12-0052 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 12-0000005
Property Address:
47875—SOFT-MOONLIGHT
APN: 649-030-069-11 -31311 -
Application description: PLUMBING
Property Zoning: ' HIGH DENSITY RESIDENTIAL
Application valuation: 650`
Applicant:
Architect Or Engineer:
P (Pir,
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of'perjury hat I am licensed under provisions of Chapter 9 (commencing with
section 7000) of Division 3 of the guess and Professionals Code, and my License is in full force and effect.
License Class: C36 License No.: 731855
ontra $
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).:
(_) 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
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, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: The Contractors' State LicenseLawdoes 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: nn
Lender's Address: K
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: -1/18/12
Owner:
LUCIEN HACK
47875 SOFT MOONLIGHT ut `
LA QUINTA, CA 92253 i
(760)771-3345
Contractor: cayof; P►0U1N._(A
STATE WIDE PLUMBING f lili�?Y�:sal.
40244 CATANIA COURT
INDIO, CA 92203---0
(760)636-0315
Lic. No.: 731855
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 SOUTHER INS CO Policy Number WSIO047530-01
_ I certify that, in the performance of the work for which this permit is issued, I shall not employ any
person in any manner so as to become subject to the workers' compensation laws of California,
and agree that, if I should become subject to the workers' compensationprovisions of Section
/ 37^^11 00 of the Labor de, I shall forthwith comply with those provisions.
Date��O'�lica t:
WARNING: FAILURE T..O.. SECURE WORKERS' COMPENSATION 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 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 andstate that the bove information is correct. I agree to comply with all
city and county ordinances and state laws relating to buil g construction; and hereby authorize representatives
of his county to enter up o the above-mentioned rt for inspection purposes.
Date 10 `� nature (Applicant or A nt):
e
Permit Fee
22.50 Plan Check Fee
5.63
Issue Date
Valuation ..
0
Expiration Date
7/16/12
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 7.5000 EA PLB WATER HEATER/VENT
7.50
-----------------------------------------------------------------------------
- Special Notes and
Comments
REPLACE 40 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
r
29.13
WATER HEATING
.List new4e installed stater heaters and (oilers for both domestic hot stater heaters (DWH) and h►dronic,space heating. Nest'ly installed
D.WH heaters and boilers must be gas. propane. or use the existing rl type.
Water heater
MiributionExtemal Tank
, Type Number In Tank E-6 Factor or
TYPdFxt Type)
R (St�d' system Capacity (gal) Tbcnnal Efficiency — kw'
474 L.—
..
1. Indicate Type (storage Gas. Heat PunWJitstantaneous, etc.)
2. Ricitrulating systems serving multiple dwelling units shall meet the recirculation requirerrrjitts of f iAn). ,The Prescriptive.
requirements do not allow the.instaUotion of a recirculating water heating system for single dwelling units.
• 3. The a neral water heating tank and p&ws shall be insulated to. meet the rc uirements of §150(1).
Contractor or Homeowner (Documentation Author's/Responsible Building Designer's Declaration Statement)
. I certify that this Certificate of Compliance documentation is accurate and complete.
• 1 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 Titte 24, Pact I and b of the California Code of Regulations.
. The building design features identified on this Certificate of Compliance are consistent with the information provided to document this
building design on the oche` applicable compliance forms, woehheetj. calculation& plans and specifications submitted to the
enforccmart agency -for amoval with this building it plication.
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. _ - ... , ... .. City Of La Quin l.C>l ,
Building 8t• Safety' Division '
P.O. Box 1504,78-495 Calle Tampico
La Quinta, CA 92253 - (760) 7774012
BuildingPermit Application and Tracking Sheet
Permit # rr,^,
Ad'dress:
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Owner's Name: � .
A. P. Number:
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Address: `7 g"7 5
Legal Description:
Contractgi: I d�L'
`-City ST, Zip:Let DLJ,
TdFP-hone: i K R . #
Address:.( (�
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ProjectDescaiption: (J C
City, ST, Zip
Telephone:'?
State Lic. # : City Lie. #:1QE-/Z)
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone-.:"aYiv>>
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Construction Type: Occupancy:
Project type (circle one): New Add, n Alter Repair Demo
Sq. Ft: # Stories: # Units:
Name of Contact Person: ,/
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Telephone # of Contact Person: 3 -�
Estimated Value of Project: V
S
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APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Rec'd'
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cales.
Called Contact Person
Plan Check Balance
Title 24 Colts.
Plans picked up
Construction }
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
20° 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 corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees