12-1171 (PLBG)Tli&f 4
P.O. BOX 1504 " VOICE (760) 77
78-495 CALLE TAMPICO FAX (760) 77� 11
LA QUINTA, CALIFORNIA 92253 BUILDING.&'SAFETY DEPARTMENT INSPECTIONS (760) 77771
BUILDING PERMIT
• _ - - - Date:- 10/04/12
Application Number: -12700001171 . Owner: �.
Property Address: 55497 SOUTHERN HILLS HALY THOMAS H' O
APN: 77.5-200-006-. - - 554.97 SOUTHERN HILLS,
Application description: PLUMBING .LA QUINTA, CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL-
Application
ESIDENTIAL-Application valuation: 225 r
Contractor:
O
Applicant Architect or Engineer: RITE -A -WAY SERVICES INCp9�0
14457.MERIDIAN PARKWAY c',,X,_
RIVERSIDE, CA 92518
(800) 974-7379G�ij�� ? D
,) Lid. No.: 760371 >�
------------------------- ------ -
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
License Class: .C20 C36 B License No::.. 780371 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is -
/ n' issued.
ivate: (�`` ZC�e tractor. - - I have and will maintain workers' compensation insurance, as iequired 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 BARRET BUSINESS Policy Number 2246
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 become 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, 1 shall forthwith corn 11_WWbose 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).: Date: (t}- —� /applicant: -
( 1-.1, as owner of the property, or my employees with wages as their sole compensation; will do the work; and ��/��/ -
the structureisnot intended or offered for sale (Sec. 7044, Business and Professions Code: The WARNING: FAILURE TO SECURE 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 1$100,0001. 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 yearofcompletion, 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, 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 fora'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 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
of La Ouinta, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance of this permit. - "-
Date: Owner: - 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
CONSTRUCTION LENDING AGENCY permit to cancellation.
I.hereby affirm under penalty of.perjury that there is a construction lending agency for the performance of the - I certify that 1 have read this application and state that the above information is correct. I'agree tocomplywith all
work for which this permit is issued (Sec. 3097, Civ. C.). . • city and county ordinances and state laws relating to building construction, and hereby authorize representatives
_ of this county to enter upon the above-mentioned property for inspection purposes. ,
Lender's Name: -
�4e:10—q—(�Siature (Applicant or Agent):Lender's Address:
LQPERMIT -
u
Application -Number r. 12-00001171
/
_-
Permit PLUMBING
'
Additional desc `
Permit, Fee 22-.50 Plan Check.Fee..
5.63 .-
-
4 Issue Date Valuation. . . . .
0.
Expiration.Date 4/02/13
' •
Qty Unit Charge Per
-Extension
i .
BASE .FEE i
15.00 a
' "•
1.00 7.5000 'EA PLB WATER HEATER/VENT
•7.50 - +
•
-_-_"Special Notes and Comments
INSTALL•NEW 40 GALLON GAS WATER HEATER
`.
LOCATED`IN CLOSET OUTSIDE CASITA. 2010 -
<*
*CODES.
— — — — — — -
`
---------------------
Other Fees " BLDG STDS ADMIN (SB1473)
1.00
'
Fee summary Charged Paid X Credited
---
Due'
Permit'Fee Total 22.50 .00- 00
22'.50
.,Plan Check Total` 5.63. .'00 .00
' Other Fee' Total 1:,00 .00 - 00
1.00
'Grand, Total 29.13 00 .00
2.9.13 +
-
• ti
r •6 I •. •a a r-
it
_ •.
LQPERMIT
J }
WATER HEATING
List newiv.installed. .water heaters and boilers for both domestic hot water heaters (I)WH) and. hw1ronic space hea*Ne,,
D.1VH heaters and boilers must be as, e. or use the existingel n .
Water Neater Distribution'iype .
Number In Tank Energy Factor or
ion
Typd� Type' Res
System Capacity (gal) 11►erir►aI Etf►cie►cy`�
1. Indicate Type (Storage Cas, Heat Ptatgr; Instantaneous; etc.)
2. Recirculating systems serving tttultiple dwrlling units, shall ineet the recirculation rigtrircrnentt of §I An).
The. Priesgiptive.
requirements do not allow the installation of a recirculating water heating system jor single dwelling units.
3. 71te evernal water heating tank and pOes shall be insulated to meet the requirements of §150U).
Contractor or Homeowner (Documentation Author's/Responsible Building Designer's Declaration Statement)
• I certify that this Cettifiare`of Compliance documentation is accurate and complete. r
• •1 am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the buildmg''design
identified on this Certificate of Compliance.
a
• i citify that the energy features 6A. performance specifications for the building design'identified on this Certificate of Compliance
conform to the requirements of Tide 24. Part fund 6 of the California Code of Regulations.
• The building design features identified on this Certificate of Compliance are consistent with die information provided to document this
building design on the other applicable compliance forms, worksheets, calculations. plans and; specifications submitted to the
enforccmet aLenc
y for approval with this budding tmrt licarioo
Name signal uo:
Company:
�Date.
License
City/Skatemp: Phone: r
Bin.# Clay ofla Qufhfd
Builduig im Safety Division
Perinit # P.O. Box 1504,78 495 Calle Tampico
La.Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Project Address:"r� l c .I Owner's Name: .
A. P. Number. Address:
Legal Description: Ci ST Zi
h', P
i
°S "ajiL?' iuxS°�y
Contractor. �. , W �, Telephone: �( �(� i!f k3fs axww?,'�E i;
C .
Address: Lt c.t Project Description:
City, ST, Zip: i.iCr sl i� 2 �( D� t
"fie
i
Telephone. FUJ -11,Li -1` -j I ° p �s2�:C? " ,• ;% II
lore— () QST C�
State Lic. #: - City Lic. #;
Arch, Engr., Designer.
j
Address:
City., ST, Zip:
Telephone: Construction Type: Occupancy:
State Lic. #: �? roject type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: Sq. FL: #Stories: #Units;
Telephone # of Contact Person: Estimated Value of Project
APPLICANT: DO NOT WRITE BELOW THIS UNE
# SubmIttal Req'd Recd TRACMG PERMIT FEES
Plan Sets Plan Cheek submitted Item Amount
Structural Cities.Reviewed, ready for corrections Plan Check Deposit. .
Truss Cates. Called Contact Person Pian Check Balance
Tide 24 Cates. Pians picked up Construction
"
—
Flood plain lan -
—P--- —-Plins-resubmitted.'. --- -Mechanical — -----
Grading plan
2a° Review, ready for correctionstiissue
Electrical
Subeontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
ready for correctionsfissuc
Developer Impact Fee
Planning Approval.
Called Contact Person
A LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
El
Permit Fees Z-2