13-1501 (PLBG)4
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 13-00001501
Property Address: 79200 DIANE DR
APN: 604-313-004-20 -26188 -
Application description: PLUMBING
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 900
T4 4a"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
DOLORES NOYOLA
79200 DIANE DR.
LA QUINTA, CA 92253
(
Contractor:
Applicant: Architect or Engineer: CAMPESINOS UNIDOS, INC
P.O. BOX39
BRAWLEY, CC
A 92227
(760)344-4500
LiC. No.: 618140
LICENSED CONTRACTOR'S DECLARATION
I 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.
Licens lass: C36 License No.: 618140
r
Dat Contractor
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).:
(_ 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
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 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 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 _ ) 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:
LQPER.MIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/25/13
"NOVs 203 D
CITY pF 9
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
� irssued.
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 CYPRESS INS Policy Number 3330058264-131
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 Code, I shall forthwith comply with those provisions.
Date: Appy:
WARNING: FAILURE -TO SECURE WORKEflS' 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 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 toenterupon the above-mentioned property for inspection purposes.
Sign�� !3y Agent):
Application Number . . . . . 13-00001501
Permit . . . PLUMBING 2013
Additional desc .
Permit Fee . . . . 23.84 Plan Check Fee
.00
Issue Date . . . . 11/25/13 Valuation . . .
. 0
Expiration Date 5/24/14
Qty Unit Charge Per
Extension
1.00 11.9200 EA PLBG WATER HEATER/VENT
11.92
1.00 11.9200 LS PLBG GAS SYS, 1-4 OUTLETS
11.92
------------- ------------------------------------------------------
Special Notes and Comments
WATER HEATER CHANGE OUT - 50GALLON/GAS
[2008 ENERGY] CARBON MONOXIDE ALARM(S)
TO BE INSTALLED PRIOR TO FINAL
INSPECTION. 2010 CALIFORNIA BUILDING
CODES.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
PERMIT ISSUANCE•M/P/E
90.57
PLAN CHECK, PLUMBING
30.98
Fee summary Charged Paid Credited
---------------------------------------------------------
Due
Permit Fee Total 23.84 2.3.84 .00
.00
Plan Check Total .00 .00 .00
00
Other Fee Total 122.55 122.55 .00
.00
Grand Total 146.39 146.39 .00
.00
LQPERMIT
ei
Bin r
City of La Quinta
Building &r Safety Division
P.O. Box 1504, 78-495 Cape Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
I l
Project Address: Za c7 )'ice ei
Owner's Name: v� N8 p 1, 0010 r �s
A. P. Number: -.
Address: `).j 0 a D 7 mm e V3r-
Legal Description:
City, ST, Zip:
Contractor: Cp^�i�j_,r
Telephone: - �� '.`'s,> 1's:W,s:'>••:'•y:;?: .<.::
Address:
Project Descr iption:
City, ST, Zip: YJa Gw� C �1c c112Z
1 C,'� e 8 v;
Telephone .`3'T
State Lie. # : 1 vl-
City Lie. C
Arch., Engr., Designer:
Address:
City,, ST, Zip:
..... ... .... 2iyy:h:. �:y • ^
:;�:{.yitiltiik:?'i'`u•:?:iy}::±�%��i:ti�:\\�'}i �'viY,•�
Telephone: �rA:v,;;.x:.::;?;.;<<ssy:•
Lie. #: t.: ::• .
Construction Type: Occupancy:
'one): Add'n Alter Repair DemoState
Project type circle New
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Caics.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2o4 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
Prescri 'tive Certificate of Compliance: Residential CF-IR-AL's-DHW
Residential Alterations page I oft .
Pro'ect.Name: ` aY eS Climate Zone: Permit #:
General Information
Site Address: '71,;L-0 c> 300,-q i-,) Y.Enforcement
A enc : A 0 U.IV\, 9\ Date: f 2�
Building T in le Family ❑ Multi Family
Project
ruect T e lacetr>ent or Change Out of Water Heater
WATER HEATING
• I certify that this Certificate of Compliance documentation is accurate and complete.
List newly installed water heaters and boilers for loth danestic hot Nater heaters (D WH) and Invironic space heading.
Newh• installed
DWH heaters and boilers must be gas. propane, or use the existingfiieI type.
conform to the requirements of Title 24. Part I and 6 of the Cal ifomia Code of Regulations.
Water Heater Distribution Type Numb�v In Tank Energy Factor
(Standard,
External Tank
ion
Type/Fuel Type' R
)r System Capacity (gal) .Thermal Efficiency
R-VInsualue
C. '� is 0.r qy r
_
Date:
Address: �
I C) .
L.ioense:
Citylsta 'p:
E)Y-Q,,\),J��Q c_.��Z7
1. Indicate Type (Storage Gas. Heat Ptunp. Instantaneous, etc.)
2. Recirculating systems serving multiple dwelling units shall meet the recirculation requirements of §/An).
The Prescriptive
requirements do not allow the installation of a recirculating Nater heating sistem for single dwelling units.
3. The external water heating tank and pipes shall be insulated to meet therequirements of § 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 Title 24. Part I and 6 of the Cal ifomia 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 other applicable compliance forms, worksheets, calculations, plans and. specifications submitted to the
enforcement agency for approval with this budding permit application.
Name: —
COs— - 6b�Y o
Signature:
Company: /
(-AM
Date:
Address: �
I C) .
L.ioense:
Citylsta 'p:
E)Y-Q,,\),J��Q c_.��Z7
Phone:
7b 0.3 21S0D