12-0237 (PLBG)(:::::eo"y000, 4
~ P.O. BOX 1504 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: 3/15/12
Application Number: 12-00000237 Owner:
Property Address: 78367 TERRA COTTA CT HUMISTON SHIRLEY
APN: 604-022-034- - - 910 ROYAL ERN WAY
Application description: PLUMBING. OCEANSIDE, CA 92057
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 700 j}
iJ t
q � � ontractor:
Applicant: Architect or Engineer:O �t 2�4i I TATE WIDE PLUMBING
t°4W� v. ! 0244 CATANIA COURT -
I IO, CA 92203--0
C:IiYo' 1l�i'A 60)636-0315
r1 "s+aAi L�ic. No.: 731855
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (cornmencing with
Section 7000) of Division 3 of the Bu ess and Professionals Code, and my License is in full force and effect.
License Class: C36 _ license No.: 731855
atP�ntr or: .
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
Lidense 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).:
(_ 1 I, as owner of the property, or my employees with wages as their sale 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 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.).
(_) .1 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.I.
Lender's Name:
Lender's Address:
LQPERMIT
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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' compensation provisions of Section
3700 of the Labor ='Ishall
orthwith comply with those provisions.
�/
WARNING:. FAILU TO 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 ovvner, 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 ve information is correct. I agree to comply with all
city and county ordinances and state laws relating to b . din construction, and hereby authorize representatives
ofcou//pt to enter upon the above-mentioned pr •erty or inspection purposes.
/Da • nature (Applicant or A no
Application Number
12-00000237.
Permit . . .
PLUMBING
Additional d_esc .
Permit Fee
22.50
Plan Check
Fee
5.63
Issue Date
Valuation
0
Expiration ,Date '.
9/11/12
Qty Unit -Charge
Per
Extension
BASE
FEE
15.00
1.00 7.5000
EA PLB
WATER HEATER/VENT
7.50
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Special Notes and Comments
INSTALL NEW 40 GALLON
ELECTRIC
WATER'
HEATER. 2010 CODES.
------------------------------
Fees
---------------------------------
BLDG STDS ADMIN.(SB1473)
1.00
Fee summary. Charged
Paid Credited
Due
Permit Fee Total
22.50'
.00
.00
,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
s
•Pre
Res
Pro
F s
'erfifncate of Comp
aerations
iron
Single Family Mull
7
residential .. •CF-IR-ALT-DHW �"
Page l eif I
Climate Zone: Permit fl:
WATER HEATING
Lin ne%4r installed %mater /eaters and boilers for borh doinestic hot stater beaten' (DWH) and h dronic space heating. Ne%ir installed
DWH heaters -and boilers must be as, e. or tut the existin e/ n .
Water ttciter
TypelFixl Type
(
(
Fxtemil Tank .
Number to Tank �gy mor halation
System Capacity (gaq Thentnl Efficiency tt-Vahmer
conform to the requirements of Titic 24. Part 1 and 6 of the California Code of Regutations.
• The building design fe"m identified on this Certificate of Compliance are consistent with the information pmvided to document tbis
building design em the other applicable l OD tpliance formes, worksheets. calculatrotts. plans acid spocirw!ftmu submitted to' do
enforcement for val with this build' lieatiorr ,
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1. Indicate Type (Storage Gas. Heat Pump..lnstahtcneous. etc. )
2. Recirculating Susumu serving ,multiple dwtllimg units shall meet _the reci.mutation requircrnents of f l An)_ 77te Prewriptive
requirements do act allow the installation of a rrcirredating water heating system for single dwelling units.
3. The c vernal water hear• tank and s shall be. insulated to meet the rr uirenents•o 1
Contractor or Homeowner (Documdxitatiou Author's/Respousibk Building Desiguer's Declaration Statetuent)
• 1 certify that this Certificate of ConViiance'docutnentation is accurate and conVte m.
• 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 ComMiance.
• 1 certify the the energy features and petforntanee specifications for the building design idea ificd ort this Certificate of Compliance
conform to the requirements of Titic 24. Part 1 and 6 of the California Code of Regutations.
• The building design fe"m identified on this Certificate of Compliance are consistent with the information pmvided to document tbis
building design em the other applicable l OD tpliance formes, worksheets. calculatrotts. plans acid spocirw!ftmu submitted to' do
enforcement for val with this build' lieatiorr ,
SWmtU=
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y: II . Dale.
Bin #
Permit
BUR
Prqject•Address _,j/
A. P. Number. i