13-0446 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
13-00000446
Property Address:
55036 FIRESTONE
APN:
775 -153 -029 -
Application description:
PLUMBING
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
700
Applicant: Architect or Engineer:
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LICENSED CONTRACTOR'S DECLARATION
•4 ����I{,.cv
VOICE (760) 777-7012
FAX (760) 777-7011
BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
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 my License is in full force and effect.
Lice se Class: C36 License No.: 936147
Dat U4s
Contractor:
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 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:
RUHL PATTY
55036 FIRESTONE
LA QUINTA, CA 9225,
(
Contractor:
STATEWIDE SERVICES
40244 CATANIA CT
BERMUDA DUNES, CA
(760)636-0315
Lic. No.: 936147
Date: 4/10/13
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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 STATE FUND Policy Number 1948371
I certify that, in the perform ce of the work for which this permit is issued, I shall not employ any
person in any manner s s to become subject to the workers' compensation laws of California,
and agree that, if I sh I become subject to the workers' compensation provisions of Section
700ofthe Labor de I shall forthwith comply
.th those provisions. .
�D 'Applicant
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 ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
conditions and restrictions set forth on this application.
1. Each person upon whose behalf this application is made, each person at whose request and for
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Quinta, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance of this permit.
2. Any permit issued as a result of this application becomes null and void if work is not commenced
within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that t above information is correct. I agree to comply with all
city a d county ordinances and state laws relating to b I ing construction, and hereby authorize representatives
of th' c myt`$�ant
er upon the above-mentioned pro r for inspection purposes.
Date. ✓v Signature (Applicant or Age O
Application Number . . . . . 13-00000446
Permit . . . PLUMBING
Additional desc .
Permit Fee . . . . 22.50 Plan Check Fee 5.63
Issue Date . . . . Valuation . . . . 0
Expiration Date , 10/07/13
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
REPLACE AND REMOVE 40 GALLON NATURAL GAS
STANDARD WATER HEATER. 2010 CODES.
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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
Prescri tive,Certificate of Compliance; Residential.-CF-1R-ALT-DHW
Residential All ations Page I of 2
Project Name: jV, CW Ht, I Climate Zone: Permit p:
General Informat
Site Address: (�y' Enforcement Agency: bate=
Buildin T in le R` mil ❑Multi Family Project T e lacemcnt or Chane Out of Water Heater
WATER HEATING
List nemly installed water heaters and boilers for both domestic hot water heaters (DWH) and h drottic ywce heating. New'I)' installed
OWH heaters and boilers must be gas. propane. or use the existinghu..Its
Waren Heater llistribution Type Number In Tank Energy Factor ur
TYPE Type' (Standard,
'tlic+rrtnal
F�nhnal Tank
lasritation
R Systan Capacity (gal) Efficiency
R -Valuer
r
1. Indicate TyPe (Storage Gas. Heat Pump. Instantaneotm etc.)
2. Recirculating systems serving multiple dwelling units shall meet the recirculation requirements of §150(n).
71e Prescriptive
rrgairements do not allow the hwallwim of a recirculating water heating system for single dwelling units.
3. The external water hewing tank and pipes shall be insulated to meet the rrouirements off 1500).
Contractor or Homeow wr (Documentation Author's/RespondlAe BWMng Designer's Dedaratkin Staten"t)
• 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 Catifx=e 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 Trek 24, Pact I 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 od= applicable compliance forms, worksheets calmmitations. plans and specification submitted to the
. enfomemant Mency for approval with this building rtapplication. TF
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City of b- Quinta
-Buiitrigg u Safety Division '
P.O. Box 1504,78-495 Calle Tampico
La.Quinta, CA 92233 -:(760) 777-7012
Building Permit -Application and Tracking Sheet
Permit #
yob
Project Address: CaC5
Owner's Name:.
A. P. Number.
Address:5.. �j e
Legal Description:
City, ST, Zip:
Contractor. �� `
Telephone. (
xz rs%y
Address: �a /'
Project Description:
City, ST, Zip:
Telephone*'/'
000
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State Lic. #
City Lic. #;
Arcfi., Engr., Designer
Address:
City., ST, Zip:
Telephone:- .Y �w
State Lia #:
Name of Contact Person:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.:
# Stories:
#Units:
Telephone # of Contact Person: —
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS UNE
# Submittal Req'd Recd TRACMG PERMIT FEES
Plan Sets
Plan Check submitted
Item Amount
Structural Cates.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss C21cs.
. Called Contact Person
Pian Check Balance
Title 24 Cala.
Pians picked up
Construction
Flood plain plan
Plans resubmitted..
Mechanical
Grading plan
tad Review, ready for correctiouslissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.L
H.O.A. Approval
Plans resubmitted
Grading
04 ROUSE:-.
7n° Review; ready for correetiouslissuc
Developer Impact Fee
Planning Approval
Called Contact Person
AJ.P.P.
Pub. Wks. Appr '
Date of permit Issue
Schodl Fees
Total Permit Fees
L...... -..... ..... _ _..