14-0126 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
14-00000126
Property Address:
78855 BRECKENRIDGE DR
APN:
770-110-029-24 -25389 -
Application description:
PLUMBING
Property Zoning:
MEDIUM DENSITY RES
Application valuation:
700
Applican
ee�t, ,&,
T414t 4 4 Q"
Archi74!7 :
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
MCMANUS GREG
78855 BRECKENRIDGE
LA QUINTA, CA 92253-Q
(
Contractor:
STATEWIDE SERVICES INC
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: 2/10/14
rf�` 1014
-------------------------------------------------------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perj^ that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the us ess and Professionals Code, and my License is in full force and effect.
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
Lice Class: C36 License No.: 936147
L L
kDate•o tractor:
_
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
— 4Code,
_
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 I am exempt from the Contractor's State License Law for the
Carrier MARKEL INS CO Policy Number MWC0044634-03
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 shy iId 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
the Labor f)6 :, 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
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
,y
D t� Applic
1 _ 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
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 ($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.).
1 _ 1 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
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
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 Quints, 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 a bove information is correct. I agree to comply with all
city and county ordinances and state laws relating to uildi g construction, and hereby authorize representatives
of county to enter upon the above-mentioned operty for i spection purposes. �
D r/�Signature (Applicant or Ag tl: C1,7
s
Application Number . . . .
14-00000126
Permit . . . PLUMBING 2013
Additional desc . .
Permit Fee . . . . 11.92 Plan Check Fee
.00
Issue Date . . . . Valuation . . .
. 0
Expiration Date . . 8/09/14
Qty Unit Charge Per
Extension
1.00 11.9200 EA PLBG WATER HEATER/VENT
11.92
--------------------------------------------------------------------7-------
Special Notes and Comments
REMOVE & REPLACE 50 GALLON WATER HEATER
2013 CALIF. PLUMBING CODE.
----------------------------------------------------------------------------
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
Bin #
Permit .#
Building
City of La Quinta
Boding a Safety Division
P.O. Box 1504, 78495 Carie Tampico
La Quinta, CA 92253 - (760) 777-7012
Permit Application and Tracking Sheet
Project Address:
I
Owner's Name: r -.e -
A. P. Number.
i
A S V
Legal Description:
1
City, ST, Zip: 4e ---k
.0 s
Contractor:
Address: (� `G
i Cn C,
Project Description
City, ST, Zip:"r�
Telephone:
, .�.;
State Lic. #:
City Lic. #:
Arch., Engr., Designer.
Address:
City., ST, Zip:
Telephone:
lc. #:
-
" ' ^ ; - �A
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
.Name of Contact Person:
Sq. FL:
#Stories:
Tffunits:
Telephone # of Contact Person -.'7
6 ,;L (p
I Estimated Value of Project: 6
APPLICANT: DO NOT WRITE BELOW THIS LINE
ti
Submittal
Req'd
Ree'd
I TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amonnt
Structural Cafes.
Reviewed, ready for cormcdoas
plan Check Deposit
Truss Coles.
CalledlContact Person
PIan Check Balance •
Tide 24 Coles.Plans
picked up
Construction
Flood plain planPlans
resubmitted
Mechanical
Grading plan
tad Review, ready for correctionsfissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant DeedPlans
picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE-,
''" Revl'ew, ready for correctlonsliccue
Developer Impact Fee
Planning Approval
Called Contact Person
AXP.P
Pub. Wks. Appr
Date of permit issue
School Fees
I
Total Permit Fees
rim
I
-Prekri five Certificate of Co
Residential Alterations
Pmiect.Name:
CF-M-ALT-Dlti
Page 1 of 2
Climate Zone: Permit M
General Information
Site Address: Enforcement Agency:
Date
Building Type.Wingle Family 0 Multi Family Project Type Mange Out of Water Heater
WATER HEATING
• I certify that this Certificate of Compliance documentation is accurate and complete.
Y installed %water heaters and !oilers for b6th domestic ho( mater heaters'(DWH) and hydronic space heating_ Ne%%�le installed
List nem4'm
DIM Treaters and boilers must be gas. propane, or use the existing eI i)pe.
conform to the requirements of 'Tale 24. Patt I and 6 of the California Code of Regulations.
• The building dcsign features identified on this Certificate of Compliance tet consistent with the information provided to document this
Warn V. -It" lhstribL" Type
In Tank EnergyFactor or
Ext crmal Tank
lawm
nsu
Typelrvet Type RS
irculatingY
System Capacity (gal) Thermal EfF%ck=y
atlatiaio
✓
_
City/Siatarlip: P��v - l (�
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1. Indicate Type (Storage Gas. Heal Ptimp. Instantaneous. etc.)
2. Recirrulating systems serving multiple dwelling units shall meet the recirculation requirrments of §ISO(n).
The Prescriptive.
requirements do not allow the installation of a recirculating anter heating system for single dwelling units.
3. The externa/ water heating tank and p4pes shall be insulated to meet the requirements of J 1
Contractor or Homeowner (Documentation Author's/Responsible Building Designer's Declaration Statetu 0
• 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.
• 1 certify that the energy features and pciformance specifications for the building design identified on this Certificate of Compliance
conform to the requirements of 'Tale 24. Patt I and 6 of the California Code of Regulations.
• The building dcsign features identified on this Certificate of Compliance tet consistent with the information provided to document this
building design on the other applicable compliance forms, worksbeets. lattotm plans and specifications submitted to the
enforcement agency for approval with this building permit plicatiott.
Nana:
Si .
V (,(�
C xnpany: Due:
JV
City/Siatarlip: P��v - l (�
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