13-0183 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
1 --00000183
Property Address:
56708 PALMS DR
APN:
764 -020 -003 -
Application description:
PLUMBING
Property.Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
2600
Tit!t
Q-"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Applicant- Architect or Engineer:
------------------
LICENSED CONTRACTOR'S DECLARATION
Lhereby affirm underpenalty of perjury that I am licensed under provisions of Chapter (commencing with
Saction 7000) of Division 3'6f the Business'and Professionals Code; and my License is in fullforceland-effect.
License Cllass:. C20 License No.: 686310
DaC to st ao t3'Conactor:
OWNER-BUILDERDECLARATION -
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 Coder 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 civil penalty of not more than five hundred dollars ($500).:
(_) I, as owner of the.property, or my employees with wages as their sole compensation, will do the work, and
the structure is,riot 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 riot 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
I mprove 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
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
,WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of p'erjury one of the following,dclarations:
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 fhe performance of the work for which this permit is
issued.:
I have and.will maintain workers' compensation insurance, as required by Section 3700 otjhe Labor
Code, for the performance of the work fo"r which this permit is issued. My workers' compensation
insurance carrier and, policy number are: '
Carrier ZENITH.INS CO Policy Number Z071741502
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 should become subject to the workers' compensation provisions of Section
3700 of the Labor Code, I'shall forthwith comply with those provisions.
Date: (3 Applicant: S�/,.t.� `
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINALPENALTIESAND 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 His.
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, indemnity 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 otthis 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 above information is correct. I agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of this countyto enter upon the above-mentioned property for inspection purposes.
Da? ZW fj Signatute:(Applicant or Agent): :S71_ L -
Date: 2/20/13
Owner:
STEINMANN MARION
56708 PALMS DRIVE
9
LA QUINTA, CA 92253
D.
(760)564-2192
FEB 2 0 2013
Contractor:
CITY OF LA QUINTA.
GENERAL AIR CONDITION
I
G FINANCE DEPT.
31170.RESERVE DRIVE
THOUSAND PALMS, -CA
92276
(76.0)343-7488:
Lic. No.: 6863.10
,WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of p'erjury one of the following,dclarations:
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 fhe performance of the work for which this permit is
issued.:
I have and.will maintain workers' compensation insurance, as required by Section 3700 otjhe Labor
Code, for the performance of the work fo"r which this permit is issued. My workers' compensation
insurance carrier and, policy number are: '
Carrier ZENITH.INS CO Policy Number Z071741502
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 should become subject to the workers' compensation provisions of Section
3700 of the Labor Code, I'shall forthwith comply with those provisions.
Date: (3 Applicant: S�/,.t.� `
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINALPENALTIESAND 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 His.
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, indemnity 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 otthis 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 above information is correct. I agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of this countyto enter upon the above-mentioned property for inspection purposes.
Da? ZW fj Signatute:(Applicant or Agent): :S71_ L -
LQPERMIT
Application Number . . . . .
13-00000183
Permit . . . PLUMBING
Additional desc .
Permit Fee . . . . 22.50
Plan Check
Fee
5.63
Issue Date
Valuation
0
Expiration Date 8/19/13
Qty Unit Charge Per,
Extension
'
BASE
FEE
15.00
•
1.00. 7.5000 EA - PLB
WATER HEATER/VENT .
7.50
Special�Notes.and Comments
:REPLACE X75 ?GAL=LON WATER`HEATER
STANDARD
a.
TYPE 2010-•CODES...
- ------------------------------------------
Other.:Fees . . . . . .
---- ------
BLDG.STDS ADMIN (SB1473)
--
1.00
Fee summary:Charged,--
Paid Credited
Due
- --- ----- --
---- - - - - -- - --
---------
I.
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
Bin. #
City of La Qurnta
Buftding BC, Safe' Division, t: _
P.O. Boz 15Q4,.74495 Calt'i far6lw
La.Qtrrnta, CA 92233 (760) 777,7012:
Building Permit'Applicatiomand -rac .1pg Sheet
Peniltt #
Project.Address-
1 J5(p%O 6 �wYIS +
� ` • M �^
wner's Name:
O 0., 0
A. P. Number.
Address: .S (o--?Og-
Legal Description:
Contractor. �,r t�� 1 S.
G 2253
"Telephone:7(Z-SV4- Zlq Z
Address: �1N-7 i� e_sex—ve.
ProjectDcicnption;.P—e oGCe -75 Gc-k\Or,
City, ST, Zip: 9:; Zz
ow er e 0A 2,r
Telephone: -7(,0-c
State Lic. # : (0.1031 U City Lic ih
Arch., Engr., Designer.
-
Address:
City., ST, Zip:
Telephone:
Gonsfrucdon Type:. Occupancy:
State Lic. #:
PiojectlAx (circle one): -New Add'n Alter Repan Demo
Sq. Ft.:. #Stories: #Unit
Name of Contact Person:
Telephone* of Contact Petsan:..
,. Estimated Value of Project: R"( ,00 - O 6,
APPLICANT; DO"NOT,WRITEBELpW THIS UNE
N
Submittal
Req'd
Recd
;TRAdM(; .
PERMIT FEES -
Plan Sets'
Plan Check submittedpltem
Amount
Structural talcs.
Reviewed; ready -for corrections
,Plan Check Deposit, .
Truss Calcs.
'Called Contact Person
:Plan Check Balance.
Tide 24 Calci.
Pians.pieked up
Construction
Flood plain plan
Pians resubmitted
Mechanical
Grading plan
V Revlew, ready for correctio6lissue
Electrical
Subcoatactor List
Called Contact Person
''Plumbing
Grant Deed
Plans picked up
SMI.
H.O.A. Approval
I.Plans resubmitted
Grading
IN ROUSE:-
3" Review; ready for correctlons/Issuc
Developer Impact Fee
Planning Approval
Called Contact Person.
Pub. Wks. App
Date of pervift issue
School Fees .
Total Permit Fees
Prescriptive Certificate of Compliance: Residential Water Heatin CF -IR -ALT -WH
General Information
Site Address:S(p� p �0.�MS 1�('. Climate Zone: Date: Z Z.o 1 13
NOTE: This foryn is only used or alteration or addition of water. hea#qg systems.
WATER HEATING t
List water heaters and boilers for both domestic hot water (DHW) heaters and hydronic space heating. Individual dwelling DHW
heaters must be gas or propane fired, and may not exceed 50 gallons. Hot water pipe' insulation from the DHW heater to the
kitchen(s) and on all underground hot water pipes is required in all component packages `in all climate zones.
• 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, Parts 1' 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
-
Energy Factor or
Name: 11
Water Heater Type /
Fuel T e'
Distribution Type
(Standard)2
Number;of
stem
Tank Capacity
al
Thennal
Efficiency
External Tank
Insulation R -Value'
Store e GG,S
c7,..cio.,r
Phone: Ito O - 3,4 } ?4 2
s
1. Indicate Type (Storage Gas, Heat Punip, Instantaneous, etc.)
2. Recirculating systems serving:multrpleidwelling-units shall meet the recirculation requirements of 150(n). The Prescriptive requirements do
not allow the installation of a recirculating water heating system for sinete dwellink units.
3. The water heating tank and pipes shall be insulated to meet the requirements of 1506). -
Contractor (Documentation Author's /Responsible 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 Title 24, Parts 1' 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 building permit application.
Name: 11
Signature:
Company:
Date: ZI Z-0 111.
cZrr�sov, r er rises
Address:
License:
(0'9(0310
/State/Zip: \ ? Z -7
Fh��s�ra �0.�s cA .. Q.
Phone: Ito O - 3,4 } ?4 2
2008 Residential Compliance Forms
March 2010