13-0208 (PLBG)s B ,
P.O. BOX 1504 ^ VOICE (760) 777-7012
78-495 CALLE TAMPICO ! FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 2/26/13
Application Number: 13-00000208 Owner:
Property Address: 51910 AVENIDA RAMIREZ GOMEZ HECTOR E
APN: 773-171-008-17 -000000-. 51910 AVENIDA RAMIREZ
Application description: PLUMBING LA QUINTA, CA 92253 D
Property Zoning: COVE RESIDENTIAL (760)601-4498
Application valuation: 800 FE2013
Q 2� I
Contractor:
Applicant: Architect or Engineer:" CAMPESINOS UNIDOS, INC. C)NOFLAQUINTA
P.O. BOX
FINANCE DEPT,
1 BRAWLEY, CA 92227
(760)344-4500
Lic. No.: 618140
------------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that,( 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: (23i5 License No.: 618140
Da49— 16-j Contractor:' -
I� -
"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 signedstatement that he dr she is licensed pursuant to the provisions of the Contractor's State
License Law (Chapter 9.(commencing with Section 7000) of Division 3 o the Business and Professions Code) or
that he or she 1s 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 o{the property, or my employees with wages as their sole compensation, will do the work, and
ehe structure is not intended or offered for sale, ISec. 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 orimprovement 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 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 owner of.
propertywhobuilds'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. 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 fSec. 3097, Civ. C.).
Lender's Name: ft
Lender's Address: -VI�
I,QPERDI IT
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
s
sued.
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 3330058264-131
I certify that, in the performance of the work for which this permit is issued. I shall not employ any
person in any_manner,sb 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 bf.the tabor Code, o hwith comply with those provisions.
Date: Appli�t:`
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 TQ 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, eachperson 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.
1 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 building a��tion, and hereby authorize representatives
of t , co�erV� to enter upon the abgve-mentioned proper or ins eEtion purposes.
Date: A
Signature (Applicant o�Agen
Application Number . . . . . 13-00000208
Permit . . . . . .
PLUMBING
Additional desc . .
Permit Fee . . . .
22.50
Plan Check
Fee
5.63
Issue Date . . . .
Valuation
. . .
. 0
Expiration Date . .
8/25/13
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
1.00 7.5000
EA PLB
WATER HEATER/VENT
7.50
----------------------------------------------------------------------------
Special Notes and Comments
CHANGE OUT 40 GALLONS
GAS WATER
HEATER.
2010 CODES.
----------------------------------------------------------------------------
Other 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
Din #
Oty of La., Quient'"a
Building'&r Safety Division
P.O. Box * 1504, 78'495 Calle Tampico
La Quinta, CA 92253 --(760) 777-7012
Building Permit.Application and Tracking Sheet
Permit #
LDL
Proje t Address:
Owner's Name:
A. P. Number:
Address: AVeVVII��
Legal Description:
Contractor:CA*77re.s��–s LKFV\"kl
City, ST, Zip:
Telephone:7615
Address: 0.�
Project Description:
City, ST, Zip--A-M"�t"-
LA jo,
Telephone: _7 6 L/V- �Ta
State Lic.
City Lic.
Arch., Engr., Designer:
Address:
City., ST, Zip:
,Telephone:
-f�
.......... ..........
Construction Type: Occupancy:
State Lic. #:
Project type (circle one): Ne"w Add'n Alter Repair Demo
Name of Contact Person:
7
# Storid - s: —7#
Units:
Telephone # of Contact Person: jl4timated
Value of . Project:
APPLICANT: DO ftT.WRITE B ELOW TH IS. LINE
#
Submittal
Req'd
Rec!d
TRACK . ING
PERMIT FEES
Plan Sets
Plan Check submitted
l[tem
Amount
Structural CaIcs.
Review.ed,ready for co.krections
Plan Check Deposit
Truss Coles.
Called C ntic tP*
erson.
Plan Check Balance
Title.24 CaIcs.
Plans piikid u
Construction
Flood plain plan
Plans res"nitted
Mechanical
plan
2d Review, ready for corrections/issue
Electrical
Subcontactor List
Called contact Person
I Plumbing
Grant Deed
Plans p4c* a up,
H.OA; Approval
Plans resubmitted
Grading
IN HOUSE:-
Review, ready for correctionsfissue
Dev e loper Impact Fee
Pla I nning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
Prescriptive Certificate of Compliance: Residential CF-IR-ALT-DHW
Residenticil Alterations Page I of?
Project Name:%,e OY�1,�e Z_ Climate Zone: " Permit #:
General Information
Site Address: e5% -'TWO Vey P,_� nforcement A enc Date: _Z
Building TypsA Single Family ❑ Multi Family Project T e lacement 'or Change Out of Water Heater
WATER HEATING
• I certify that this Certificate of Compliance documentation is accurate and complete.
Ust new -4, installed water heaters and boilers for lath domestic hot water heaters (D WH) and hydronic space heating.
DWH heaters and boilers must be g.as, propane, oruse the existing tel type.
NeK•h• installed
Waley Heater
T.ypdFu,el Type'
DistriNAion Type
(Standard, NumbLr In Tank Energy Factor or
Rqcirculating)iSystem Capacity (gal Thermal Efficiency
External Tank
Insulation
R-Vi ue
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.
Na /"j
77&sGb� �srV
Signa
Company:
Date:
Address:
4bosx 3-9
License:
City/StatdZip:
w1 CA 1L227
0 3� L/ D D
1. Indicate Type (Storage Gas. Heat Puunp• 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. The evemal water heating tank and pipes shall be insulated to nue► therequirements of 9150(i).
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.
• 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.
• l 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 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 agency for approval with this budding permit application.
Na /"j
77&sGb� �srV
Signa
Company:
Date:
Address:
4bosx 3-9
License:
City/StatdZip:
w1 CA 1L227
0 3� L/ D D