11-0826 (PLBG)P.O..BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
'11-00000826
Property Address:
54055 AVENIDA VELASCO
APN:
774-214-025-4 -000000 -
Application description:
. PLUMBING
Property. Zoning:
COVE RESIDENTIAL
Application valuation:
520
(;&4 4 4 Q"
Applicant: Architect or Engineer:
USED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
I hereby affirm under penalty of perjthat I a ed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the BIS I ness a Pr si als Code, and my License is in full force and effect.
License Class/: C36 se No.: 7J0 44
Date: lyi i Contractor:
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)•:
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 _ 1 I, as owner of.the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions C •The Contractors' State License Law does not apply to an owner of
property who builds or improves ereon and who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' St a Licens Law.). '
(_ 1 I am exempt under Sec. B.&P.C. f son
Date: L�� ' 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
Owner:
CHALOUX RAYMOND G
54-055 AVENIDA VELASCO
LA QUINTA, CA 92253
Contractor:
A REEMDY•ROOTER & PLUMBING Ii
PO BOX 77355
CORONA, CA 92877
(951)272-8966
Lic. No.: 790544
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/02/11
); 2011 IL—
C
4t --
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 CA INS CO Policy Number 460073170104.1
I certify that, in the n4rPorm nce of the work for which this permit is issued, I shall not employ any
person in any mLner s ecome subject to the workers' compensation laws of California,
and agree that,b o e bject to the workers' compensation provisions of Section
3700 of the La I all orth i omply with those provisions.
Date: b 1 N.1 11 Applicant
WARNING: FAILURE TO SECURE WORKERS' COM NSATION 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 appl' n becomes null and void if work is not commenced
within 180 days from date of issuanof suc permit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and stat that v in rm tion is correct. I agree to comply with all
city and county ordinances and state laws relatin to uilding nst cti and hereby authorize representatives
of this to nter upon the above-mentioned ro rty fo sp io urpo
r
0,Date: u a' Signature (Applicant or Agent):
Application Number. . . . 11-00000826
Permit PLUMBING
Additional desc
_
Permit Fee 22.50 Plan Check Fee
5:63
Issue Date . . . Valuation
0
Expiration Date.. 1/29/12 .
Qty Unit.Charge -Per
Extension
BASE FEE
15.00
1.00 7.5000. EA PLB WATER HEATER/VENT
7.50
----------------------------------------------------------------------------
Special Notes and Comments
40G ELECTRIC WATER HEATER CHANGE OUT
[.67EF/R-16 TANK INSULATION] 2010 ENERGY
CODE.
August.2, 2011.1:10:00 PM AORTEGA
--------------------------------------------------------------_--------------
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
Prescriptive Certificate of Compliance: Residential, CF-M-ALT-DHW
Residential Alterations t,. , s t4(kPage I of 2
Pro'ect Name: qcraR CY1r_\V Climate Zon Permit #:
General Information
Site Address:
Enforcement Agency: Date:.
Building Type: 0 Sin le Family 0 Multi Family
Project Type: 0 Replacement or Change Out of Water Heater
WATER HEATING
Sig_ ruse:
List newl' installed water heaters and boilers for both domestic hot ater heaters (DWH) and hwlronic space heating. Newh^ installed
DIVH heaters and boilers must be gas. propane, or use the existin it , e.
Address: LLicense:
aOL��ii�
Distribution Type
Water Heater � (Standard. Number In- Tank Energy Factor or
Type/Fucl Type r System Capacity (gal) Thermat Efficiency
Recirculating).
External Tank .
Insulation
R -Value
bQcrf C mrd '
d
1. Indicate Type (Storage Gas, Heat.Punip. Instantaneous, etc.)
2. Recirculating systems serving multiple dwelling units shall tenet the recirculation requirements' of §150(n).
The Prescriptive
requirements do not allow the installation of a recirculating water heating system for single dwelling units.
3. 71e external water heating tank and pipes shall be insulated to mteet the requirements of § /
Contractor or. Homeowner (Documentation Author's/Responsible Building Designer's Declaration.Statement)
• I 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 identified on this Certificate. of Compliance
conform to the requirements of Title 24, Part l and 6 of the California Code. of Regulations.
• The building design features identified on this CertificatcofCompliana \consistent with the information provided to document this
building design on the other applicable ;compliance+forms, wocalculations,
\ plans and specifications submitQed to the
enfnnrement awenry fnr annrnvA with this huilrtina nermit annlirahnn /�1
Nam:
Sig_ ruse:
Company: V
Date:
Address: LLicense:
aOL��ii�
.
7�OS
City/statelZip:
�o-�� �: ck, q ac
Phone.
qsl
G
Bin #
City of La Quinta
Building & Safety Division
P.O. Box 1504, 78495 Calle .Tampico
La Quinta, CA 92253 - (760) 777-7012
Permit Application and Tracking Sheet
Permit #
<<• cls*Building
Project Address: Sqclss Avewao,Owner's
Name:
A. P. Number:
Address: 5540! '5
Legal Description:
City, ST, Zip: LA. (Zcsl w�k e 'd
Contractor: a t"z Q`P
l Wl
i::Yli%l,•%N^:v�:{,i:^i>.�:i::'F,.�.�;irij:v1::K
Address: �� EyyL g�
Project Description: �t no `-1fO
City, ST, Zip: QAt'O N is C_A • q aW(
~ C 1�
Tele hone:
P 9S! a'1a
<r;;<>`::> z,';><g<:''.>:.:<'-
><<,>v r:_> ;>:;.:v..
kf1 1pavio (—oC',YVI4. k-ccNt,
State Lic. # : —130sz4q City Lic. #: 07 1
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:rri...;
v<:; :s>.'::>:>•<z:":::s:>
y.;.:..,s,.,. .:;;;::::::::.:. .:.;..:.:.
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Construction Type: Occupancy:
State Lic. #:
Project type (circle one): New Add'n Alter. Repair Demo
Name of Contact Person:
Sq. Ft.:
# Stories:
#Units:
Telephone # of Contact Person:
Estimated Value of Project: i5 O
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cates.
Reviewed, ready for corrections
Plan Check Deposit
r
Truss Cates.
Called Contact Person
Plan Check Balance
!w
Title 24 Calcs.
Plans picked up
Construction
i
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for correctionsrissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
{�
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
�—
IN HOUSE:-
3" Review, ready for correctionstissue
Developer Impact Fee
�+
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees