12-0724 (PLBG)L-
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
12-00000724=
Property Address:
�30AVENIDA VALLEJO
APN:
773-324-004-23 -000000-
Application description:
PLUMBING
Property Zoning:
COVE RESIDENTIAL
Application valuation:
700
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
---------------------- - ----------------- -----------
LICENSED CONTRACTOR'S DECLARATION
hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
L' ense Class: C36 License No.: 731855
Date oniractor. `
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.).
(_) 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: P .
LQPERMIT
Owner:
MIRIAM.KAHN
52830 AVENIDA'VALLEJO-
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760).777-7011
INSPECTIONS (760) 777-7153
Date: 7/05/12
Contractor: .' rLt:
'
STATE WIDE PLUMBING 40244 CATANIA COURT
INDIO, CA 92203--0(760) 636-0315Lic. No.: 731855
LA QUINTA
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 MARKEL INS CO Policy Number MWC00329801-01
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 de, I shall forthwith comply with those provisions.
Dat : APPlica �1/7i
WARNING: FAILURE 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. I
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 construction, and hereby authorize representatives
of this county to enter upon the above-mentioned neer^tyy'forriinsspec�tio/npurposes.
ate _ gnature (Applicant or AggQU}9
Application Number 12-00000724
Permit PLUMBING,
Additional desc .
Permit Fee `22.50 Plan Check Fee
5.63
• Issue Date Valuation
0
Expiration Date . .1/01/13
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 7.5000 EA PLB WATER HEATER/VENT
7.50
--------------- ------ ---------------------------
Special Notes and Comments
REMOVE .& REPLACE 40 GALLON N/G•WATER
HEATER.
------,--,---------------
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
LQPERMIT
J
•Pcescri tive Certificate of Com liaa ce: Residential.. _ _ .: CF=1R-!
Residential Alterations
"ect.Namc: Climate Zane: Permit #:
General Information
Site Address
j7 -77 --Enforcement enc : Date:
Building T in le family D .Mull ami( : • Ptv"ect T Re lacecnent or.Chan a Out of Water I-'
�y
6
,T-DHW :
,agc t of! .
WATER HEATING
List ne%44v installed %voter heaters and boilers for bbrh:domestic hot Nater heatersgDWH) and h drouic space hearing. Nrx•h installed
DtVH heaters and boilers trust be as p or use the existing l h .
Wata Heater
tDistribixtion Number In Standad,. Tank r �'uxnal Tank
lasulatian
TypalFuel Typc
R System Capacity (gall cyR"VaXT
..
X=1
I
I
1. Indicate Type (Stortsge Gas. Heat Pump. Instaivaneoies. etc.)
2. Reciretdating systems serving multiple dwelling ' units shall meet the recirculation requiretnents of §150(n). The Presctipt"
requirements do not allow the installation of a recirculating water heating system for single dwelling units.
J. The eternal nuterheating tankandpipes ihdtl be insulated to meet the rc uirenwnts of §150U).
k
r •
Contractor or Romeowner (Docuentation Author's/Responsible Building Designer's Declaration Statement)
• 1 certify that this Certificate of Commplianceldocumentation is accu *ate and complete.
• 1 am eligible under Division 3 of the Cslifomia Business and Professions Code to accept responsibility for the building design
identified on this Certificate of Compliance.
• D certify that the energy featutzs andperformance:specifications for the building design identified on this Certificate of Compl'tattce
conform to the requ'tremerrts of Title 24. Part I and 6 of the California Code of Regulations.
. The building design features identified on this Certificate of Conipliatrce consistent with the information provided to document this
building design on the other applicable forms. wo calculations. plans and specifications submiMod to the
enforcement for val with this,buiidin ` permit ligation
77fl
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Building a Safety_ Division .
Box 1504, 78-495. Ca11e. Tampico
la.Qtnnta, CA 92253 -:(760) 777-7012
Building Permit -Application and Tracking Sheet
Permit #P.O:
f , %(�
: a-. (� -�N1 C
Owner's Name:. �1/7. Cl/Ly1Ka
EP.'Number
Address:5 J v �CU�rI an:
City, ST, Zip
Telephone: (� - 7 .;>...r--�••.�';s� -
Contracto .
u,
Address: Li L1"tl5t.Y l ,
Project Description: b
City, ST, Zi :
r
Telephon ;O
.,IQ�r�•1.
State Lie. #: S
City Lic. #•:�'�
Arch., Engr., Designer.
Address:
City., ST, Zip:
Telephone:MEMO
State Lic. #: , .... .'
Name of Contact Person: ^
Construction Type:. Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.:
#Stories:
#Units:
Telephone # of Contact Person.
Estimated Value of Project: Qom_
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Recd
TRACKING.
PERMIT FEES
Plan Sets
Plan Check submitted
Item Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit, .
Truss C21cs.
Called Contact Person
Pian Check Balance
Title 24 Cake.
Plans picked up
Construction
Flood plain plan
Plans resubmitted..
Mechatiical
Grading plan
2i4 Review, ready for correctionsfissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
3,4 Review; ready for eoriections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees '
Total Permit Fees