANCE $91 85: $0:00
1,_. M ~I
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PAID `,"PAIQ
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WATER HEATER/VENT
101 0000-42401"
0
$12 09;,'
$0.00
PAID BY
METIOD,.
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RE #
CCTD BYE
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:CEIPT R110—CHECKS#`
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DESCRIPTIONx���,
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atrAMOUN`�
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WATER HEAT VENT PC
301 0000+42600
0 :
`' $Z 25
$0.00'
r' 4a ;ate: E+•�Y
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CHECK#,.
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77
Tl Paid`forPUMBING FEES
otaL U-;:. $0.00
..P6id;�
sME =
Iain #
City of La Quin a
Building Bf:SafetyDivision
Permit # P.O. Box 1504;: 78-495: Calle .Tampico.
b,Quinta, CA 92253 (760) 777-70'12.
oc���;Bullding °Permit Application and TrackingFSheet
ct res: .265 .} :
ProeAdds
J. �1V dI: d Owners Name: der t h Y
A. P. Number. Address: ^
_ , Z A
G V rii yst o
Legal Description: City, -ST; Zip:.
Lz :� 2 a� z s3
Contractor:
Te e 1
L
krl
X31
ne
P..
Address: cQ t ic\ Project Description: �2 011 4- �D ((cam
City, ST, Zip:
Telephone:
hone: O �3
State Lie. # : q k �2-3
City. Lic #
Arch., Engr., Designer:
Address:
City., ST, Zip:
hone:
Telephone:
n trti ti n TY e: Occupancy:
Stat e Lie. #
'a 9
cle one w : N ' dd'n
J type 'P. e ( cir New A Alter Re ai Demo
P
Name of Contact Person:
°.;
`Sq.'Ft.:
#' Stories:
# Units:.
Telephone # of Contact Person:
Estimated Value of Project;
APPLICANT: ,DO NOT WRITE IBtb' ;THIS_ _CINE
?
H
Submittal
Req'd
.• Recd
, TRACKING <b
,PERMIT FEES
Plan Sets
Plan"Check subgiitted
Item'
Amount
Structural 'Calm
Reviewed, ready for,corrections
�P.laii Check Deposit
Truss Calcs.
Called -Contact -Person
Plan Check Balance
Title 24 Calcs.
Tlans'picked,up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan '
2pd Review, ready,for- corrections/issue
Electrical '
Subcontactor List
&lied: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
Dcveloper.Impact Fee
Planning Approval
t
Called,Contacf Person'.
A.LP.P. .
Pub: Wks. Appr
Date of Permit.issuc
School Fees
Y ` .
Total Permit Fees
Description: 40 GALLON WATER HEATER CHANGE
Type: PLUMBING Subtype:
Status: APPROVED
Applied: 6/25/2015 EVA
Approved: 6/25/2015 EVA
Parcel No: 773282020 Site Address: 52655 AVENIDA RUBIO LA QUINTA,CA 92253
Subdivision: SANTA CARMELITA VALE LA QUINTA Block: 165
Lot: 7
Issued:
UNIT 17
Lot Sq Ft: 0 Building Sq Ft: 0
Zoning:
Finaled:
Valuation: $800.00 Occupancy Type:
Construction Type:
Expired:
No. Buildings: b No. Stories: 0
No. Unites: 0
Details:. WATER HEATER CHANGE OUT - 40GALLON/GAS [2008 ENERGY)
CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL
INSPECTION. 2013 CALIFORNIA BUILDING CODES.
CONDITIONS
FINANCIAL INFORMATION
Printed: Thursday, June 25, 2015 2:28:11 PM 1 of 2
SYS7Pti1S
BOND INFORMATION
ATTACHMENTS
Printed: Thursday, June 25,ZO152:Z8:11*PN1 2ofZ
I
.
.
.
CLTD77777BSAS
DESCRIPTION
ACCOUNT.
QTY
AMOU NT
PAID:DATE
RECEI PT. #
CHECK #
METH 06'
PAID B�
SB1473 FEE
101-0000-20306
0.
$1.00-
$0.00Total
Paid forBUILDING STANDARDS ADMINISTRATIONPERMIT
ISS UANCE
101-0000-42404
0
$91.85
$0.00Total
Paid for PERMIT ISSUANCE: $91.85 $0.00WATER
HEAiER/VENT
101-0000-42401
0
$12.09
$0.00WATER
HEATER/VENT
101-0000-42600
0
$7.25
$0.00PCTotal
Paid forPLUMBING FEES: $19.34. $0.00TOTALS:
$112.19 $0.00
BOND INFORMATION
ATTACHMENTS
Printed: Thursday, June 25,ZO152:Z8:11*PN1 2ofZ