13-0238 (PLBG)r —,
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
13-00000238
Property Address:
55444 FIRESTONE
APN:
775 -151 -066 -
Application description:
PLUMBING
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
2306
Tiht
"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Applicant: Architect or Engineer:
------------------
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 Class: C36 License No.: 880269
Date: �J'L-1, 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 _ 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 theContractors' 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:
KAREN HIATT
55444 FIRESTONE
LA QUINTA, CA 92253
(
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/06/13
Contractor: 1�
FRANKLIN PLUMBING, BEN 1J N 1�
2712 E. LA CADENA DRIV
RIVERSIDE, CA 92507
(800) 600-0675 �•eCi
Lic. No.: 880269
�A QUINTA
CIT`�O,,,.c
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.
____=04Pdve 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 INS CO OF WEST Policy Number WVE502266100
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 the workers' compensation provisions of Section
3700 of the Labor Code, I shall forthwith comply with those provisions.
Date: AA -12';P 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 the above information is correct. I agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of this county to enter upon the above-mentioned property for inspect poses.
Date: 5-44L— Signature (Applicant or Agent):
Application Number . . . . . 13-00000238
Permit . .
. PLUMBING
Additional desc .
Permit Fee . . .
. 22.50
Plan Check Fee
5.63
Issue Date . . .
.
Valuation . . .
. 0
Expiration,Date
9/02/13
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 7.5000 EA PLB WATER
HEATER/VENT
7.50
------------------------------------------------7---------------------------
Special Notes and
Comments
REPLACE 50 GALLON
GAS WATER HEATER IN
GARAGE _ SAME LOCATION. 2010 CODES.
-----------------------------------------------------------
Other Fees . . .
----------------
. . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary
Charged _ Paid
Credited
Due
Permit Fee Total
22.50
.00 .00
22.50
Plan Check Total
5.63
.00 .00
5.63
Other Fee Total
1.00
.00 .00
1.00
Grand Total
29.13
.00 .00
29.13
LQPERMIT
liln.#
City. of La Quinta
Buikiing a Safety Division
P.O. Box 1504,78-495 Calle Tampico
La.Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
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Project Add=-
1-�
Owner's Name:. I iJ.YQ
A P. Number. 7 5-1r�- 1— Q
Address:
City, ST, Zip:
Tel hone:
eP _
Legal Description:
Contractor
Address:S
Project Description:
City, ST, Zip: \ Q�_v
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Telephone: gt:Jl —Cri h
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State Lia # : gg� City Lic, #; ^
Archy Engr., Designer: 01A
Address:
City., ST, Zip:
Telephone:
.
Construction Type:. Occupancy:
project type (circle one): New Add'n Alter Repair Demo
Sq. FL: # Stories: # Unity:
State Lia #:
, : r
` -
Name of Contact Person:S UrG
Telephone # of Contact Person.
Estimated Value of Project
APPLICANT: DO NOT WRITE'BELOW THIS LINE
N
Submittal
Req'd
Recd
TRACKING PERMIT FEES:
Plan Sets
Plan Check submitted
item Amount
Structural Calm
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Cates.
Called Contact Person
Plan Check Balance.
Title 24 Caies.
Plans picked up
Construction
Flood plain plan
Plans resubmitted.
Mechanical
Grading plan
Z`j Review, ready for correctionsrMue
Electrical
Sabcoutactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.KL
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
3" Review; ready for correctionsftsue
Developer Impact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
Prescriptive Certificate of Compliance: Residential Water Heating CF -IR -ALT -WH
General Information
Site Address: 4l k E7\fesAcineClimate Zone: Date: _
NOTE. This form is only used or alteration or addition of water heating systems.
WATER HEATING
List water heaters and boilers for both domestic hot water (DHW) heaters and hydronic• space heating. Individual dwelling DHW
heaters must be gas or propane fired, and may not exceed 50 gallons. Hot water pipe insulation from the DHW heater to the
kitchen(s) and on all underground hot water pipes is required in all component packages in all climate zones.
• 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, Parts I and 6 of the California Code of Regulations.
Energy Factor or
building design on the other applicable compliance forms, worksheets, calculations, plans and specifications submitted to the enforcement
Water Heater Type /
Distribution Type Number of Tank Capacity
Thermal
External Tank
Fuel Type'
(Standard)2 System (gal)
Efficiency
Insulation R-Value3
r
[C,ty/State/Zip:
o
fZ-1
1. Indicate Type (Storage Gas, Heat Pump, Instantaneous, etc)
2. Recirculating systems serving multiple dwelling units shall meet the recirculation requirements of 150(n). The Prescriptive requirements do
not allow the installation of a recirculating water heating system for single dwelline units.
3. The water heating tank and pipes shall be insulated to meet the requirements of 1506).
Contractor (Documentation Author's /Responsible 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, Parts 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 other applicable compliance forms, worksheets, calculations, plans and specifications submitted to the enforcement
agency for approval with this building permit application.
Name:
Signature:
Company:n � k t�
Date:
Address: n I,
License: Ip,�
[C,ty/State/Zip:
Phone
2008 Residential Compliance Forms March 2010