13-1605 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 13-00001605
Property Address: 52105 EISENHOWER DR
APN: 773-225-016-5 -000000-
Application description: PLUMBING
Property Zoning: COVE RESIDENTIAL
Application valuation: 185
T4t!t 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
CONAWAY CRAIG
*,NOT ON FILE
UNKNOWN, CA 99999
Contractor:
Applicant: Architect or Engineer: �/ �{ TOMMY ROOTER
�V3 80975 INDIO BOULEVARD #C3
IN92201
60)
760) o.: 4- 944 lc. No.: 930133
J .9
VOICE (760) 777-7012
FAX (760) 777-7011
(INSPECTIONS (760) 777-7153
Date: 12/11/13
---------------------------------- ---------- - - - - ----------------------------------------- - - - - - —
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 s: C36 icense No.: 930133
Date: '� Contractor:
�,.t
WNER-BUILDER DECLARATION
I hereby affirm under penalt eexempt 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.).
(_ 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:
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.
_lave 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 NORGUARD INS Policy Number THWC435917
I certify that, in the performance of the work for which this permit is issued, 1 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 rkers' compensation provisions of Section
3700 of the Labor Code, I shall c p with those provisions.
ppl
WARNING: FAILURE TO SECU�INALPENALTIES
MPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS 15100,0001. 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 a ree to comply with all
city and county ordinances and state laws relating to building construct is n, a orize representatives
of this county to enter upon the above-mentioned property for in as.
It-/ -
Dale: ' I Signature (Applicant or Agent) -
Application Number . . 13-00001605
Permit . . PLUMBING 2.013
Additional desc'.
Permit Fee . . . . 11.92 Plan Check Fee .00
Issue Date Valuation 0
Expiration Date . . 6/09/14
Qty Unit Charge Per
Extension
1.00 11.9200 EA PLBG WATER HEATER/VENT
11.92
----------------------------------------------------------------------------
Special Notes and Comments
WATER HEATER CHANGE OUT -
50GALLON/ELECTRIC [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
7.15
Fee summary Charged Paid Credited
------------------------------
Due
---------------------------
Permit Fee Total 11.92 .00 .00
11.92
Plan Check Total .00 .00 .00
.00
Other Fee Total 98.72 .00 .00
98.72
Grand Total 110.64 .00 .00
110.64
LQPERMIT
e
06/06/2013 THU 15:09 FAX La Quinta Bldg & Safety
Din
Peif #
Project Address:
A- P. Number:
Contractor:
Address: Q S -
City, ST, Zip
Telephoner �0 C)_g 7 L
State Lie. #
Arch., Eagn, Designer.
Address:
City., ST, Zip:
Telephone:
State Lie. #:
Name of Concoct Person:
Telephone It of Contact Pelson:
City Of La QUInta
Birlfding 8r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
U Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
{ Owner's Name: C
Address: a
City, ST, Zip:
% Telephone. -
(� Q\ VkJ C ?j Project Description:
Lic. # C
iz001/001
Constnrction Type: Occupancy:
,., Project type (circle one): New Add'n Alter Repair Demo
1. C� Q }/�. Sq. FL: # Stories: #•Unica:
EStiMSIdd Value of Project:
APPLICANT: 00 NOT WRITE BELOW TMIS 1 -IMF
#
Snbmittal
Req'd
Reed TRACKING PERMIT FEES
Plan Sets
Plan Cheek submitted Item Amonat
Structural Cabs.
Reviewed, ready for corrections Plan Check Deposit
Truss Calm
Called Contact Person Plan Check Balance,
I.Tide24Cales.
Pians picked up Construction
Flood plain pian
Pians resubmitted Mecdanlcal
Gmdtng plan
2'! Review, ready for correctioWasue I Fdectrical
Subeontactor List
Called Contact Person Plumbing
Grant Deed
Plans picked up
H.O.A. Approval
Plans resubmitted Grading
IN HOUSE-,
''' Review, ready for correetlonsAssue Developer Impact Fee
Planning Approval
Called Contact Person A.LPs.
Pub. Wks. Appr
Date of permit issue
Schodl Fees
Total Permit Fees
Prescri tive Certificate of Compliance: Residential CF-IR-ALT-DRW
Residential Alterations Page I of
Project Name: ( p <ac1 Climate Zone: Permit #:
Site Address: 5 )OS 1SPnhUt � I Enforcement Agency: I Date: I a� —I d
Building Type: Single Family D Multi Family Proiect Tyne: Revlacement 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 both domestic hot water heaters (DWH) and i�vdronic space heating. Newly installed
DWH heaters and boilers must be gas, propane. or use the existingfAuel type.
Distribution Type
Water Heater (Standard. Number In
TypelFuel Type Recimulatin System
Tank
Capacity (gal)
��BY Factor or
Thermal Efficiency
External Tank
Insulation
R -Value
building design on the other applicable compliance forms, worksheets, calculations, plans and specifications submitted to the
enforcement agency for approval with this building permit application.
Mme:
C
Company:
Date:
cpm
Address: Ccense:
C \� \\ 3
Li(13 0 1 3 3
City/State/Zip:
Phone:
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1. Indicate Type (Storage Gas. Heat Pump. Instantaneous, etc.)
2. Recirculating systems serving multiple dwelling units shall meet The recirculation requirements of §ISO(n).
requirements do not allow the installation of a recirculating water heating system for single dwelling units.. .
3. The external water heating tank and pipes shall be insulated to meet the requirements a 1 S '
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.
• 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.
• 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, Pard 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 building permit application.
Mme:
C
Company:
Date:
cpm
Address: Ccense:
C \� \\ 3
Li(13 0 1 3 3
City/State/Zip:
Phone:
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