12-0516 (PLBG)4 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: 5/09/12
Application Number: 12-00000516 Owner:
Property Address: 49195 AVENIDA EL NIDO SCHARER ROY
APN: 658-290-012- - - 49195 AVENIDA EL NIDO
Application description: PLUMBING LA QUINTA, CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 700
Contractor: D
Applicant: Architect or Engineer: STATE WIDE PLUMBING [rte
40244 CATANIA COURT
INDIO, CA 92203--0 MAY 09 2012
(760)636-0315
l Lic. No.: 731855
r CITY OF LA fIUINTA
FINANCE DEPT.
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LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Busines and Professionals Code, and my License is in full force and effect.
Licen lass: C36 License No.: 731855
`00at racto .
00000OWNER-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)•:
(_ 1 1, 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.).
(_) 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. , BAP.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: v L
LQPERMIT
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.
1 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 SOUTHER INS CO Policy Number WSIO047530-01
_ 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 CCA$ , I shall forthwith comply with those provisions.
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 above information is correct. I agree to comply with all
city and county ordinances and state laws relating to bui g construction, and hereby authorize representatives
of thi county to enter upon the above-mentioned pro y or inspection purposes.
)f51n.tur. (Applicant or Ag t):
Application Number . . . . . 12-00000516
Permit
PLUMBING
Additional desc . .
Permit Fee . . . .
22.50
Plan Check
Fee
5.63
Issue Date . . . .
Valuation
. . .
. 0
Expiration Date
11/05/12
Qty Unit Charge
Per -
Extension
BASE FEE
15.00
1.00 7.5000
EA PLB
WATER HEATER/VENT
7.50
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Special Notes and Comments
INSTALL NEW 40 GALLON
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
M
LQPERMIT
Prescriptive Certificate of Com 1
Residential AI erotioris
Pm'ect Name: Oita I�
Genemi Information
Site Address•.
Building Type: Mingle Family O Multi
c Residential ..... ' CF -U -ALT-DUW. .
Page I of 2 .
Climate Zone: Permit p:
�1
Enforcement etx : Date:
Y I Pfoiect Tvoe: Replacement or ChanRe Out of Watef Heater.
WATER HEATING
List newh- installed water heaters and boilers for both domestic hot water hiarers (DWH) and hYdrottie space heating. Newly installed
D.WH heatea_and boilers mast, be gas, p or tut the existing el
Water Heater�WIIype
(StandardNumber In Tank E—gy Factor
TyperFxt Type System Capacity (gal) The mal Efficient
Er<temal Task
Insulation
R-Vakur
1. Indicate Type (Storage Gas, Heat Pump. Instantaneous. etc.I
2. Reci-Viating systems serving multiple dwelling units shall wet the reciriculatlon requirrments of §150(n1.
requirrtnents do not allow the bW alkttim of a ncirrulating wtterheating system for single dwelling units.
J. The external water heattank and s shall be insulated to meet the rc uinments o 1
Thr Prescriptive,
Contractor or Homteowner (Docnmemtatton Audwr's/ItesponsffAe Building Designer's -Declaration Statement)
• t 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 wad 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 w document this
building design on the other applicable eomplianet forms. wotkdx c s, calculat ons. plans and specificaf submitted to the
enforccment agency for amoval with this building Derma anotiietion. ./ -
CityrStaump:
Dare
License3 SSS
-7C� 3(��
Bin #
Cray .of.`. La
Building 9 Safety Division '.
P.O. Box 1504,.'78-495 Calle Tampico ,
L-4.Quinta, CA 92253 -:(760) 77-7,7012
Building Permit Application and Tracking Sheet
Permit #
�
Project Add JU-Mho Ob
Owner's Name:. f'
A. P. Number.
Address:
Legal Description:
City, ST, Zip:
Contractor:. — 1 u(/n /� j
Telephone:? % %btu"
Address: LOPYLLQ h
Project Description:
City, ST, Zip:
Telephone — b
Mmwim MEN,', "`
State Lie. # : 7731
-City Lic. 9.-
:Arch.,
Arch.,Engr., Designer.
Address:
City., ST, Zip:
p ` � � <, ° � °
Tele hone:
State Lic. #: w�
Name of Contact Person:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.:
# Stories:
# Units: .
Telephone # of Contact Person: Q
Estimated Value of Project Q t 0
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Recd
TRACKING
PERMTP FEES
Plan Sets
Plan Check submitted
Item Amount
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit, .
Truss Calcs.
Called Contact Person
Pian Check Balance
Title 24 Cale 8*.
Plans picked up
Construction
Flood plain plan
Plans resubmitted..
Mechatilcal
Grading plan
tad Review, ready for rnrrectionshsstte
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
SALL
H.O.A. Approval
Plans resubmitted
Grading
IN tJOIISE:-.
'^' Review; ready for correetionslissue
Developer Impact Fee
Planning Approval.
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees