12-1321 (PLBG)- o
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
12-00001321
Property Address:
51710 AVENIDA DIAZ
APN:
773-121-007-7 -000000-
Application description:
PLUMBING
Property Zoning:
COVE RESIDENTIAL
Application valuation:
700
T4ht 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
ANCKER WILLIAM A
51710 AVENIDA DIAZ
LA QUINTA, CA 92253
VOICE (760)
FAX (760) 1
7153
/12
Contractor:
Applicant: Architect or Engineer: STATE WIDE PLUMBING
40244 CATANIA COURT
INDIO,-CA 92203--0
(760)636-0315
LiC. No.: 731855
--------------------------------------------------------------------------------------------------
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.
License Class: C36 License No.: 731855
te: Co actor:
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.).
1 _) I am exempt under Sec. , BAP.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:
LQPERMIT
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 Codde//f I shall forthwith comply with those provisions.
{fate - plicant: '/4�A7Z:6
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 (5100,000). 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.
1 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 build g construction, and hereby authorize representatives
of this
county to enterrupon the above-mentioned property for inspection purposes.
ture (Applicant or Age
n
Application Number . . . . . 12-00001321
Permit . . . PLUMBING
Additional desc .
Permit Fee . . . . 22.50
Plan Check
Fee
5.63
Issue Date
Valuation
. . .
. 0
Expiration Date 5/06/13
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
REMOVE & 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
29.13
LQPERMIT
"
Preiwriptiye Cerfirk rte of Compliaalee:
Residential AlArations
Pm'ect. Name:
•A
Climate Z.,one: Permit f):
"T-DHW i.:
'aac 1 of 2
General Information
Site Add�ess rcementAgency:Date=
Buildin �inle =mil 11 Multi Famil Project a lacetrmgnt or Chan a Out of Water Heater
WATER HEATING
List newh• instatltd water heaters and boilers jor both domestic hot Nater heaters°(DWH) and h.Wronic space heating. Ne%4.v installed
Dt1'H heaters and boilers must be gas, e, or tete the existin el I)re.
Water Huta
TyP� Type,
Must tion Type Number M . Tank Energy Factor or
(SufwwdL SYem C tY(8aq Timernal Efficiency
Ree'
External Tank
Ittsulatioo
R -Value'
�MG M/ l I •
f
t
1. Indicate Type (Storage Gas. Heat Ptunp: Instantaneous, etc.)
2. Recirculating systems serving multiple dwilling units shall meet the recirculation requirements of §ISO(n).
requirrments do not allow the installmion ofd recirculating 'water heating system jor single dwelling units.
J. The evernal water hewing tank and pipes shall be insulated to meet the requirements o I
The Prescriptive.
Contractor or Homeowner (Documentation Author's/Responsible Building Designer's Declaration Statetaent)
• I certify that this Certificate of Compliance!documcntation is accurate and complete.
• i am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the building design
identified on this Certificate of Compliarice.
• t certify that the energy features and performance specifications for the building design identified on this Certificate of Compliance
conform to the requirements of 7 Me 24, Part I and 6 of the California Code of Regulations.
• Tfie building design features identified on this Certificate of Compliance tats consistent with the information provided to document this
building design on the other applicabkIoompliance forms, wortcsheets, calculations. plans and specificaCrons submitted to the
mformnxiii awrrry for anomvnl with this"twtilrtina rrrmir annli--mien
MMA III /
II
r•
�MG M/ l I •
rA
city of La du►nta
Building & Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address:
Ave-
-z-- wner's Name:
A. P. Number:
Address: l _� t
Legal Description:
Contractor:
City, ST, Zip:
le hon .
W► e e�
Address:
Project Description:
q6 0�2110L'-
Cityr ST, Zip. -)
Telephone
e P
r�
U
State Lic. #--I ..1 S J
Arch., Engr., Designer:
City Lic. #.
Address:
City, ST, Zip:
e:
Telephone:hon
a c
- Construction Type: Occupancy:
r Repairair De mo
ProJ thPetci (circle e: Nev A d'n Altere
SLic.
Name of Contact Person:
1
Sq. Ft.:
# Stories:
#its:
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 Cales.
Called Contact Person
Plan Chcck Balance
Title 24 Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Nfechanical
Grading plan
tad Review, ready for correctionslssue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
''d 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