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11-1358 (PLBG)4 e(4ry OWN' P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA; CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Application Number: 11,1? 60 00T358--, -_I Owner: Property Address: 8"0360 VIA "VALEROSA BEAL FREDERICK &. JONI APN: 777-250-023- - - 80360 VIA VALEROSA Application description: PLUMBING LA QUINTA, CA 92253 Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 250 Contractor: VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 12/22/,11 Applicant: Architect or Engineer: PLUMBING INSTALLERS�� 13400 SATICOY STREET #25" CF)'yon� 1..ey9:l.�e�l�li NORTH HOLLYWOOD, CA 91605 ��:•">i,':' ; ' (818)982-6952 n �llr LiC. No.: 915215 LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penaltyof perjury one of the following declarations: Section 7000) of Division 3 of the Business and Professionals Code, and__ my License is in full force and effect. I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided Licen lass: C36 D34 nse No.: 915215. _ for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. D�! Oate:ntractor: VLhave 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" ' I OWNER -BUILDER DECLARATION insurance carrier and policy number are: - I hereby affirm under penalty perjury that I am exempt from the Contractor's State License Law for the q., Carrier TOWER SELECT IN _ Policy Number WCCO2130900 following reason (Sec. 7031 Business and Professions Code: Any city or county that requires a permit to _ 1 certify that, in the performance of the work for which this permit is issued, I shall not employ any construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner so as to become subject to the workers' compensation laws of California, permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State - and agree that, if I should become subject to the workers' compensation provisions of Section License Law (Chapter 9 (commencing with.Section 7000) of Division 3 of the Business and Professions Code) or 3700 of the La or Code, I ih ll.f t ith comply with those provisions. that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by r� any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: e: 2 l A icant: (_) 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 WARNING: FAILU E TO SECUg ORKE S' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND and who does the work himself or herself through his or her own employees, provided that the - DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN improvements are not intended or offered for sale. .If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. 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.). (_) I am exempt under Sec. , B.&P.C. for this reason Date: Owner: / STRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that thepd 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 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 c nstruction, and hereby authorize representatives of this county yttto�enter upon a above-mentioned property for spec tion urposes. ted/7 S' ature (Applicant or Agent): / 7 — / General Information Site Address: . * I Enforcement Agency: Date: Building TSingle Family 0 Multi Famil- I Project Type: 0 Replacewnt or Change Out of Water Heater WATER HEATING List nem4v installed water heaters and boilers for both domestic hot water heaters (DWH) and hydronic *ace heating. 110144Y installed MVH heaters and boilers must be as, propane, or wir'the esisting ffiu I h Water tk-ater TypdF-q Type,Ree Distrilitition Type .4timbix In Tank Energy Rctor ur (StandanJL System Capacity (gat) Thermal Efficiency (gall Ew&nal Tank Institatian R-Vakw) • I ccn'ify that the energy features and performai-we specifications for the building design identified.on-,this Certificate.of Compliance conform to the requirements of ride 24, Part I and 6 of the California Code of Regulations. • The building design features identified on this Certificate of Compliance are consistwi with the information provided to document this building design on the other applicable wTplianm lomu, woe sheet calmlations. plans and specifications submitted to the enfmccmext agency for approval with this buUing permit application - ligay Si JC= L1- 217- ZDate: 40 L f U Z;,Fjr, 0 Une Ci!Yjta(dzip: 1. Indicate rMe (Storage Gas. Heat Pump: Instankm-ata. etc.) 2. Recirr�ulafing systems serving multiple dive/ling units shall wet the recirculation requirements qatdarements of §1 requirements do not allow'(he installation of a rec"ating water heating system for single dwiling units; 3. The external crater hewing tank and pipes ihaU be insulated to meet the requirements of J 15OUX n). Prescriptive. Contractor or Homeowner (Documentation Author's/ResponsiMe Building Designer's Dedaration Statement) • I 'certify that this Certificate of Compliance dommentafion, is accurateand complete. • I am eligible under Division 3 of the California Business and ptolessions Code to accept responsibility for the building design identified on this Certificate of Compliance. • I ccn'ify that the energy features and performai-we specifications for the building design identified.on-,this Certificate.of Compliance conform to the requirements of ride 24, Part I and 6 of the California Code of Regulations. • The building design features identified on this Certificate of Compliance are consistwi with the information provided to document this building design on the other applicable wTplianm lomu, woe sheet calmlations. plans and specifications submitted to the enfmccmext agency for approval with this buUing permit application - Name: Si JC= L1- 217- ZDate: 40 L f U Z;,Fjr, 0 -Ycr-f Address: h3q6-6 S��L:�2v Ci!Yjta(dzip: .......... - Bin # ; r � • Qurn A: " Building 8t, Safety Division P.O. Box 1504,78-495 Calle Tampico ... , S La Quinta, CA 92253 = (760) 77777012 Building Permit Application and Tracking Sheet Permit # Project Address: ®Wla Owner's Name: A. A. P. Number: Address: Legal Description: ;;.City; ST, Zip: cA Z2 -S3 ELM nn Contractor: I _� Address: � ,. i j �' : Tele h ;` .. _.P one: -- , 707' l Kill Project Description: City, ST, Zip: S� Telephone: City Lic. #: State Lic. # : Arch., Engr., Designer. Address: City, ST, Zip: ' " ' Telephone: #> = "tib•, �>. ; ;..'.::u:SeeJ;; ' :eS.• ... ' l'"+`y:;", ''>.%%'v<v<:?"' Construction T Occup ancy State Lic. #: Project circle one): New Add'n Alter' Repair Demo Name of Contact Person: Sq. Ft.: __T_# Stories: # Units: Telephone # of Contact Person: Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal. Req'd Rec'd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cafes. Reviewed, ready for corrections Plan Check Deposit Truss Cafes. Called Contact Person Plan Check Balance Title 24 Cafes. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2"" Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- ''d Review, ready for corrections/i.sstic Developer Impact Fee Planning Approval' Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees