13-0270 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
13-00000270
Property Address:
60321 POINSETTIA PL
APN:
764-270-999-91 -300232-
Application description:
PLUMBING
Property Zoning:
MEDIUM HIGH DENSITY RES
Application valuation:
700
Applicant:
Architect or Engineer:•
BUILDING & SAFETY DEPARTMENT �_ +
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury at I am licensed under provisions of Chapter'9 (commencing with
Section 7000) of Division 3 of the Bu in ss and Professionals Code, and my License is in full force and effect.
License Class: C36 LicenseNo.: 936147
Datg��_J�ContM Cy U�
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 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 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 contractors) licensed
pursuant to the Contractors' State License Law.).
I _ 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:
A X
LQPERAI IT
Owner:
FREDRICK WENDOFF
LA QUINTA, CA 92253
(760)771-9088
Contractor:
STATEWIDE SERVICES
40244 CATANIA CT
BERMUDA DUNES, CA 9
(760)636-0315
LiC. No.: 936147
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/13/13
N, ,
13
C/Ty 3
FjN\FD , 74
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
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 s as to become subject to the workers' compensation laws of California,
and agree that, if I sh Id become subject to the workers' compensation provisions of Section
I ^�� 33700 of the Labor e, I shall forthwith comply with those provisions.
Date:. [ ✓ r Appli
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 the bove information is correct. I agree to comply with all
city and county ordinances and state laws relating to bu' i g construction, and hereby authorize representatives
of thi ounty to enter upon the above-mentioned pro rt for inspection purposes.
Date' Signature (Applicant or A .
Application Number . . . . . 13-00000270
Permit . . . . . PLUMBING
Additional desc .
Permit Fee 22.50 Plan Check Fee
5.63
Issue Date . . . . Valuation
0
Expiration Date 9/09/13
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 7.5000 EA PLB WATER HEATER/VENT
7.50
---------------------------------------------------------------'-------------
Special Notes and Comments
WATER HEATER CHANGE OUT - 50 GALLON/GAS
(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 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
alit ff
Permit #
�C Project Address:
A. P. Number:
%�Contractor:
Construction T pe:
4
Address:
P r 0 ec t e c�
tr
J type (circle one):
�
City, ST, Zip:
49prchEngr.,
:
# nits:
#
Designer:
Address:
RecdffReviewed,
City, ST, Zip:
Teleohon
State Lic. #:
Name of Contact Person:
Telephone # of Contact Person:
# Submittal
Plan Sets
Structural Calcs.
Truss Calcs.
Title 24 Calcs.
Flood plain plan
Grading plan
Subcontactor List
Grant Deed
H.O.A. Approval
IN HOUSE: -
Planning Approval
Pub. Wks. Appr
School Fees
City of La •Quinta
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
wner's Name: o" A Ir., n t t
11
City, ST, Zip: _ l
I P
elephone:
fq Project Description:
City Lic. #: r
Total Permit Fees
Construction T pe:
an c•
Occupancy:
P Y•
t
P r 0 ec t e c�
tr
J type (circle one):
�
New Add'n Alter Repair Demo
Sq. Ft.:
# Stories:
# nits:
r Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
'd
RecdffReviewed,
TRACKING
PERMIT FEES
itted
Item
Amount
for corrections
Plan Check Deposit
Called Contact Person
Plan Check Balance
Plans picked up
Construction
Plans resubmitted
Mechanical
tad Review, ready for corrections/issue
Electrical
Called Contact Person
Plumbing
Plans picked up
S.M.I.
Plans resubmitted
Grading
Jrd Review, ready for corrections/issue
Developer Impact Fee
Called Contact Person
A 1 P P
Date of permit -issue
Total Permit Fees
-iptive Certificate. of Compliance: Residential C)F-IR=ALT-DRW
thiol Alte p11011S Page 1 of I
Name: Climate Tone: Permit q:
General Information
Site Address: p ; Enforcement enc Date:
Building T Single'Farhily 0 Mu ti Family' Pro'ect T e lacertnent or Change Out of Water Heater
WATER HEATING
• I certify that this Certifiare of Compliance documentation is accurate and complete.
List new�r installed water heatersand boilers for beth domestic hot water healers (DWH) and h.ttrortic space heating.
Newly installed
D.WH heaters and boilers must be gas, propane. or nuc the existingfuel type.
conform to the requirements of Tette 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
Water Heater
TYP&� Type(Staxidaid
Rc�c
Number In Tank F�BY Fac w
System Capacity (gal) lltemtal Eniciu►cy
External Tank
Usutatioa
ItNatuer
Si �A
O
AdIq: license:
0x-44 ataln 1 a �-� 3
1. Indicate Type (Storage Cas, Heat Puunp; Instantaneous, etc.)
2. Recirculating systentx serving multiple dwelling units shall meet the recirculation requirements of §lAn).
The Prrsctiptivr.
rrquirmsents do not allow the installation of a recirculating water heating system for single dwelling units.
I The eaernal water heating rank•and pipes shall be insulated to meet the rc uirrments of J150U).
Contractor or Homeowner (Documentation Author's/Responsible Building Designer's Declaration Statement)
• I certify that this Certifiare 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.
• 1 certify that the energy festunx and performance specifications for the building design identified on this Certificate of Compliance
conform to the requirements of Tette 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 othei applicable compliance forms, wotlrsheets cakulations. plans and spociGcations submitted to the
enforcement for approval with this budding uapplication- LF
Si �A
C -10,31 r Date:
AdIq: license:
0x-44 ataln 1 a �-� 3