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13-1679 (PLBG)L P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 T4'yl 4 4 Q" Application Number: 13-00001679 Property Address: 53715 AVENIDA RUBIO APN: 774-112-021-10 -000000- Application description: PLUMBING Property Zoning: COVE RESIDENTIAL Application valuation: 700 Applicant-�,/2 Architect or Engineer: -X_, / 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. License Class: C36 License No.: 936147 Date: / 3_1 Contra to 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 ISec. 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.). (_ I 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: EVELYN KELSEY 53715 AVENIDA RUBIO LA QUINTA, CA 92253 ( Contractor: Q STATEWIDE SERVICES INC u 40244 CATANIA CT BERMUDA DUNES, CA 92203 (760)636-0315 Lic. No.: 936147 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 1/13/14 °D JAN 13 2014 CITY OF LA 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. _ 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 STATE FUND Policy Number 1948371 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 sho d become subject to the workers' compensation provisions of Section / 3700 of the Labor C , I shall forthwith comply with 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 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 t a ove information is correct. I agree to comply with all city and county ordinances and state laws relating to ildi g construction�inspection and hereby authorize representatives of this county to en r upon the above-mentioned peoses..DateSignature (Applicant or geni� a Application Number . . . . . 13-00001679 Permit . . . PLUMBING 2013 Additional desc . . Permit Fee . . . . 11.92 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 6/29/14 Qty Unit Charge Per Extension 1.00 11.9200 EA PLBG WATER HEATER/VENT 11.92 --------------------------------- Other Fees . . . . . ----------------- . . . . BLDG STDS ADMIN (SB1473) 1.00 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 98.72 00 .00 98.72 Grand Total 110.64 .00 .00 110.64 LQPERMIT -17> 76ll Bin # City Of La Quinia 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 # Project Address45 LLb Owner's Name: ki S A. P. Number: Address: Ave / Legal Description: City, ST, Zip: Contractor:4:,;� f, -L 'C0 S Telephone:� Yf ` Address: LtL i- l _ N—, Project Description: i _( City, ST, Zip: i t V -/y Telephoner e —1 OL1 - old; r State Lie. # : 3 ( city Lic. #; Arch., Engr., Designer: Address: City., ST, Zip: Telephone: ; f ' .r� Construction Type: Occupancy: Project type (circle one): New Add'n Alter Repair Demo Sq. Ft : # Stories: # Units: State Lie. #:wf, Name of Contact Person: ' C.G Telephone # of Contact Person: } --®( Estimated Value of Project:Of ) APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES Plan SetsPlan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called, Contact Person Plan Check Balance Tide 24 Cates. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2"0 Review, ready for correctionsAssue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- 70 Review, ready for correctionstiissue Developer Impact Fee Planning Approval Called Contact Person A,I,P,P, Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees PiCeSCci Oye- Certificate of Residential Atte at'ons Project Name: D P -L -j, Residential:, 'MIR -ALT -DH • Page 1 of 2 Climate Zone: Permit #: General Information Site Address: Enforcement Age Date -1 Building Type: ❑ Single Family 13 Multi Famil Project T e lacement or Change out of Water Heater WATER HEATING • I certify that 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 List ne%4-Y installed anter heaters and boilers for both do+nestic hot eater heaters (DWH) and lndronic space heating. Neµ•h installed D.WH heaters and boilers rrutst be gas. propane. or use the existing eI I)Ve. Distribution Water Heaterpe TypetRid Type' Re(cStandand' Number In Tank F—gy Factor or System Capacity (gal) Thenal Efficiency External Tank Insulatim (t -Valuer / n ' signature: ^ , Company: Date: � � 2 Vr/t es o��y 0,?4�'�� 1. Indicate Type (Storage Gas, Heat Ptunp: Instantaneous. etc.) 2. Recirculating systems serving multiple. dwelling units shall meet the recirculation requirements of §lAn). requirements do not allow the installation of a recirculating water heating system for single dwelling units. 3. Tyre rVernal water heating tank and pipes, shall be insulated to meet the requirements o The Prescriptive. Contractor or Homeowner (Documentation Author's/Responsible Building Designer's Declaration Statement) • I certify that 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 Tette 24, Patt I and 6 of the California Code of Regulations. • The building design features identified on this Certificate of Compliance we consistent with the information provided to document this building design on the other applicable compliance forms, wo lations. plans and specifications submitted to the enfomcment agaicy for val with this building permit lication / n ' signature: ^ , Company: Date: � � 2 Vr/t es o��y 0,?4�'��