12-1329 (RER)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
TW!t 4 4 a"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
'TIONS (760) 777-7153
Application Number:
12-00001329'
Owner:I" J
Property Address:
52530 EISENHOWER DR
THE NORRIS GROUP L
APN:
773-301-002-22 -000000-
1845 CHICAGO AVE SEC
Application description:
REMODEL - RESIDENTIAL
RIVERSIDE, CA 9250
Property Zoning:
COVE RESIDENTIAL
Application valuation:
500
Contractor:
Applicant:
Architect or Engineer:
GRISA ENTERPRISES INC
44695 SAN BENITO CIRCLE
PALM DESERT, CA 92260
(760) 341-0555
Lic. No.: 921518
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 Bus' ss and Professionals Code, and 'eensie'is in full force and effect.
Lic e C ss: C ss: B: Lic .:Lic .: 921518
Date: ontractor:
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 (5500).:
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 contractors) licensed
pursuant to the Contractors' State License Law.).
(_) 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
11/09/12
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.
1F 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 NORGUARD INS Policy Number GRWC222985
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 Id become subject to the workers' compensa . mprovisions of Section
3700 of th Labo Co e, I shall fo h comply with tl wsians.
<te: '1-2 pplicant:
WARNIN
_TTT
TO SECU ORKERS' 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 b ilding construction, and hereby authorize representatives
this c unty to enter upo the above-mentione pe y for inspection s.
Date:v, Q 2 nature (Applicant or Agent).
Application Number
Permit . . .
Additional desc . .
Permit Fee . . . .
Issue Date . . . .
Expiration Date . .
. . . . 12-00001329
BUILDING PERMIT INV FEE
30.00 Plan Check Fee . . 9.75
Valuation . . . . 500
5/08/13
Qty Unit Charge Per
Extension
BASE FEE
-------------------------------------------------7--------------------------
30.00
Permit PLUMBING INV FEE
Additional desc . .
Permit Fee . . . . 45.00 Plan Check
Fee
5.63
Issue Date . . . . Valuation
. . .
. 0
Expiration Date 5/08/13
Qty Unit Charge Per
Extension
BASE FEE
30.00
1.00 15.0000 EA PLB WATER HEATER/VENT
15.00
----------------------------------------------------------------------------
Special Notes and Comments
INSTALL 40 GALLON PROPANE FUELED WATER
HEATER AND WALL A/C UNIT IN GARAGE.
INVESTIGATION FEE ASSESSED PER 1997
UNIFORM ADMINISTRATIVE CODE §304.5 FOR
WORK BEGUN WITHOUT BUILDING PERMIT.
----------------------------------------------------------------------------
Other Fees . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
ENERGY REVIEW FEE
.98
STRONG MOTION (SMI)
- RES
.50
Fee summary Charged Paid Credited
---------------------------------------------------------
Due
Permit Fee Total 75.0.0 .00
.00
75.00
Plan Check Total 15.38 .00
.00
15.38
Other Fee Total 2:48 .00
.00
2.48
Grand Total 92.86 .00
.00
92.86
LQPERMIT
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CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DATqM/a BY
I I
Prescri fly
Residential.
Pm ect Name:
General Infon
Site Address:
of Compliance: Residential
1 Climate Torte:
❑ Multi
Enforcement
CF71R-ALT-DH
Page I of 2
Permit N:
Date:
or Charter, Out of Water.Heater
WATER HEATING
List neww• installed.waar heaters and boilers for both domestic hot water heaters (DWH) and lndralic space heating. Ne%• v installed
DWH heaters and boilers mast be gas., prWane. or use the existing el
Wates Hater !
Typdlw Type
Distribution Type
(Stydard. Numbs In Tank E—By Factor
Ree System Capacity (gal) . Thermal Effw micy
6,nemal Tank
insulation
R-Value'
• 1 certify dint the energy features and pesf0munce specifications for the building design identified on this Certificate of Compliance
conform to the requirettuents of Title 24. Part I and 6 of the California Cock of Regulations.
• The building design features identified on this Certificate of Compliance arc consistent with the information provided to document this
building design on the other applicable compliance forms, worltslwem calculations. plans and specifications subtruixed to the
enfotecment agency for approval with this building. permit kwon -
Man=
Oap (9) r1��
�:
I l g
ZAdd:
14
1. Indicate Type (Storage Gas. Heat Pump: Inrtantaneous. etc.)
I Recirculating systems serving multiple dwelling units stall. Hatt the recirrulation requirements of §1ARX
rlegrrirrments do awe allow the installation of a recirculating water heating system for single dwtelling units.
i. The external water heat' rank and ' s shall be iuuulated_to nae[ the require►nents off l
The Prescriptive
C mtractor or Homeowner (Documentation Author's/ResponsgAe Building Designer's Declarad" Statement)
• 1 certify [fiat 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.
• 1 certify dint the energy features and pesf0munce specifications for the building design identified on this Certificate of Compliance
conform to the requirettuents of Title 24. Part I and 6 of the California Cock of Regulations.
• The building design features identified on this Certificate of Compliance arc consistent with the information provided to document this
building design on the other applicable compliance forms, worltslwem calculations. plans and specifications subtruixed to the
enfotecment agency for approval with this building. permit kwon -
Man=
Oap (9) r1��
�:
I l g
ZAdd:
14
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Qt% Of La Quinta
Building 8i' Safety Division
P.O. Box 1504,78-495 Calle Tampico
P.Quinta, CA 92253 - (760) 7777012
Building Permit Application"and Tracking Sheet
Perinit #
Project Address:Owner's
Name: .
A. P. Number.
Address:
Legal Description:
City, ST, Zip: Si
Contractor. L �� 0().
Telephone:
Address: �(�PIT
Project Description:
City, ST, Zip: -
TeleP hon e: i
D
a
!•.. .ii�o
"
State Lie. #: V I ��^^
owl
City Lie.. #;
1 C
Arch, Engr., Designer:
Address:
City, ST, Zip:
Telephone:
' !��-/�
State Lia #: ,,;r;.;�aw�J,��
Name of Contact Person:
Construction Type:. Occupancy:
Project type (circle one): New Add'a Alter Repair Demo
Sq. Ft :
#Stories t# Units.
Telephone # of Contact Person:
Estimated Value of Project
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd'Rec'd
TRACENG
PERMIT FEES
Plan Sets
Plan Check submitted
Item Amount
Structural Cates.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Calcs.
Called Contact Person
Pian Check Balance
Tide 24 Calcs.
Plans picked up
Construction '
Flood plain plan
Pians resubmitted
Mechanical
Grading plan
tad Review, ready for correctionsfiissue
Electrical
Subeontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
SALL
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
7i° Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees