10-1369 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
10-00001369,
53940 AVENIDA DIAZ
774-152-010-15 -000000-
PLUMBING
COVE RESIDENTIAL
1000
Tity/ 4 4 Q"
Architect or Engineer:
P(P
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
--------------------------------------------------
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 lass: C36 License No.: 831798
0
ate: (2� 5 -t tractor.
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 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(sl 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:
LQPERMIT
Owner:
MICHAEL HALE
53940 AVENIDA DIAZ
LA QUINTA, CA 92253
Contractor:
KCrS 23 1/2 HOUR PLUMBING
702 EUGENE ROAD
PALM SPRINGS, CA 92264
(760)327-8718
Lic. No.: 831798
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 12/15/10
UA
2010 J
Gfr'� 0F LA QUINIA
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
%4, issued.
1 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 PRESERVER INS Policy Number WCCO01035700
_ 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 orkers' compensation provisions of Section
3700 of the Lab -Code, I shall forthwith y with those provisions. '
Date: LOI`can
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.
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 Ouinta, 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 a county ordinances and state laws relating to building construction, and hereby authorize representatives
of is
county to enter upon above-mentioned grope or inMspect urpo�sles..�.
Date: `L - r nature (Applicant or Agent):
Application Number . . . . . 10-00001369
Permit . . .
PLUMBING
Additional desc .
Permit Fee
22.50
Plan Check Fee
5.63
Issue Date . . . .
Valuation . . .
0
Expiration Date
6/13/11
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 7.5000
EA PLB WATER
HEATER/VENT
7.50
----------------------------------------------------------------------------
Special Notes and Comments
INSTALL NEW 50 GALLON
ELECTRIC WATER
HEATER. 2007 CODES.
----------------------------------------------------------------------------
Other Fees . . . . .
. . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged
Permit Fee Total 22.50
Plan Check Total 5.63
Other Fee Total 1.00
Grand Total 29.13
LQPERMIT
Paid Credited Due
.00 .00 22.50
.00 .00 5.63
.00 .00 1.00
.00 .00 29.13
Prescriptive. Certificate of Compliance: Residential CF-IR-ALT-DHW
Residential Alterations Page l of 2
Project Name: Climate Zone: Permit #:
General Information
Site Address: y e, i,02
Enforcement Agency: Date: 12 -
2Buildin
Building Type: 0 Single Family 0 Multi Family
Project Type: 0 Replacement 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 domestic hot ►rarer heaters (D WH) and Itw/ronic space heating. Newly installed
DWH heaters and boilers must be gaus. propane, or nue the existingfifel type.
Water Huta ,
Typu/Furl Type..
Distribution 'lype
(Startdazd, Number In Tank Energy Facto or
Recirrculat t System Capacity (gal) Tttamal Efficiency
External Tank
Insulation
R -Value
• 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:
Signature:
C
\� V 5 S J ul.c
Company: Date:
12-15-1`0
Address: License:
15-D �2 3 / - �' S
City/Stat*Zp: Phone:
'>60 _3 -8^7/x.
1. Indicate Type (Storage Gas, Heat Pump. Instantaneous, etc.)
2. Recirculating systems serving multiple dwelling units shall meet the recirculation requirements of §lAn).
requirements do not allow the installation of a recirculating Nater heating system for single dwelling units.
3. The external Nater heating tank and pipes shall be. insulated to meet therequirements of § 150(j),
The Prescriptive
Contractor or Homeowner (Documentation Author's/Responsible Building Designer's Declaration Statement)
• I certify that this Certificate of Compliance documentation 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 Compliance.
• I 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 l and 6 of the California 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:
Signature:
C
\� V 5 S J ul.c
Company: Date:
12-15-1`0
Address: License:
15-D �2 3 / - �' S
City/Stat*Zp: Phone:
'>60 _3 -8^7/x.
Bin #
City of La Quinta
Building 8r Safety Division
Pennit #
.
P.O. Box 1504, 78-495 Calle Tampico
OCR
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Project Address: q0 p yam/ b 1,4 -z.
Owner's Name: 1A1 1 ti io, EL t-A A 4,49-
,49-A.
A.P. Number:
Address: ; 39 Ll b V e t, 1,4 Z
Legal Description:
City, ST, Zip: L-.
Contractor: �C S Z 3 pl 1i 7/- U"'T3 i i h C
Telephone
Address: 0161-wes I 4
Project Description:
City, ST, Zip: �, S 64 ! ZZ L-
Telephone: 260 - 3 i.7- 8 %ip
State Lic. # : D 3 7 5
,,j �sy`
is City Lie. C
Arch., Engr., Designer.
Address:
A L k,-L,-C w o Zs�tbd�
City, ST, Zip:
Telephone:
Construction Type: Occupancy:
State Lic..#:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact person: Estimated Value of Project: 1tJ0
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Recd
TRACING
PERMIT FEES
Plan Sets
Pian Check submitted
Item Amount
Structural Cales
Reviewed, ready for corrections
Plan Check Deposit
Truss Cala.
Called,Contact Person
Plan Check Balance
Titre 21 Cala
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading pian
2'! Review, ready for correctionsi4nue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Dad
Plans picked up
S.M.L
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
3" Review, ready for correctiowAssue
Developer Impact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees