13-0736 (PLBG)P.O. BOX 1504 r VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 6/13/13
Application Number: 13-00000736 Owner:
Property Address: 55027 INVERNESS KAY RACKAUCHAS
APN: 775-131-009- - - 55027 INVERNESS WAY
Application description: PLUMBING LA QUINTA, CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL (
Application valuation: 800
Contractor:
PRNA
Applicant: Architect or Engineer: ALL STAR WATER HEATERS30300 PUERTO VALLARTA W
MENIFEE, CA 925842013
(951)301-0067LiC. No.: 812894 LA QUINTA
CE DEPT,
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 Profes ' d y l full force and effect.
License Class: C36 Licen No.: 812894
%fe:
C/
OWNER -BUILDER DECLARATION
1 hereby affirm under pe erlury 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 Icommencing 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 1$500).:
(_) 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: N 1
I.QPERAI IT
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.
��f'�(1/ ave 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 OAK RIVER INS Policy Number 2200062086121
I certify that, in the performance of the work for which this permit is issu II not employ any
person in any manner so as to becobjeeE•te-tie w pensation laws of California,
and agree that, if I should me subject t or er ' ompensation provisions of Section
/�'� 3700 of the Labor Code, ith comp) it those provisions.
�D e"lY
L
WARNING: FAILURE TO SECURE ORKERS' 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 1 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 constru ' exf•here y authorize representatives
(of tthhiiisss county, to enter upon the above-mentioned proper spection purpose
Signature (Applicant or entl:�
J, 9
Application Number . . . . . 13-00000736
Permit . . . PLUMBING 2013
Additional desc . .
Permit Fee 11.92
Plan Check Fee
.00
Issue Date . . . .
Valuation . . .
. 0
Expiration Date 12/10/13
Qty Unit Charge Per
Extension
1.00 11.9200 EA PLBG WATER
HEATER/VENT
11.92
----------------------------------------------------------------------------
Special Notes and Comments
WATER HEATER CHANGE OUT - 50GALLON/GAS
[2008 ENERGY) CARBON MONOXIDE ALARM(S)
TO BE INSTALLED PRIOR TO FINAL
INSPECTION. 2010 CALIFORNIA BUILDING
CODES.
----------------------------------------------------------------------------
Other Fees . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
PERMIT
ISSUANCE M/P/E
90.57
PLAN CHECK,
PLUMBING
7.15
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 98.72
.00 .00
98.72
Grand Total .110.64
.00 .00
1-10:64 _
- LQPFRMIT
Bin #
City of La Quin
Building & Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: 1/� V)et-�a L
Owner's Name:
A. P. Number:
/
Address: O 1-nvel-"Ve6s
Legal Description:City,
Contractor: C qTw 14ftQVf
ST, Zi ; QLIGI%(2n
Tele hon
` J:4:. •..+,.:.: < Vit}<v,. t2�;t
Address:-3030CI
Project Description:��(�
City, ST, Zip:
Telephone .� (�
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State Lic. # :
City Lic. #•:
Arch., Engr., Designer:
Address:
City,, ST, Zip:
Telephone: �(� +"»<'' '"`
�v.%; y t;f 't;c: i. .t,: tY.•;.;c:}.ti
State Lic. #: .
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: PV Ci
APPLICANT:
DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cates.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cates.
Called Contact Person
Plan Check Balance.
Tide 24 Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2id 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:-
3" Review, ready for correctionsfissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
01
tATZR MW
t[ weutr a*tary c �iivrsr ar nr a c,�aa aQ ty,
Aaeters wawa & tY or1r+OM .Allo. OW OW Rot.atired 10,144W, Aff•ew erp(ps ireWWOXJude Ike Di1WAeon N AtWCA.tre(t)
NWOX It Modred. be all ' le.
>rat.r Hater stn butidn Type Number In tam Energy, aster or External Tank
Typ!/Puel Type' (StIindprd, System Capacity (pl) Thermal Efficiency Insulstion R-YaluO
Reaireulatin )'
Stora a Gas Standard
50
.62
other indireei Wester tanks have R -It external insulation or R-1'5 internal insulation wh.are the.
intirnel Insulation !.=slue is..ridicated an•the esterior of the tank:
irst 6 feet of hot ytd.colt. woty piped alwsest to water beater .tank, noes -recirculating systems, and
ntire length of recireulatiat sections of he►t rater i are.inavlatad r .S,tsndarda tai►1 Jb.O-9.
oling system 0i➢in:.'auction, chilled tracer. -or rine Hoot),and pipits •invulated between hsatind
FOJ
'1. 1peawe Type 1Nf1'"e W, AN wtteretewaderi,eu.
2. WrMiallRg WI&V p.niq seubtp/s I►wlll ej rwl{s epatt putt tAt trdlwllatloR r4f1drrwene10 if 11160). The Prwacrlpttwc
tegidrom aw do met a&w she hwelkdan qJe redradatIq watt► beet/01 J f &W Jdr tlu k 'lw ubm MaN.
3..7he aert m -w- ufwr A t AW betwaulata/ m' ►awWW_ - 1106).
Documen'tidon Autboc't ant
WttieiV p :ate '. 1!! . atelm 9wdte Mauuwt
110-'j 113: Mater hestera. are..sertitiod by the 9"Ony COU4810".
1.113UM48ter host ni see revlatien loops serving mt t plc drerlling.onits and High-Riso residential
occupancies area the air.'ralasse valva, baakfJow prevention, pWV isoletion valve, and racirculttion.
leo ..eonneetioneselaeta of 1113.411.
'160DIA: Storage gas water haatirs rated with in Inarlp Factor no greater than the federal alnfaul standard
are ex,!resell "pped.wi•th.3naula4loo-havin on installed thermal resistance of 1-12 or eater.
150(j) ID: Mf trod stamp Lanka, such at storage t$Aks. or backup tanks for solar .ate4 sting sjatem, or
other indireei Wester tanks have R -It external insulation or R-1'5 internal insulation wh.are the.
intirnel Insulation !.=slue is..ridicated an•the esterior of the tank:
irst 6 feet of hot ytd.colt. woty piped alwsest to water beater .tank, noes -recirculating systems, and
ntire length of recireulatiat sections of he►t rater i are.inavlatad r .S,tsndarda tai►1 Jb.O-9.
oling system 0i➢in:.'auction, chilled tracer. -or rine Hoot),and pipits •invulated between hsatind
FOJ
urce and Indirect hot qkr tank ahiO bo. Insulate# to able. 13". and tion IWA.
ps ensu ation for stem hydronieheating systems or hot water systema >lb. i, meets the
requirements of -15 search Table 133%4
lbo(j)3A: Insulation is protected frog dwQe. ins u n� st due: to sunlight, moisture, 64uipmint
esintenana and wind
Documen'tidon Autboc't ant
� I iJiitt tMls Ceet!lliae�a et ar+onwesetatleo is ties.
KaN: Jeff Sprague t t' Ponor ttAutharized agent R Contractor
31 •:
COManY t All Star Water Heaters
•Contraetot 1 icensa : 812894
Address: 30300 Puerto Vallarta
Phone•
• 951-345-4083
City/State tip: Menifee CA 92584
ate' '!CU'/
uuSMp.