13-1521 (PLBG)P.O. BOX 1504 4 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: 12/02/13
.Application Number: 13-00001521 Owner:
Property Address: 79745 NORTHWOOD DEE LATTORE
APN: 762-022-026- 79745 NORTHWOOD
Applicat , ion description: PLUMBING LA QUINTA, CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL (
Application valuation: 1400
Contractor:
Applicant: Architect or Engineer: STATEWIDE SERVICES INC V3
40244 CATANIA CT I a
BERMUDA DUNES, CA 92203
(760)636-0315 Cl,,v (31: LA. QUI%TA
Lic. No.: 936147 `% Q
Ty of F091
IFINANCE OFTI
-------------------------------------------------------------------------------- --------------
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjurv4at 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 n/ss 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
LicenseClass: C36 LicenseNo.: 936147 1 ir by Section 3700 of the Labor Code, for the performance of the work for which this permit is
sued
14 —on 4,��IChasve an� will maintain workers' compensation insurance, as required by Section 3700 of the Labor
Da'tej Contract
JV _7 ir Code, for the performance of the work for which this permit 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 in any manner as to 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 s d become 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 or 0 '40 with
3700'of the Labor o , I shalljor-thwith 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
Dart t. n
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: Appli ant:
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. 704-4, 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 p roperty 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 StCTION 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.). APPLICANT ACKNOWLEDGEMENT
1, 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 a permit 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 contractorls) licensed I . Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License Law.). whose benefit work is performed under or pursuant to any permit issued as a result of this application,
I I am exempt under Sec. B.&P.C. for this reason the owner, and the applicant,'�ach 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 un' der or following issuance of this permit.
Date: Owner: 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 suc permit, or cessation of work for 180 days will subject
CONSTRUCTION LENDING AGENCY permit to cancellation.
nd state tha e
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify that I have read this application a2bove information is correct. I agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.). city and county ordinances and state laws. relati buil ing construction, and hereby authorize representatives
.of this county to enter upon the above-mentioned prope y or inspection purposes.
Lender's Name:
DaAlll�n I a- Signature (Applicant o
Lender's Address:
LQPERMIT
Application Number . . . . . 13-00001521
Permit . . . . . . PLUMBING 2013
Additional desc
Permit Fee 11.92
Plan -Check Fee
.00
Issue Date . . . .
Valuation . . . .
0
Expiration Date 5/31/14
Qty Unit Charge Per
Extension
1.00 11.9200 EA PLBG WATER
-----------------------------------------------------------------------------
HEATER/VENT
11.92
Permit . . . . . . PLUMBING 2013
Additional desc
Permit Fee 11.92
Plan Check Fee
.00
Issue Date . . . .
Valuation
0
Expiration Date 5/31/14
Qty Unit Charge. Per
Extension
1.00 11.9200 EA PLBG WATER
HEATER/VENT
-----------------
11.92
-------------------------------------------------------------
Special Notes and Comments
WATER HEATER CHANGE OUT - (2)
50GALLON/GAS [2008 ENERGY) CARBON
MONOXIDE ALARM(S) TO BE INSTALLED PRIOR
TO FINAL INSPECTION. 20iO CALIFORNIA
BUILDING CODES.
---------------------- 7 ---------- 7 --------------------------------------------
Other Fees . . . . . . . . . PERMIT
ISSUANCE M/P/-E.
90.57
PLAN CHECK, PLUMBING
14.30
Fee summary Charged Paid
--- ------- ----- ----
Credited
-----------------------
Due
-----------------
Permit Fee Total
.00 .00
23.84
Plan Check Total .00
.'00 .00
.00
Other Fee Total 104.87
.00 .00
104.87
Grand Total 128.71
.00 .00
128.71
LQPERMIT
Bin # City of La Quinta
Boding u"Safety Division
P.O. Box 1504, 78-495 Calle Tampico
permit # La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
ProjectAdck&T.1.41 :ZY,5- wr Owner's Name: Ve- e- a 4-6-ny-e
W4+1 wo I d ". -
A. P. Number. Address: q e) on
Legal Description: City, ST, Zip: t -A (14 C1
contractor ;felephone�
- qi.
CLe 1�?J1LAa1L,6&3 P,
A AA-- 0- -, -7 C_e-N n- u/ I !=� e-_, , c-, I I Proit Descrintion: 10 i_0 /n'-)
C -ty-S
ity. ST. Zic-&__4�
ETelephon�_&,,Nq_01�_W
�LCA_ Q�A -61 t,�d
�Ig� 011-1
N= r,�;L
State Lic. #
City Lic. N.
Arch., Engr.. Designer.
Date of permit issue
Ad&=:
School Fees'
City., ST, Zip:
Telephone:
State Lie. #:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Dgemo
.Name of Contact Person:
-2'
-1 �7 TV� e) 3
q. FL:
Ston*e,s:
#Units:
Telephone # of Contact Person:
V
t. CA)a HE,
stimated Value of Project
# Submittal Reqld
APPLICANT: DO NOT WRITE BELOW THIS LINE
Recld TRACKENG
PERMT FEES
Plan Sets
Plan Check submitted
Item
Amorifit
Structural Cares.
Rcviewc� rcady for correctiow
Plan Ch*cck Deposit
Truss Cates.
Calle&�Contact Person
Plan Check Balance.
Tide 24 CaIcs.
Plans picked up
coustrriction
Flood plain plan
Plans resubmitted
Mechanical
GmdIng plan
r' Review, ready for correctionstissue
Electrical
Subcontector List
Calledl Contact Person
Plumbing
Grant Deed
Plans ck-ed up
SALL
[
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
I
RevtLw, ready for correctionsrmue
Developer Impact Fee
Total Permit Fees
Planning Approval
Called, Contact Person
A.LPT.
Pub. Wks. A-ppr
Date of permit issue
School Fees'
Total Permit Fees
-;erfit
-Prre�krijgt�liye,( idte of
'FR-eviden-hal Alterations
Climitte Zone: Permit #:
Nvlal
General Information
Site Address:, E;forcement!�.&ene . y: Date:
Building lype:!JLSingle Family 0 Multi Family ftiect TyPeMeplacem�nt or Change Out of Water Heater
WATER HENTING
Ust nem -1 * Y installed %vater heaters and boilers for built domestic hot, water hearers-(DWH) and h.w1rottic.%wre hearing. Ne%i.v installed
MH heaters and boi * rs must be gas. prwopan or itse the e.visting fit* PC.
Distri� Type
Water Heater (Standa4
TyPdT-0 Type, Reckadatilwy
Nun*;x.In Tank Fjwgy Fww ur
Systern Capacity (gal) Tbcffrial Efficiawy
Ext6mal Tank
Insubdim
R-Vakx)
identified on this Ccrtil`icate of Conipliar".
• I certify that the energy fettitites and perfogmance specifications for the building design ideritifted, on this Certificate of Complian6e
Ithis
conform to the requirements of Title 24. Pan I and 6 of the California Code of Regulations.
• The building design features identified on this Certificate of Compliance am consistent with the inf::��ion provided to document
I to t�
building design on the other applicable compliance forms. worksheem plans and submitted to the
ca��
enforcement agency for approval with this building permit app[*K"ME'KXL
specirmmlions
Name:
1. Indicate Type (Storage Cos. Heat Ptunp; Instanganeotm etc.)
2. Recirculating sYstems serving nudliple dwelling units shall nieet the recirculation requirrinents of flAn).
requirrtnents do not allow the installation of a mcirculating water heating systernfor single dvx1fing units.
J. 7he evernal %vier heating rank and pipes be insulated to tneet the requirements of § 150(i).
The Prescriptive
Contractor or Homeowner (Documentation Author's/Responsible Building Designer'.s Declaration Statement)
• I certify that this Certificate of Compliance dor-urmnialion is accurate and complete.
• I am eligible under Division 3 of the California Business and Professions Code to pt Msibility for the building design
res;
identified on this Ccrtil`icate of Conipliar".
• I certify that the energy fettitites and perfogmance specifications for the building design ideritifted, on this Certificate of Complian6e
Ithis
conform to the requirements of Title 24. Pan I and 6 of the California Code of Regulations.
• The building design features identified on this Certificate of Compliance am consistent with the inf::��ion provided to document
I to t�
building design on the other applicable compliance forms. worksheem plans and submitted to the
ca��
enforcement agency for approval with this building permit app[*K"ME'KXL
specirmmlions
Name:
C?"Y:
D.Se:
Addmn:
o
Ci tyfS
L-613) CM 91c,
Phone:
-2t,-0-49