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13-0443 (PLBG)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA; CALIFORNIA 92253 Tihf, 4 4 a" Applicant: Architectneer: iA— BUILDING & SAFETY DEPARTMENT BUILDING PERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 4/10/13 Owner: LOUTSENHIZER KIM 53205 AVENIDA NAVARRO LA QUINTA, CA 92253 (760)771-0877 . Contractor: STATEWIDE SERVICES INC 40244 CATANIA CT D BERMUDA DUNES, CA 92203 (760)636-0315 9 6 APR 1 1 ^013 Lic. No.: 936147 LA LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION Application Number: ,---13-0.0000443-- --- Property Address: 53205 AVENIDA NAVARRO APN: 774-064-022-10- -000000- Application description: PLUMBING Property Zoning: COVE RESIDENTIAL Application valuation: , 700 Applicant: Architectneer: iA— BUILDING & SAFETY DEPARTMENT BUILDING PERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 4/10/13 Owner: LOUTSENHIZER KIM 53205 AVENIDA NAVARRO LA QUINTA, CA 92253 (760)771-0877 . Contractor: STATEWIDE SERVICES INC 40244 CATANIA CT D BERMUDA DUNES, CA 92203 (760)636-0315 9 6 APR 1 1 ^013 Lic. No.: 936147 LA LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury tint I am licensed under provisions of Chapter 9 (commencing with • - I hereby affirm under penalty of perjury one of the following declarations: Section 7000) of Division 3 of the Bus i and Professionals Code, and my License is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided License Cles LicenseNo.: 936147 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is �' r_issued: ffC36 DateContract - :- '. - - 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 thispermit 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 STATE FUND Policy Number 1948371. 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 inany manner so 8N, o 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 shoul come 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 3700of the Labor Co , !, hall 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).: A Date: ( pplicant: 1 _ 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and 1 --- 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.l. - APPLICANT ACKNOWLEDGEMENT (_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the. project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for apermit subject to the 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application. - property who builds or improves thereon, and who contracts for the projects with a contractors) licensed - 1 . Each person upon whose behalf this application is made, each person at whose request and for pwrawant to tha Oaittedol.W4`0[Cit. 1-1-- Loo-). ' - . - - whose benetit work is performed under or pursuant to any permit issued as a result of this application, I—) I am exempt under Sec. BAP.C. for this reason the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City I frelated t th work bein 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 of La Ownta, its officers, agents and emp ogees or any act or omission o e o g 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 ve information is correct. I agree to comply with all city and county ordinances and state laws relating to b ' in construction, and hereby authorize representatives of thi count to enter upon the above-mentioned pdperty or inspection purposes. -Date: Signature (Applicant orAg t): ' Application Number 13-00000443 Permit PLUMBING Additional desc . Permit Fee . . . . 22.50 Plan Check Fee 5.63 Issue Date . . . Valuation- 0 Expiration Date- 10/07/13 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 AND REMOVE 40 GALLON ELECTRIC WATER,. 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 LQPERMIT Prescri tiye Certificate of Com fiance: Residential.. CF-IR-ALTrDHW ' Residential Alterations Project Name: - r tr Climate Zone: Permit #: General Information Site Address. , S 2• Enforcement Agency: Date: Building Ty Single Family 0 MultiFarnily Project Ty Re lacenwrit or Change Out of Water Heater WATER HEATING List new4c installed water heaters and boilers for both domestic hot water heaters (DWH) and hydrottic:space heating. New•lY installed DWH heaters and boilers utust be gas, propane. or use the existing e1 h Waleyq Tier TYp� Type' Type Roc Numl><x In Tank �gy hof System Capacity (gal) T6ecmal Efficiency Extemat Tank Matta R -Value' 1. Indicate rmw (Storage Gas. Heat Peatp: Instantaneous, etc. ) 2. Recirculating systems serving multiple dwelling units shall ince( (he recirculation requirements of §1AR( requirements do not allow the installation of a recirculating water heating system for single dwiling'units. 3_ The external water hparing, tank and ' ' s shag be insulated to meet the reuin►nents of § 1 The Prescriptive Contractor or Homeo(Documentation Author's/ResponsUAe Building Designer's Declaration Statement) • I certify that this Certificate7of Compliance documentation is accurate and complete. • I am eligible udder Division 3 of the California Business and Ptofessions Code to accept mspxuibility 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 Tette 24, Parti and 6 of the California Code of RegulaCtoc►s. "o • The building design features identified on this Certificate of Compliance arc consistent with the information provided to document this building design on the other applicable compliance forms, worksheets, calculations. plans and specifications submitted to the enforccM-t agency for approval with this building it -cation ' N � � SibnatusG I/LIe C4 Y Date: _j �c -C4 . . t�- ce— Address: O.. License: City/Stau:07 Phone: Bin.# Oty 0f LCt Quanta -Bwtcrmg a Safety Division P.O. Box 1504,'78-49S Calle Tampico ta.Quinta, CA 92253 -:(760) 777-7012 Building Permit Application' and Tracking Sheat Permit # i Project Address � v � i Owner's Name: . (r1 . A. P. Number. Address: c)S 4,U 6q a ,Q Legal Description: City, ST, Zip: Contractonzo%J,p,_ J Ce3 Tele hoe % Address: L OaAarl• 1`q Project Description: 12- 40c-v) City, ST, Zip: 17- 110, _ ' Telephone• �� , .,:. . C�.,.,,,.. ,y State Lic. # :q3 City Lie. ##, Arch., Engr., Designer. Address: City., ST, Zip: Telephone: ' `�� .; Construction Type• . Occupsncy: State Lic. #:;wgj»% Project type (circle one): New Add'n Alter Repair Demo Sq. Ft.: # Stories: # Uthim Name of Contact Person: Telephone # of Contact Person: Estimated Value of Project: 7 APPLICANT: DO NOT WRITE BELOW THIS UNE # Submittal Req'd Rec'd TRACIUNG PERMIT FEES Plan Sets Pian Check submitted Item Amount Structural Cales. Reviewed, ready for corrections Plan Check Depcsit. . Truss Calcs. Called Contact Person Plan Check Salaice Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted.'. Mechanical Grading plan 2id Review, ready for correctionslissue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up SALL ILO.A. Approval Plans resubmitted Grading. IN MUSE:- 1n° Review, ready for corrections/issue Developer Impact Fee Planning Approval. Called Contatt Person A.I.P.P. Pub. Wks. Appr Date of permit Issue School Fees Total Permit Fees