12-1351 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 12-00001351
Property Address: 43785 GALAXY DR
APN: 609-480-027-4 -23773 -
Application description: PLUMBING
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 700
Applicant:
Tihf
"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
RAEMY BERNARD
43785 GALAXY DRIVE
LA QUINTA, CA 92253
Architect or Engineer:
atp
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury th I am licensed under provisions of Chapter 9 (commencing with
section 7000) of Division 3 of the Busi s and Professionals Code, and my License is in full force and effect.
License Class: C3�6 �/ License No.: 731855
/ate/�15'/ /�oAIracto :
�i / 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.).
(_) 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—) 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:
KA
Lender's Address:
LQPERMIT
Contractor:
STATE WIDE PLUMBING
40244 CATANIA COURT
INDIO, CA 92203--0
(760)636-0315
LiC. No.:,731855
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: . 11/15/12
D 0
;i201?
CITY OF LA (QUINTA
FINANCE DEPT.
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 sho become subject to the workers' compensation provisions of Section
1 0.,37000 of the Labor de I shall forthwith comply with those provisions.
at �T —V pplicanii
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.
1 certify that I have read this application and state that the ab ve information is correct. I agree to comply with all
city and county ordinances and state laws relating to buildi construction, and hereby authorize representatives
of th's Auntyytto enter upon the above-mentioned prope f r inspection purposes.
ate: 7�/5
_�Aignature (Applicant or Age
- 2
LQPERMIT
Application Number . . . . . 12-00001351
Permit . . . PLUMBING
Additional desc .
Permit Fee . . . . 22.50
Plan Check
Fee
5.63
Issue Date . . . .
Valuation
. . .
.
0
Expiration Date 5/14/13
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 50 GALLON GAS WATER
HEATER. 2010 CODES.
Fee summary Charged Paid Credited
---------------------------------------------------------
Due
Permit Fee Total 22.50•
.00
.00
22.50
-
Plan Check Total 5.63
.00
.00
5.63
Grand Total 28.13
.00
.00
28.13
e
LPtescriQtiveCertifc to of Compliance• Residential -CF-IR-ALT- Ar' n-Res!id�ential Altera 'cts�eName: Climate Zone: I Pereira #: 6
General information
Site Address: .Enforcement Agency, Date:
Buildin T Sin le Famil ❑ Multi F -Project T e lac=ement or Chane Out of Water Heater
Contractor or Homeowner (Documeatation Author'sMesponsible Building Designer's Declaration Statement)
• l certify that this Certificate of Compliance doatmrntation 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. '
• 1 certify that the energy fewAtres and performance specificatiotu for the building design identified on this Certificate of Compliance
conform to the requirements of Tide 24, Part I and 6 of the California Code of Regulations.
• The building design feaures identified on this Certificate of Compliance nuc consistert with the information provided to daurtiett ibis
building design Oen the other applicable'complianee forms, woeohects. Calculations plats and spacif+cations submitted to the
enforccmug for approval with this buildingit lication
Name: Si
t
1
Address,
i WATER HEATING
Lint nrN•!c installed ►Hrrrrr htortn and boilers for Iwrh domestic hot water htartrs�IDWH) and lndrorric slwcr liturirrg. NtN•lp installed
D1VH heaters and ()olJirs rr►usr be as, t, or ►ac the t_ristirt r! n
External Tank
Wats tt�ttr DWnbtruade 7� Number k+ . Tank MF%ct- •lnsulatioaTyp��ThiRerSSyuemCapacity(gal) R-Valuer
1. Indicate 7jPr (Stomgr Car. Heat Primp: /nrku►ktntoret; etc.)
2. Recirculating systems serving rnubipJe dwelling units shall iritet the rrcircularion requlrcrnentr of §JSO(n). The Prescriptive
nq►rlrcmenfs do not allow the installation of a rixirrulating lavatcrheatirag nstrm for single dwelling ►u►lts.
3. 7Tie d.vrrnal wntrr heat' tank anpipes d shall Gr insulated to
meet the rc uirrrnents o !
X
City of La Quinta
Building 81: Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit # 1��\
Project Address:
FS
/ Ur" wner's Name:
A. P. Number:
Address: S
Legal Description:
City, ST, Zip:
r:
Contractor:
{ ' ,fin P
a ne•
� le ho
-
Address:- \
1�
, �� Project Description: .50
City ST, Zip po
Telephone -1:
r�
V
State Lic. # c �.SS
City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
P
..............
....................................................
.....................................................
....................................................
......................................................
.....................................................
Construction TN e: Occupancy:
P P
- Project one: Nev Ad 'n Alter Repair Demo
State Lic. #:
Name of Contact Person:
t
Sq. Ft.:
# Stories:
# Bits:
Telephone # of Contact Person:
Estimated Value of Project: • , G
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cates.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Chcck Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, rcady 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:-
''" Review, ready for correctionsfissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees