BPLB2015-0081.78-495 CALLE.TAMPICO c&4 V Qum&
LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BPLB2015-0081
Property Address:
47595 VIA MONTIGO
APN:
643120029
Application Description:
ADAMSON RESIDENCE WATER HEATER CHANGE OUT
Property Zoning:
Application Valuation:
$2,700.00
Applicant:
K C'S 23 1 / 2 HOUR PLUMBING
I
702 EUGENE RD
PALM SPRINGS, CA 92264
i
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 Professions Code,
and my License is in full force and effect.
License
%pClass:
QC36 License
�No.:831798 �g /
Date: t�• � f —�� . CR ontractor: �' l � �VV✓`s t3� v�_
1 — _—
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
orapebasis for the alleged exemption. Any violation of Section 7031.5 by any applicant for--
permit
rmit subjects the applicant to a civil penalty of not more than five hundred dollars
($500).:
(_ 1, 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, 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 Na
Lender's Add
Owner:
JAMES ADI
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/9/2015
47595 VIA IGO
LA QUINTA A 22MN 9 2015
COMMUCIT
NITyp Q M CITY OF LA NTNTA
DEPARTMEN7
Contractor:
K C'S 23 1/2 HOUR PLUMBING I
702 EUGENE RD
PALM SPRINGS, CA 92264
(760)327-8718
Lic. No.: 831798
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:— Policy Number: _
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 3100 of the Labor Code, I shall forthwith
comply with those provisions.
----_ ,
Date: �� Applicant:
t,
WARNING: FAILURE TO SECURE WOR 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 Building Official 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 city to enter u bove-
mentioned•property for inspection purposes.
Date: - /op— / � Signature (Applicant or Agent
t
FINANCIAL INFORMATION
aAa+ r t 'DESCRIPTION ACCOUNTi" �PAID PAID.:DATE'
m.'AMOUNT
..sk ta. s'..t*cr'Ss,.x ..z. • Cif .[ r;;s. _.:I k
BSAS SB1473 FEE 101-0000-20306 0 $L00 $1.00 6/9/15
t. �� " RECEIPT # t'f. f
PAID'BY Y METHOD t�tiik CHECK # CLTD BY
q" =r r Y > �.`r t
K C'S 23 1 / 2 HOUR PLUMBING I CHECK R6911 32316 MFA
Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $L00 $1.00
x ; r� f . J
ACCOUNTS ;.
QTY
AMOUNT
PAID ;
AID: DATE
G;DESCRIPTION �x a ,
.> e
�':3.
;•
PERMIT ISSUANCE
101=0000-42404
0
$9_.85
$91.85
6/9/15
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PAID BYr�c;-Z
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�� RECEIPT#
t +CLTD BYr{
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K C'S 23 1 / 2 HOUR PLUMBING I
CHECK
R6911
32316
MFA
Total Paid for PERMIT ISSUANCE: $9_.85 $91.85 .
DESCRIPTION � 't
5y' ACCOUNT *R
AMOUNT
PAID"
IPAID'DATE'
R
yh
f
.QTY
U- - a.. Er
WATER HEATER/VENT
101-0000-42401
.0
$12.09
$12.09
6/9/15
r r 3� PAID BYE-
METHOD �'r
s
st,e,'RECEIPT #
` r CHECK #
CLTD BY
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CHECK
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yQTY.`
l AMOIUNT a n
`PAID
PAID DATE;:
u
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WATER HEATER/VENT PC
101-0000-42600
0
$7.25
$7.25
6/9/15
BY,f�
+METHOD
RECEIPT #
CHECK #CLTD
BY '
s .Rbc? ,PAID
,�
:„'
K C'S 23 1/2 HOUR PLUMBING I
CHECK
R6911
32316
MFA
Total Paid forPLUMBING FEES: $15.34 $19.34
TOTALS:
1
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4
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Description: ADAMSON RESIDENCE WATER HEATER CHANGE OUT
Type: PLUMBING Subtype: Status: ISSUED
Applied: 6/9/2015 MFA
Approved:. 6/9/201S MFA
Parcel No: 643120029 Site Address: 47595 VIA MONTIGO LA QUINTA,CA 92253
Subdivision: TR 26152 Block: Lot: 257
Issued: 6/9/2015 MFA
Lot Sq Ft: 0 Building Scl Ft: 0. Zoning:
Finaled:
Valuation: $2,700.00 Occupancy Type: Construction Type:
Expired: 12/6/2015 MFA
No. Buildings: 0 No. Stories: 0 No. Unites: 0
Details: WATER HEATER CHANGE OUT - 75 GALLON/GAS [2008 ENERGY) CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL
INSPECTION. 2013 CALIFORNIA BUILDING CODES.
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APPLICANT K C'S 23 1/ 2 HOUR PLUMBING 1 702 EUGENE RD
A u'Y
CONDITIONS
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NAME TYPE _ .: NAME>;: ADD;RESS1
p, :r, sa
APPLICANT K C'S 23 1/ 2 HOUR PLUMBING 1 702 EUGENE RD
PALM SPRINGS CA 92264 (604)317-7080 _
CONTRACTOR K C'S 23 1/2 HOUR PLUMBING 1 702 EUGENE RD
PALM SPRINGS CA 92264 (604)317-7080
OWNER JAMES ADAMSON 47595 VIA MONTIGO LA QUINTA CA 92253 (604)317-7080
FINANCIAL
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K C'S 23 1/2 HOUR
BSAS'SB1473 FEE
101-0000-20306 0
$1.00
$1.00
6j9/15, R6911
32316 CHECK
MFA
PLUMBING I
Total Paid forBUILDING STANDARDS ADMINISTRATION
$1.00
$1.00
BSA:
Printed: Tuesday, June 09, 2015 12:10:47 PM 1 of 2
SYSTEMS
BOND INFORMATION
ATTACHMENTS
Printed: Tuesday, June 09, 2015 12:10:47 PM 2 of 2'
- SYSTEMS
Bin #
City Of La 'Quinta
Building &r Safety Division
P.O.Box 1504 78-495 Calle Tampico
. p
La Quinta, CA 92253 - (760) 7777012.
Building Permit Application•and Tracking Sheet
Permit #
V
Btu,
Project Address. S G `
V
Owner's Name: Aii�l: 5 S15
A. P. Number:
Address: (.i rj q V i 6 A, [�
Legal Description:
City, ST, Zip: pk (�_ AA ZZ�
Contractor: n 3
l: Z Z liro70
e— G
Tele
telephone: �
P 3
Address: % p a _u _ F MProject
Description:
City, ST, Zip:?, 11 ZZCP
S n c S (.tom p
e h ne•'
TelP0 3Zn 8
..................
State Lic. # : -7
City Lic. #:
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone: e one:
P
a
St to Lic. #
Cotru
ns cti n Type: e: P
Y P Occu anc Y•
Project Pe (circle rcle one):.: New Add'nAlter, Repair.a'nDemo
Name of Contact Person:Sq.
Ft.:
# Stories:
# Units:
Telephone# of Contact Person:
Estimated Value of Project-% CC)
APPLICANT: DO NOT WRITE BELOW THIS LINE
ti
Submittal
Req'dRecd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2°" Review, ready tor'corrections/issue
Electrical ,
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked upS.M.I.
H.O.A. Approval
Plans resubmitted
I Grading
IN HOUSE:-
'"' Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I,p,p,
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees