11-0837 (PLBG)77800 Calle Madrid
11-0837
11441
10894
P.O. BOX 1504 4
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number:
11-0_0000837
Property Address:
77860 CALLE MADRID
APN:
774-221-024-12 =000000 -
Application description:
PLUMBING
Property Zoning:
COVE RESIDENTIAL
Application valuation:
700
Applicant: Architect or Engineer:
dd
-- ---------------
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 Professionals Code, and my License is in full force and effect.
License Class: B C27 License No.: 547412
Date:8" 3^ `Contractor: /J
ki
WNER-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 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).:
(_) 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.).
( 1 I am exempt under Sec. , B.AP.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:
LQPERMIT
Owner:
WILSON BARBARA
77800 CALLE MADRID.
LA.QUINTA, CA 92253
(760)771-6965
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 77.7-7153
Date: 8/03/11
C
Contractor:
PARKWOOD ENTERPRISES CORPORATN t + n
77800 CALLE MADRID ' , ' `) 2011
LA QUINTA, CA 92253 _
(.760) 777-7476 CITY(,),)= r A; 1WN7A
Lic. NO.: 547412 Fa r •%'((- .Ppt
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 NORGUARD INS CO Policy Number PAWC223909
_ 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
3700 of the Labor Code, I shall forthwith comply with those provisions.
Date: — 3— r Applicant: /D-,
WARNING: FAILURE TO SECURE WORKER OMPENSAT N 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 hull 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-mentioned property for inspection purposes.
Date: a '! r Signature (Applicant or Agent): Y •
Application Number 11-00000837
Permit . .
. PLUMBING
Additional desc .
.
Permit Fee . . .
. 22.50
Plan Check Fee
5.63
Issue Date . . .
.
Valuation . . .
. 0
Expiration Date .
. 1/30/12
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 7.5000,EA PLB WATER
HEATER/VENT
7.50
---------------------7------------------------------------------------------
Special Notes and
Comments
REPLACE OLD WATER
HEATER WITH.A NEW
ELELCTRIC 50 GALLON 2010 CODES.
----------------------------------------------------------------------------
Other Fees . . .
. . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary
Charged Paid Credited
------------------------------
Due
-
-----------------
Permit Fee Total
----------
22.50
.00 .00
22.50
Plan Check Total
5.63
.00 .00
5.63
Other Fee Total
1.00
.00 .00
1.00
Grand Total
29.13
.00 .00
29.13
LQPERMIT
Prescrio tive Certificate of Compliance: Residential CF-1R-ALT-DHW
Residential Alterations Page I of 2
Pmiect Name: /moi C_r iSinc. : Climate Zone: Permit #:
General Information
'Site Address: ?- yvc, C U c-- Enforcement Agency: Date:
Building T Sin le Family O Multi Family Project Type.XReplacemcnt or Change Out of Water Heater
WATER HEATING
• I certify that this Certificate of Compliance documentation is accurate and complete.
List newly installed wcuer heaters and boilers for both danes►ic hot water heaters (DWH) and hydronic .V)ac•e hearing.
DWH heaters and boilers must be gas. propane, or use the existingfit I type.
Newh• installed
Distribution Type
Water Heater Number In Tank Energy Facto► or
TypdFturt Type' (Standud System Capacity (gal) Tttamal Efficiency
Recirculat
External Tank
Insulatiao
R -Value
0 4;AA Q / 3 -
building design on the other applicable compliance forms, worksheets, calculations, plans and specifications submitted to the
enforcement agency for approval with this budding rmitlication.
Naive:
A -
Signature:
c«mpanDate:
Company:
/
1. indicate Type (Storage Gas. Heat Panip. Instantaneous. etc.)
2. Recirculating systents serving nudliple dwelling units shall meet the recirculation requirements. of §150(n).
requirements do not allow the installation of a recirculating water heating system for single dwelling units.
3: The external water heating tank and pipes shall be insulated to meet therequirements of § 15 '
The Prescriptive
Contractor or Homeowner (Documentation Author's/Responsible Building Designer's Declaration Statement)
• I certify that this Certificate of Compliance documentation is accurate and complete.
• 1 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.
• 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 t 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 specifications submitted to the
enforcement agency for approval with this budding rmitlication.
Naive:
A -
Signature:
c«mpanDate:
Company:
/
Address: License:
P&-
CitytStaterLip: Phone:
L,A 9P -7&o- P3/—G,-z-7
Bin #City
of .La Quinta
Building &r 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: -7 7 - <:!A=LLC- AIA-i3 21d
Owner's Name: 13,+11-e3 p -2,A- 6,4-11 r( S o-`/
A. P. Number:
Address: 77.- b' as•GL /t'1 /zi U
Legal Description:
Contractor:..::
/C.JG.wvz. U ' % P cs L . ' .
City, ST, Zip: 40 Z
.., cam- . 9 z•s-3
, y; :.:.....:. •.;:::
Telephone? 6 - - i "7 / --6 6..5 -
,.5 -Address:
Address: X17 -.61o7o d•GC-- 1 -2.4 -AD /Z-.1 /J
Project Description: o L' )
City,ST,Zip: /-4 2-Zs3
Telephone: 7Go- 7'17-7V .>>'Zo '`yyv»<z<sr: s //, : >> €`>>
:iY..,..f v:?.;NtJv'}'?):i.'•: iF:sJij>:L i:::.v}r vn'
State Lic. # : City Lie. #-.
Arch., Engr., Designer.
// y A
I'7.L' J - /`. L G.
Address:
City., ST, Zip:
Telephone:'>w
State Lie. #:
;.
r;ny`f
Construction Type: Occupancy:
projecttype (circle one): New Add'n Alter •Repair Demo '
Name of Contact Person: /, 4,c oc c f 'S c /9 r-
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: '7(,0-
Estimated Value of Project: -2"' °-=-
APPLICANT: DO NOT WRITE BELOW .THIS LINE
#
Submittal
Req'd
Recd
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 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for eorrectionsrissue
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 correctionsfissue
Developer Impact Fee
Planning Approval
Called Contact Person
I A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees