13-0349 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
.LA QUINTA,.CALIFORNIA 92253 BUILDING & SAFETY, DEPARTMENT -
BUILDING PERMIT v
Application Number: 13-00000349 Owner:
Property Address: 52300 AVENIDA RAMIREZ KIM FISHER
APN:. 773-262-003-20 '-000000- LA QUINTA, CA 92253
Application description: PLUMBING (760) 771-0763
Property Zoning: COVE RESIDENTIAL
Application valuation: 700
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) .777-7153
Date: 3/25/13
Contractor:
Applicant: Architect or Engineer: STATEWIDE SERVICES IN D d
40244 CATANIA CT
(� BERMUDA DUNES, CA 92
(760)636-0315
9 6 l��yn �.5 20
1 � Lic. No.: 936147 t P4�(
CJ CITY pF
FINAN EQEPTA _ -
• LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with ,
I hereby affirm under penalty of perjury one.of the following declarations:. - -
..Section 7000) of Division 3 of the Busi ess and Professionals Code, and my License is in full force and effect. _
_ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: C36 License No.: 936147
y,
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
Date J' Con[rac[ � ,�
_ 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
OWNER -BUILDER DECLARATION
insurance carrier and policy number are:
I hereby affirm under penalty of perjury that 1 am exempt from the Contractor's State License Law for the
Carrier STATE FUND Policy Number 19483.71
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to
_ I certify that, in the performance of the work for which this permit is issued, I shall not employ any
construct, alter, improve, demolish, ,or repair any structure, prior to its issuance, also requires the applicant for the
person in any manner so as to become subject to the workers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
and agree that; if I sh999 Id become subject to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
3700 of the Labor C6 e, I shall forthwith comply with those provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
/J S /
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
Dai Applica '
(_ 1 I, as owner of the property, or my employees with wages as their sole compensation, will -do the work, and
.. _ the structure isnot intended or offered for sale (Sec. 7044, Business and Professions Code: The.
a WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves. thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL'FINES UP TO ONE HUNDRED THOUSAND
- and who does the work himself or herself through his or her own employees, provided that the
DOLLARS is 100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
. improvements are not intended or offered for sale. If, however, the building or improvement is sold within
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. -
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.).,
APPLICANT ACKNOWLEDGEMENT
I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
• • 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
conditions and restrictions set forth on this application. .
• . property who.builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
1. Each person upon whose behalf this application is made, each person at whose request and for '
pursuant to the Contractors' State License Law.). -
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
(_ 1 I am exempt under Sec. , BAP.C.'for this reason
- 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. - -
•
Date_: Owner: -
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 ISO days will subject
- CONSTRUCTION LENDING AGENCY
permit to cancellation.
1 hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the -
rl certify that I have read this application and state bove information is correct. I agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.). ..
city and county ordinances and state laws relatingg construction, and hereby authorize representatives
•
dbuil
tcounty to enter upon the above-mentioned or inspection purpLender's
Name:
• -
Da Signature (Applicant or Agen
_of
_ \
Lender's Address: ll�
��
1.QTRRA1IT
�.. Application Number . . . . 13-000003.49
Permit PLUMBING
Additional desc .
Permit, Ree: 24.00. Plan 'Check Fee
6.00
Issue Date. Valuation . . .
. 0
Expiration Date 9/21/13
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 6.0000 EA PLB FIXTURE
6.00
1.00 .•3 . UUUU EA PLB VAS PIPE 1-4 OUTLETS
3 . UU .
Special Notes and Comments
WATER HEATER CHANGE OUT - 50GALLON/GAS,
RELOCATE TNP TO TERMINATE INTO LAUNDRY
DRAIN LINE. [2008 ENERGY] CARBON
MONOXIDE ALARM(S) TO BE INSTALLED PRIOR
TO FINAL INSPECTION. 2010 CALIFORNIA
BUILDING CODES.
---------------------------------------------------------------------------
Other Fees . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee.summary Charged Paid Credited
Due
Permit Fee Total 24.00 .00 -.00
24.00
Plan Check Total 6.00 .00 .00
6.00
Other Fee Total 1,00' .00 .00
1.00
Grand Total 31.00 .00 .00
31.00
Dill n
Permit #
�✓ `�)qq
JC Project Address:
A. R. Number:
Legal Description:
Contractor:
40 Address:
4 City ST, Zip:
Telephonq--0-3--0-3t�
//
State Lic. # : ` l T ((l
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
City of La Quinta
Building W Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
wner's Name:
City, ST, Zip UL-kA'r
1� ciGQS' C elephone -j7 - U
1�<.L �,V Project Description: S
City Lic. #: D ,�
Co
n
stru
ct
io
n
Type:
e
:
) Occupancy:
P
c
K.
yStateLic# Project type (crrcleone.New Add'n Alter
Repair D
l
emoName of Contact Person: V r1
-71- 1--), 1- /!, lC Sq. Ft.: # Stories: # Units:Telephone # of Contact Person:
Total Perrait Fees
K
Estimated Value of Project:
APPLICANT:
DO NOT WRITE BELOW
THIS LINE
#
Submittal
Req'd
Recd
TRACKING
Plan Sets
.
7PER7MITFEES
Plan Check submittedItem
Structural Calcs.
Amount
Reviewed, ready for correctionsPlan
Che:k Dpt
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 corrections/issue
Developer, Impact Fee
Planning Approval
Called Contact Person
A. 1. P. P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Perrait Fees
K
Pt-eSkr . ive Certireite of Cam lia ce- Residential.. : ' CF=IR-ALT,
Residential Alt rations e�g�
Pra'ect.Name:Climate Zane: Permit #:
General Information
Site Address. Enforcement enc . Date: -
Building Type: UUinele Family ❑ Multi Familv I -ProiectType- Ineolacement or Change Out of Water Heater
.-WATER HEATING
List neu-IT installed water heaters and !oilers for both domestic hot. eater heaters- (DWR) and h dronic space heating. Ne%4V installed
DtVH heaters and toilers must be gas, propane. or use the existing l type.
Water Hata
TYI Type,Reci
(
rculaand
Tank Energy factor or F�nsulamal Tank
Number In I
Insulation
system Capacity (gal) 'tttennai FATiciency R_Vatue'
building design on the other applicable oomplianee forms, woti,sheets. cakulatmm plans and specificaitom submitted to the
enforcement agency for approval with this b iddin - it tit akx
Name: � l
S'
Date:
VV CZ?5 1) 0
CitytstatdZip: ,, Q Phone:
1. Indicate i')pe (Storage Cos. Heat Pwnp: Instantaneous. etc.)
2. Recirculating systems serving muldple dwelling units shall *)nett the recirculation requirements of §ISO(n). The Presctiptive-
req!drements donor allow the installation of a rrcirrulating water heating S1Mrem for single dweI fens, units.
3. The ecrernal water hewing tank and shall be insulated to meet the rc uirementts o
Contractor or Homeowner (Documentation Author's/Responsible BuUdiug Designer's Declaration Statement)
. I certify that this Certificate of Compliance'documentation is accurate and complete.
• I atm eligible under Division 3 of the California ^Business. and Professions Code to aeeept 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 t and 6 of the California Code of Regulations.
. The building design featum identified on this Cenificate of Compliance arc consistent with the information provided to document this
building design on the other applicable oomplianee forms, woti,sheets. cakulatmm plans and specificaitom submitted to the
enforcement agency for approval with this b iddin - it tit akx
Name: � l
S'
Date:
VV CZ?5 1) 0
CitytstatdZip: ,, Q Phone: