12-0174 (PLBG)P.O. BOX 1504
Contractor:
�t,_,� i
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 '
Application Number:
200.00.0:1-T4..
�T8-5 D
Property Address:
O�P;VEN NUESTRA
APN:
770-174-006-195 -000000-
Application description:
PLUMBING
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
250
Ta�/ 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
IVAN KANNO
78510 AVENIDA NUESTRA
LA QUINTA, CA 92253...,,,,
Inar,
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 2/28/12
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: If
Lender's Address:
LQPER.M IT
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 building construction, and hereby authorize representatives
o�9s county to enter upon t above-mentioned property f r inspection purposes. '
Date S' ature (Applicant or Agent):
Contractor:
�t,_,� i
Applicant: Architect or Engineer:
PLUMBING INSTAL�ER
23 ?0�� r
13400 SATICOY SkR #25 1
NORTH HOLLYWOOD, CA 9iI„y
(818)982-6952 F1,;1;a�Ai!)lyi
1l11
P 1'
Lic. No.: 915215
-----------------------=.-------------------------------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
. I hereby affirm under penalty of perjury that 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 Business 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
Licennsse)Class: C36 D34 _ LicenseNo.: 915215
_
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
/ L
6�J1� waC� ?l ((i%)1() )/LC ' J �iS7G1 l
Dat CCon or: `� �
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
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 TOWER' SELECT IN Policy Number WCCO2130900
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 so 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 should beco ' 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
3700 of the Labor Code, I she 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).:
licant:'
Da�FAILURE
(_ 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
WASECURE 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.).
APPLICANT ACKNOWLEDGEMENT'
1 _ 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 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 contractor(s) licensed
- 1. 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,
1 _ I I am exempt under Sec. , B.&P.C. for this reason
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
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: If
Lender's Address:
LQPER.M IT
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 building construction, and hereby authorize representatives
o�9s county to enter upon t above-mentioned property f r inspection purposes. '
Date S' ature (Applicant or Agent):
Application Number .
. . . .
12-00000174
Permit . . .
PLUMBING
Additional desc . .
Permit Fee
22.50
Plan Check
Fee
5.63
Issue Date
Valuation
. . .
. 0
Expiration Date
8/26/12
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 7.5000
EA PLB
WATER HEATER/VENT
7.50
----------------------------------------------------------------------------
Special Notes and Comments
INSTALL NEW 50.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
LQPERMIT
General Information
Site Address: Enforcement Agency: Date i2
Building Type: ❑ Single Family ❑ Multi Family Project Type: O Re lacement or Chane Out of Water He ter
WATER HEATING
List nem4'v installed anter heaters and boilers for loth domestic hot outer heaters (DWH) and lndronic space heating. Nrule installed
DtVH heaters and boilers must be gas, propane. orale the eeistin el twe
Water lk�ia
Typd� Type'
piton Type
(Standard.
R
Number In Tank Energy Factor or
System Capacity (gal) Tbennal Efficiency '
Exterml Tank
emulation
R -Value►
I. Inditnte Type (Storage Cas. Heat Prune; Instantaneous, etc.)
2. Recirculating systems serving multiple dwr/ling units shall meet the recirculation requirements of §lAn).
requirements do not allow the installation of a recitrulating water heating Mtem for single dwelling units.
3. The eaernal %aur heating tank and pides shag be insulated to meet the requirements of § l SO(i)
The Ptrscriptive
Contractor or Homeowner (Documentation Author's/Responsible Building Designer's Declaration StMemeust)
• I certify that this Certificate of Compliance documentation is accurate and comptere.
• 1 am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the building design
Wentifted on this Ceutifrcate of Compliance.
• l certify dud the energy features and performance specifications for the building design identified on this Certificate of Compliance
conform to the requ"ttemerus of Tette 24.Part I and 6 of the California Code of Regulations.
a 'The building design features identified on this Certificate of Compliance ars consisamt With dee information provided to document this
building design on the other applicable compliance forms, worldroem calculations plans and spocificaCrons submitted to the
enforoemerd agency for approval with this building it applkatkm
Name: Ste: -
Compartr ► � DaOe�
Address:
IN
CitytSuatdzip: _
Permit #
Project Address:Mffix
Citiy. of La C uii�ta
Buliding 8r Safety Division
P.O. Box 1504,78-495 Calle Tampico
La.Qulnta, CA 92253 -:(760) 777-7012
Building Permit Application and Tracking Sheet
Owner's Name: .
Dom,
A. P. Number. . .7 � �i v I I a J u e
Address: � \
Legal Description:
Contractor.
City, ST, Zip:
ho
Telepne:
Address:
��
_
�� �'
"
Project Description: e
City, ST, Zip: `
Cl T I., r�;
Telephone:
State Lic. # : [ •
1
City Lic. mY
M64 Engr., Designer.
Address:
City., ST, Zip:
Telephone:
Construction Type:. Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: # Stories:#Units:
State Lie. #:
Name of Contact Person:
Telephone # of Contact Person:
2" Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
PIP Sets
Req'd
Recd
TRACMG PERMIT FEES
Plan Cheek submitted Item Amount
Structural Calc%
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Calcs.
Called Contact Person
Pian Check Balance
Title 24 Calci.
Plans picked up
Construction
Flood plain plan
Plans resubmitted.".
Mechanical
Giading plan
2`' Review, ready for correctionVissue
Electrical
Subeontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
&1%LL
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'^' Review; ready for correctionalissue
Developer Impact Fee
Planning Approval.
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees