14-0423 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
14-00000423
Property Address:
80108 VIA TESORO
APN:
777 -310 -004 -
Application description:
PLUMBING
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
1950
Tiht 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
FARNHAM SHERMAN & ANNE
31 HARRINTON DRI -VE
FAIRPORT, NY 14450
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/10/14
Applicant: Architect or Engineer: GENERAL AIR CONDITIONI
n
31170 RESERVE DRIVE 1
THOUSAND PALMS, CA 926
(760)343-7488 ((((((JJJJJJ
Lic. Noo..: : 686310
--------------------------------=�'--dam.-_
------
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 penalty of 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
License 1 ss: C20 License No.: 686310 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
/Issued.
Date: �o Contractor: �� I/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
OWNER -BUILDER DECLARATION insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier ZENITH INS CO Policy Number Z071741503
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to _ I 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 Labor Code, I shall forthwith 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
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: Date: I(C))' Applicant:
(_) 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.).
I 1. @S QWner Qf the oronerly. Pm PxrIiisivPIv rnntrartino with liranrnrl rnntr,nt—o to 99n.Qtru9l fho prajaat (668.
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—) I am exempt under Sec. I BAP.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
1 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
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 ($100,0001 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
IMPonTANT Ayyllwdun la lieielry nieue w olid UIIeUIUI ui aulwing anti Safety To? a 06iffirt 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 -motioned property for inspection purposes.
Date: 4 tU IL1 Signature (Applicant or Agent):
Application Number . . . . . 14-00000423
Permit . . . PLUMBING 2013
Additional desc . . 3
Permit Fee . . . . 11.92
Plan Check Fee
.00
Issue Date . . . .
Valuation . . .
. 0
Expiration Date 10/07/14
Qty Unit Charge Per
Extension
1.00 11.9.200 EA PLBG WATER
HEATER/VENT
11.92
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Special Notes and Comments
WATER HEATER - REPLACE 50 GALLON GAS
WATER HEATER. 2013 CALIFORNIA BUILDING
CODES.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
PERMIT
ISSUANCE M/P/E
90.57
PLAN CHECK, PLUMBING
10.15
Fee summary Charged Paid
----------
Credited
--------------------
Due
---------------------------
Permit Fee Total 11.92
.00 .00
11.92
Plan Check Total .00
.00 .00
.00
Other Fee Total 101.72
.00 .00
101.72
Grand Total 113.64
.00 .00
113.64
LQPERMIT
Bin
Permit #P.O.
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Project Address: 0 O� V i
ii �,
Qty of 1. a Q uin to
Building 8t• Safety Division
Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
SO(O Owner's Name: fk
A. P. Number:
Address: $ 0 1 0 8 \Ji 0. I—
eSpC p
Legal Description:
City, ST, Zip: L� Qvi'r\N." CA 1::%Z -L53
Contractor:
ere: � � r
h � � O i
`�
Telephone: 60 - Z&q- -7 a q
Address: '3W)0 _�)eSe.Yve_ br
Project Description:
City, ST, Zip:' 'i xoQSt2Y\c1 1*'N
CA CJZ27t-
c �GC_e S » LJc kcr ueCACf
Telephone:
is>s z
State Lic. # : (o$(03i0
City Lie. #;
Arch., Engr., Designer.
Address:
City, ST, Zip: .
Telephone:
::z::>::.ri :::.:<>::<;:: <;::<:s><?::::;::;:::;:::;:
'`'.«<s^<>'>.:::zr<3:<:>_?<: <r:<::<>s::<:lter
Construction Type: Occupancy:
State Lic. #:
Project type (circle one): New Add'n A Repair Demo
Name of Contact Person:
Sq. FL:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
# Submittal Req'd Recd TRACIONG PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural C21c5.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cala.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for corrcclionsrissue
Electrical
Subcontact'or List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN IiOUSE:
'"' Review, ready for correctionsrssue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
Prescriptive Certificate of Compliance: Residential- CF-IR-ALT-DHW
Residential Alterations
Project Name: b01 of i r— le soro Climate Zein: JS-. Permit #:
General Information
Site Address: •S OI O 6 Vi-�sO-ro
Enforcement Agency: C OZ. Le - Date: 4 n t
-BuildingT Sin le Family❑ Multi FamilyPrc)
ect Type: O Re lacen>ent or Change Out of Water Heater
WATER HEATING
• I certify that this Certificate of Compliance documentation is accurate and complete.
List newl'v installed water heaters and boilers for both domestic hot water heaters (D WH) and Indro►tir space heating. NewlY installed
D1VH heaters and boilers ►nest be gas. propane, or use the existing tel t)Ve.
Watei Floater Distribution Type Number In Tank Factor tx
rgY
TypdFt1d Type Rc,� �' � System Capacity (gal) Thmrwl Efficiency
External Tank
Insulation
R- aluet
5-�O.c d I O .58
?1Z
building design on the outer applicable compliance forms, worksheets, calculations, plaas and specifications submitted to the
enforcement agency for val with this budding permit application.
Name:
Sibnaaure:
1. Indicate Type (Storage Gas. Heat Pump. Instantaneous, etc.)
2. Recirculating systems serving ►nultiple dwelling units shall meet the recirculation requirements of flAn).
regpirenrents do not allow the installation of a recirculating water heating system for single dwelling twits.
3. The external inter heating tank and pipes shall be insulated to meet the rc uire►nents of § 1
The Prescriptive
Contractor or Homeowner (Documentation Author's/Responsible Building Designee'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 accep• 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. Part 1 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 outer applicable compliance forms, worksheets, calculations, plaas and specifications submitted to the
enforcement agency for val with this budding permit application.
Name:
Sibnaaure:
co-pai iy: Date:
�htr A
c.1 i l otic
Address: tjc=nse:
3it�0 l�e.se�c.« �r- (o�lo3ib
City/SutdZip: Pte:
lh00S 1�cL\m5 C1� qZz�� `7too-3y3-�Lf88