12-0874 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:
12-00000874
5476'0—AVENIDA VELASCO
774-215-008-8 000000 -
PLUMBING
COVE RESIDENTIAL.
230
Architect or Engineer:
d /A
4
BUILDING& SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
HANNIBAL MELISSA
54160 AVENIDA MADERO
LA QUINTA, CA 92253
Contractor:
PLUMBING INSTALLERS
13400 SATICOY STREET #25
NORTH HOLLYWOOD, CA 91605
(818)982-6952
Lic. No.: 915215
VOICE (760) 777-7012
FAX (760) 777-7011.
INSPECTIONS (760) 777-7153
Date: 8/03/12
. -------------------------------------------------------------------------------------------------
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 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
�Rofesslonals
License las : C36 C61 D3 License No.: 915215
/Dat ✓ /"�' Contractor: -
_
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 workerscompensation
r
OWNER -BUILDER DECLARATION -
insurance carrier and policy number are:
I hereby affirm under penalty of perju that I arpexempt 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
_ Icertify 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 bec r e.su ject 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 s II fo with 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
4
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
Dat Applicant: -
(_ 1 I, 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
WARNIN : FAILURE TO SECUR ORKERS'•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 hisorher 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.).
(_) 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 am exempt under Sec. , B.&P.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
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 building c struction, and hereby authorize representatives
oft is ty to enter up the above-mentioned prope for nspe purposes.
ate. �Z- gnature (Applicant or Agent): 1
Application Number . . . . .
12-00000874
Permit PLUMBING,
Additional desc .
-Permit Fee 22.50-
Plan Check
Fee
5.63
Issue Date
Valuation
0.
Expiration Date 1/30/13
Qty Unit Charge, Per
Extension
1 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 i.00.,.00
-
.00
1.00
Grand Total 29.13
.00
.00
29.13
LQPERMIT
.. - ..
Piescri tive• Certificate of Com Bance-.
Residential Alterations
Pm•ect Name
�7w nolove-n+ a-
t�
Aiden' tia! CF-1R4LT-DHW -
Ngelof2
Climate Zone: Permit #:
General information
Site Address: Enforcement Agency: Date:
Buildin T Sin le Famil rl Multi Famil Pro ect T : ❑ !placement or Change Out of Water Heat r
WATER HEATING
• I certify that this Certificate of Compliance documentation is accurate and complete.
List newly installed Later heaters and boilers for both dotnestic hot eater heaters (DWH) and lntfronic space heating. Ne%ly installed
D.WH heaters and boilers mast be gas. prqpme. or•tue the existing eI 1)rr.
Water Fknia DisUibulion Type
Typr/RxI R d'
NunAk-r In TankTypeor or
S EnaBY Fact
yste*n Capacity (gall. ittetmal FPf0.iauy
Extcrosl Tank
tawtatioa
• The building design features identified on this Certificate of Compliance art consistent with the information provided to docu
building design on the other applicable compliance forms, worfcsttom calculations. plans and specifications submitte
enforccmern for approval with this budding it application.
Name:
signatvae•
Mat an
may: Date:
Address:
1300
City/Ststc( ip: Piton:
1. Indicate Type (Storage Gas, Heat Pwnp; Instantaneous, etc-) a
2. Recirculating systems serving multiple dwelling. units shall meet the recirculation requirements of §1 S0(n).
requirements donor allow the installation of a recirculating water heating system for single dwelling units.
I The external wuter heating rank and pipes shall be insulated to meet the reauirr►nents of 6150(!1.
The Prescriptive.
Contractor or Homeowner (Documentation Author's/Responsible Building Designer's Declaration Statettteat) .
• 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]tothe
identified on this Certificate of Compliance.
• 1 certify that the energy features and performance specifications for the building design identified on this Certificate of Co
conform to the requirements of Title 24. Part I and 6 of the California Code of Regulations.
• The building design features identified on this Certificate of Compliance art consistent with the information provided to docu
building design on the other applicable compliance forms, worfcsttom calculations. plans and specifications submitte
enforccmern for approval with this budding it application.
Name:
signatvae•
Mat an
may: Date:
Address:
1300
City/Ststc( ip: Piton:
Bin#
.. ..... ...... _ .. .. :., ,.. . i
City of La Quints
.
Building 8T Safety WisigntA
" P.O. Box 1504, 78-495. Calle Tampico
La Quinta,. CA 92253 - (760) 777-7012
Building Permit
g Application and Tracking Sheet
Permit #
i�
Project Address:. II�O l !J�
Owner's Name: C.—
A. P. Number:
Address c) V
Legal Description:City;
ST, Zip: 9a
Contractor: TY (.1.
Address: 13.
.:r
Telephone / >z,,,:.,;:
Project Description:
City, ST, Zip:
Telepho Z• h«4 fcr`>::»:.;f<:>:;
State Lie. # : J City Lie.
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone: �Y�
tic. �u"+p!1g3�;:<;a�•. <,;q.'.,,,:::....:yfiv,:'!
State Lie. :•s , N„ %;;:<:>::;: ;s>
erson:,
Name of Contact Person:-F#
Cons truction Occupancy.
y��
eet type (circle one): New Add'n Alter Repair Demo
Sq. Ft:
# Stories: # Units:
Telephone # of Contact Person:
Estimated Value of Project: oo
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item Amount
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cales•
Called Contact Person
Plan Check Balance
Title 24 Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2'' Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'.'� 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