11-1233 (PLBG)14
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 11-00001233
Property Address: 56186 PEBBLE BEACH
APN: 775-132-017- -
Application description: PLUMBING
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 1500
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BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Applicant: Architect or Engineer:
-------------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I a licensed un rovisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business d P ofessio s e, and my License is in full force and effect.
License Class: B \ rens 444405
D tractor:
OWNER -BUILDER DECLARATION
1 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 (5500).:
(_ 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and 00,
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.).
(_ 1 I am exempt under Sec. , BAP.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: 0 Ilk
LQPERMIT
Owner:
JEFFREY BEKENDAM
VOICE (760) 777-7012
FAX (760) 777-7011
;INSPECTIONS (760) 777-7153
Date: 11/15/11
56186 PEBBLE BEACH
LA QUINTA, CA 92253
iD
Contractor:
201 L
PRUITT CONSTRUCTION INC, R
163 ENTERPRISE WAY CfPYQF�!_AgU NTA
UPLAND, CA 91786 F9P!.
(909)982-0363
Lic. No.: 444405
-----------------------------------------------
WORKER'S COMPENSATION DECLARATION -
I hereby affirm under penalty of perjury one of the following declarations:
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 theperformance of the work for which this permit is
U issued.
V_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 STATE FUND Policy Number 0000678-2010
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 b me subjec the workers' compensation provisions of Section
3700 of the Labo Code all , hwi mp wi t se provisions.
pplicant:
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 inforOurpos iscorrect. I agree to comply with all
city and county ordinances and state laws relating to buildin construcnd h y authorize representatives
of this county to enter upo the above-mentioned pro ertr i spe
i�aie: 11—ITS-1 / ignatwe (Applicant or Agent):
LQPERM[T
Application Number . . . . . 11-00001233
Permit PLUMBING
Additional desc .
Permit Fee . . . . 30.00 Plan Check Fee
7.50
Issue Date . . Valuation
0
Expiration Date 5/13/12
Qty Unit Charge Per
Extension
'BASE FEE,
15.00
2.00 7.5000 EA PLB WATER HEATER/VENT
15.00
------------------------------------------------------------------
Special Notes and.Comments
----------
CHANGE OUT 2 50 GALLON GAS WATER
HEATERS. 2010 CODES.
-------------------_---------------------------------------
Other Fees . . . . . . . BLDG STDS ADMIN (SB1473)
.1.00
Fee summary Charged Paid,. Credited
Due
Permit Fee Total 30.00 .00 .00
30.00
Plan Check.Total 7.50 .00 .00
7.50
Other Fee Total 1.00 .00 .00
1.00
Grand Total 38.50 .00 .00
38.50
LQPERM[T
Peescri the. Certificate. of Compli�
Residential Alterations
Project Name: a -a,.
General Information
Site Address: ,5 6 . ¢ t
Building T Sin le Family ❑ Multi F
ce:.Residential
Climate Zone:
Enforcement Agency:
Project Type: O Replacement or Ch
CF-IR-ALT-DHW ,
Page I of 2
Permit #:
Date: %f-15-11
Out of Water Heater
WATER HEATING
• t certify that this Certificate of Compliance documentation is accurate and complete.
hot ater'heaters (DWH) and hYdronic .ip are heating'. Newh• installed
Lint newlh installed water heaters and boilers for loth domesticr�
DWH heaters and boilers must be as, propane, or use the existin «el 47)e.
DistritwtionT
Water Haxter Number In Tank Factor or
Typ*�1 Type' (Surd' Number
Reciteulati ) System Capacity (gal) Thermal Efficiency
External Tank
Insulation
R -Value
a e yt. So 4-/— b 0 F/a
.
building design on the other applicable compliance forms: worksheets, calculations. plans and ificattons submitted to the
enfbE5amt agency for approvawith this building emit application. 1-1
Name
1. Indicate T*e (Stomge Gas. Heat Ptunp: Instantaneous. etc.)
2. Recirculating -systems serving multiple dwelling units shall meet the recirculation requirements of §I50(n).
requirements do not allow the installation of a recirculating water heating system for single dwelling units.
3. The external water heating tank and poes shall be insulated to meet the requirements of § I50(i).
The Prescriptive.
Contractor or Homeowner (Documentation Author's/Responsible Building Designer's Declaration Statement)
• t 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.f
• 1 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 other applicable compliance forms: worksheets, calculations. plans and ificattons submitted to the
enfbE5amt agency for approvawith this building emit application. 1-1
Name
ComPan� _ Date:
tlr tom=
Address: % License: L
3 G`l/' S�
LC�tJTe f !2/ �i
CitylstatoMp: Phase:
� � OA 6. 3
Bin #.
City 0f QU►11 i
Building 8T Safety.Div9lon
P.O. Box 1504, 78-495 Cale Tampico .
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
i
Project Address: `9 lee 66/ 46@l* --A
Owner's Name:
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
Contractor:�s:M'
s,C[ / % iu g T q%'..
Telephone:
sof!. 'A.;•,
Address: `'L3 tGnJ' � CA)
Project Description:
City, ST, Zip:
Telephone
r..:sr;,.`tir.::
City Lic. #;
State Lic. # : o
(J S
Arch., Engr.,' Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. #: } �< <f ^:t"•t ys>:>
iJiir rwiw.. Y:':•td%`?;:i`l ;:.:.,.nvs:
Construction Type: Occupancy:
Project t),pe (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:
# Stories: #Units:
Telephone # of Contact Person:
Estimated Value of Project: / S Q Q �^
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
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
Title 24 Cates.
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:-
Review, ready for correctionsrL%ue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees