BPLB2014-100778-495 CALLE TAMPICO
LA QUINfA, CALFORNIA 92253
T4tr44Qumrw
COMMUNITY DEVELOPMENT DEPARTMENT
. BUILDING PERMIT
Application Number: BPLB2014-1007
Property Address: 52875 AVENIDA CARRANZA
APN: 773321006
Application Description: WATER HEATER CHANGE OUT
Property Zoning:
Application Valuation: $0.00
Applicant:
D Q
STATEWIDE SERVICES INC DBA STA
73804 DINAH SHORE DRIVE l(l ,..
PALM DESERT, CA 92211
CITY OF LA OU19TA
nr.uw�NCiY DEVELOPMENT D
EPARTMENI
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 Professions Code, and
my License is in full force and effect.
License Class: _ License No.: 936147
Date: - ( C.. e`Contractgr:
OWNER -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 Profession! 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:
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/29/2014
Owner:
MARIA ARZAGA
52875 AVENISDA CARRANZA
LA QUINTA, CA 92253
Contractor:
STATEWIDE SERVICES INC DBA STA
73804 DINAH SHORE DRIVE
PALM DESERT, CA 92211
(760)393-6115
Llc. No.: 936147
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:
CarriN._ Policy Number:_
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 !,4t, if I should become subject to the
workers' compensation provisions of Sec ' n 3 00 of the Labor Code, I shall forthwith
comply with those provisions.
Date: O Applican .
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 Building Official 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
construction, and hereby authorize representatives of this ci to enter upon the above-
mentioned property for inspection purposes.
Date: / ignature (Applicant or Ag
DESCRIPTION
CITY AMOUNT
PAID
PAID DATE
FINANCIAL INFORMATION
ACCOUNT
PERMIT ISSUANCE
101-0000-42404
0 $90.57
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid for PERMIT ISSUANCE: $90.57 $0.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
PAID
PAID DATE
WATER HEATER/VENT
101-0000-42401
0
$11.92
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
CITY
AMOUNT
PAID
PAID DATE
WATER HEATER/VENT PC
101-0000-42600
0
$7.15
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid for PLUMBING FEES: $19.07 $0.00
TOTALS:$109.64 $0.00
----------.'--- - --- --- J .
2014-07.-25 08:59 Installed -Sales #208 7603934062 >> P 1/2
Bin #I. City of b Quffito -
AWK of Division
Burldrng 8z ety
Permit i P.O. Box 1504, 8-495 Calle Tampico
La Quinta, CA 922 3 - (760) 777-7012
Building Permit Application and Tracking Sheet
Project Address: 5 Q V tt7 Owner's Name: fflv1 ,
A. P. Number:
Address: a.734V y. cyl�1
Legal Description:
City, ST,V* &,,t&Liyx4q
Contractor: Lc_
y 'x. -«mss
Address: v LL 10 -.I. -a
Project Description: 12
City, ST, Zip: 6
rIA1- G
Telephone - U�"`EM
State Lie. # :
CityLic. R:
I
Arch., Engr., Designer:
g
Address:
City., ST, Zip: ��
I
Telephone:
:,: �n2 .. ;�s<
CAastructionType: Occupancy:
Project 4pe (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. FL: (
# Stories:
9 Units:
Telephone # of Contact Person:
P �� �� � 0�
Estimate Value of Project; (' -
APPLICANT: DO NOT WRITE BELOW
THIS LINE
d
Submittal
Req'd
Rec'd
TRACKING
I
PERMIT FEES
Plan Sets
Plan Check submitted
I
Item Amount
Structural Cates.
Rcvitwcd, ready for correctioas
I
Plan Cbeelt Deposit
Truss Caics.
Called Contact Person
Plan Check Balance
Title 24 Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
I
Mechanical
Grading plan
2°" Review, ready for correctionstivue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans pick -ed up
S.M.T.
H.O.A. Approval
Plans resubmittedI
Grading
IN HOUSE: -
Review, ready for correctlonsris�a
Developer Impact Fee
Planning Approval
Called ContaetPerson
I
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
I
School Fees
Total Permit Fees
2014-07-25 09:00 Installed Sales #208 7603934062 >i> P 212
•Prescried .
Residential,
Pmiect Flame:
Site �
Build
of Compliance. Residential. SCF-IR-ALT-DHW -
� Page t of z
CrRate Zane: Permit #:
I
1t9 e. u' v'CU? . ' Enforcement A 4nc : Date:
ily Multi Family . Proiect Type: Replaces of or change Out of Water Heater
WATER HEATING .1 1
List newly installed water heater and boilers for both domestic hot seater ieatrrr(DWH) and htdronic space heating. Newf.v installed
O1VH heaters and boilers mutt be as e, or use the existirt of
nat Tank
Water Hutt Disitrtwtan T� Numtxx n MIM orsulation
T.ypdT iType' (Standard. Systan -Vatcte�
Rec'
I_ indieae 6Pe (storage Cos. Heat Piww Instantaneous. etc.)
2. Recirculating systems serving multiple dwelling units shall meet tiquirements
recirculation requirements of VA11). The Prescriptive
requirements do not allow the installation of a recirculating water heatinnwem for single duTtling runits.
3. The eaernal water heads tank and pipes shalt be insulated to meet the o
Contractor or Homeowner (Documentation Author's/Responsible Building Designer's Dechration htatement)
• I certify that this Certificate of Compliance documentation is acwratI complete.
• 1 am eligible under Division 3 of the California Business and Profions Code to accept responsibility for the building design
identified on this Certifx=c of Cwnpliance_
• I certify that the cmgy features and performance specifications for building design identified on this Cc ificate of Coinpliatici
at
conform to the requirements of Title 24. Parti and 6 of the California Code of Regulations.
• The building design features identified on this Certificate of Conipliart�t are consistent with the information provided to document this
building design on the other applicable coTpliance fomu, t+vo calcutattorm plans and specifications submitted to the
emforccmeit agency for royal with this building it appli
Na Stsnlaaua
I r &41C i
Y:
Dat `
e•
)' a
City/Su�q (
RPhone: