14-0250 (PLBG)1 4
�l�i�IUCtI
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number:
14-00000250
Property Address:
53485 AVENIDA
JUAREZ
APN:
774-034-024-12
-000000-
Application description:
PLUMBING
Property Zoning:
COVE RESIDENTIAL
Application valuation:
800
Applicant:
Architect or Engineer:
6 -
--------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury th am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Busine s nd Professionals Code, and my License is in full force and effect.
License Class: C36 LicenseNo.• 936147
V Dat : Contracto
QA�3n�
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 ($500).:
1—) 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
and who does the work himself or herself through his or her own employees, provided that the
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
one year of completion, the owner -builder will have the burden of proving that he or she did not build or
improve for the purpose of sale.).
(_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
I—) I am exempt under Sec. , BAP.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name: _
Lender's Address:
LQPERMIT
X
Owner:
RAVEN LUNDIE
53485 AVE JUAREZ
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/10/14
Contractor: D
STATEWIDE SERVICES INC
83780 CORTE SOLI$ {� � �
COACHELLA, CA 92236 fYt„\ j 0 2014
(760)984-0126
Lic. No.: 936147
----------------7------------------------------
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 MARKEL INS CO Policy Number MWC0044634-03
I certify that, in the performance of the work for which this permit is issued, I shall not employ any
person in any manners s to become subject to the workers' compensation laws of California,
and agree that, if I sh I become subject to the workers' compensation provisions of Section
/ of the LaborA1 I shall forthwith comply with those provisions.
Date: ` Applic t.
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 1$100,0001• 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 build4 construction, and hereby authorize representatives
of this county to r pon the above-mentioned y or inspection purposes.
Dt Signature (Applicant or Age _
_*
Application Number . . . . . 14-00000250
Permit . . . PLUMBING 2013
Additional desc . .
Permit Fee . . . . 11.92 Plan Check Fee
.00
Issue Date . . . . Valuation . . .
. 0
Expiration Date . . 9/06/14
Qty Unit Charge Per
Extension
1.00 11.9200 EA PLBG WATER HEATER/VENT
11.92
-------------------------------------------- -------------------------------
Special Notes and Comments
WATER HEATER CHANGE OUT - 40GALLON/GAS
[2008 ENERGY] CARBON MONOXIDE ALARM(S)
TO BE INSTALLED PRIOR TO FINAL
INSPECTION. 2013 CBC
m
-------------------------------------------------------
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
-Din #
Permit #
aJo
Building
City of La Quinta
-Building &r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Permit Application and Tracking Sheet
Project Add'
Called' Contact PersonPlumbing
Owner's Name:
A. P. Number.
Address: i/lG�
Legal Description:
Contractor:S
(
f
City. ST, Zip=
Telephone: .
Address: f% 91�—/-
Vai!')/}2cy-
Project Description:
City, ST, Zip:
H.O.A. Approval
Telephone. Llo
State Lic. # :
City Lic. k
Grading
Arch., Engr., Designer:
IN HOUSE:
Address:
Developer Impact Fee
City., ST, Zip:
Telephone:
State Lic. #:ice''
I .
' y
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
TY&A,7
Sq. FL:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project
APPLICANT: DO NOT WRITE BELOW THIS LINE
it
Submittal
Req'd
Recd
TRACMG
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Rcvlewed, —dy for corrections
Plan Check Deposit
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 correcdonsriissue
Electrical
Subcoutactor List
Called' Contact PersonPlumbing
Grant Deed
. Plans picked up
S.M.L
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:
'"' Review, ready for correcdonslrssue
Developer Impact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
Prescri tiye Certificate.of Compliance: Residential
Residential Alterations
Pmject Name: J Climate Zone:
J
CF-IR-ALT-DHW
Page 1 of 2
Permit tl:
General Information
Site Address: . , =Enforcement Age!!jx. Date:
Building Type: 0 Single Family ❑ Multi Family Project T e lacemCnt or Change Out of Water Heater
WATER HEATING
• 1 certify that this Certificate of Compliance documentation is accurate and complete.
List ne%4*m installed water heaters and boilers for both domestic hot water heaters IDWH) and lt%space ace heating.
Ne%IY installed
DIM heaters and boilers ntust be gas, pryopant, or use the existingjjruitI h
conform to the requirements of Title 24, Part I and 6 of the California Cock of Regulations.
Disuibatim T 'jx
Water ticarcr Numtxr In Tank Energy Factor or
TypdFuel TypeI Rrc . system Capacity (gal) Thermal Efficiency
Extermal Tank
Insulation
enfmcc mmcm agencyfor approval with this budding rinit applitmdon.
Name L. -I
Si6runtre:
' /
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cityfstat� P}KKx: �%Q�/
1. Indicate Type (Storage Gas, Heat Pump: Instantaneous. etc.)
2. Recirculating systems serving multiple dwelling. units shall meet the recirculation requirements of §150(n).
The Prescriptive.
requirements do not allow the installation of a recirculating water heating system for single dwelling units.
J. The external water heating tank and pipes shalt be insulated to meet the requirements o t
Contractor or Homeowner (Documentation Author's/Responsible Building Designer's Declaration Statetuent) .
• 1 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.
• 1 certify that the energy features and performance specifications for the building design identifted on this Certificate of Compliance
conform to the requirements of Title 24, Part I and 6 of the California Cock of Regulations.
. The building design features identifted on this Certificate of Compliance am consistent with the information PmvWW to document this
building design on the other applicable compliance forms, worksheets. Ldion& pt&m and spmrica mos submityod to the
enfmcc mmcm agencyfor approval with this budding rinit applitmdon.
Name L. -I
Si6runtre:
' /
,7/p l� 7
cityfstat� P}KKx: �%Q�/