BPLB2016-0093`L
is
78=495 CALLE TAMPICO 4.4 VOICE (760) 777-7125
FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 .COMMUNITY DEVELOPMENT DEPARTMENT
4`';#�INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 7/6/2016
Application Number: BPLB2016-0093 Owner:
Property Address: 54685 AVENIDA RUBIO LORI COSMO
APN: 774271021 54685 AVENIDA RUBIO .
Application Description: CHANGE OUT 40 GALLON ELECTRIC WATERHEATER LA QUINTA, CA 92253
Property Zoning:
Application Valuation: $8.00
Applicant:
JORGE A ALVAREZ
PO BOX 984
THERMAL, CA 92274
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: C36 License No.: 880103
Date:
Contractor:
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 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 Na
Lender's Add
Contractor:
JORGE A ALVAREZ
PO BOX 984
THERMAL, CA §2 ?74 .
(760)698-8975
Lic. No.: 880103
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: Policy Number:
I certify that in the performance ofthe 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:
Applicant:
WARNING: FAILURE TO SECURE WORKERS' CCMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMir1AL 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 CO[JE,
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 appltation 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 be 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 cancelation.
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 ordnances and state laws relating to building
construction, and hereby authorize representztives of this city to enter upon the
above-mentioned property for inspection purposes.
Date: Signature (Applicant or Agent):
f
FINANCIAL INFORMATION
DESCRIPTION;;,.,;,
�nACCOUNT'Y. qTY -AM OUNTS'.p i PAIDA z
PAID DATE
# s;
BSAS SB1473 FEE
101-0000-20306
0 $1.00
$1.00
6/23/16
y
PAID BYr 't,
a
Y ;; METHODS, :>'
.i � 4 St Vii+ ,°
RECEIPT #
- #'L
s a
CHECK
CLTD BY -S:
„ �r
*.'
,
x
?01606253769031412
RUTH RODRIGUEZ
CREDIT
WE
ECON
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 $1.00
�#DESCRIPTION —
ACCOUNTu..QTY
AMOUNT
>e
rte PAhD
PAID DATE;'
a
s
Credit Card Fee
101-0000-43505
0
$2.47
$2.47
6/23/16
B, Y•
PAIDe.. t-% e,X
t. H
RECEIPT #
#''
CLTD BYE '
,..• t5 r7 ^Ki .... 7 y na ,
t�. 1
s. t<`3 S
E ACHECK
2016062 169031412
RUTH RODRIGUEZ
CREDIT
WEB885
ECON
Total Paid for Credit Card Fee: $2.47 $2.47
DESCRIPTION
AMOUNT
yin PAID '„
°PAID DATE'
�
PERMIT ISSUANCE
101-0000-42404
0.
$91.85
$91.85
6/23/16
PAID`BY a �
s r s METHOD £��
uRECEIP7 #
fir,„w
CLTD BY't;
. ,.. q _g., '•.. Ys.'a'3
<>..:... .? o
,�-.
Z01606231690314121
RUTH RODRIGUEZ
CREDIT
WEB885
ECON
57
Total Paid for PERMIT ISSUANCE: $91.85 $91.85
- * 4 Yi. i : _•s if -- '1
% DESCRIPTION ;:
Yg Y$ ~ R S Y F
r ACCOUNT �x
-QTY
_..�:
AMOUNT
,, § �...a
P AID '
-
PAID DATE=:
z ss
a.fiT
WATER HEATER/VENT
101-0000-42401
0
$12.09
$12.09
6/23/16
A?
PAID'BY f i�
_E
METHOD `
'R
'RECEIPT # t'9
ff CCHECK # `"'
CLT D BY
,,
,:'
g '
RUTH RODRIGUEZ
CREDIT.
WEB885.
201606 5769031412
ECON
DESCRIPTION`
ACCOUNT
QTYMOUNT
A
PAID
PA1D'DATE
_
x
C+ ,''_ ,�»<
a'
rye F.
WATER HEATER/VENT PC
101-0000-42600
0
$7.25
$7.25
6/23/16
t ?'
METHOD �
RECEIPT#
CHECK #
CLTD BY
;PAID."BY
�•us:. rs.
.LCHE
-
2016062319031412
RUTH RODRIGUEZ
CREDIT
WEB885
ECON
_
576
Total Paid for PLUMBING FEES:- $19.34 • $19.34 -
TOTALS: $114.66 $114.66
f
Description: CHANGE OUT 40 GALLON ELECTRIC WATERHEATER
Type: PLUMBING - WATER
Subtype:
Status: ISSUED
Applied: 6/23/2016 ECON
HEATER CHANGEOUT (WEB).
Approved: 6/23/2016 ECON
Parcel No: 774271021 Site Address: 54685 AVENIDA RUBIO LA QUINTA,CA 92253
Subdivision: SANTA CARMELITA
VALE LA QUINTA Block: 270
Lot: 9
Issued: 6/23/2016 ECON
UNIT 25
Lot Sq Ft: 0
Building Sq Ft: 0,
Zoning:
Finaled:
Valuation: $8.00
Occupancy Type:.
Construction Type:
Expired: 12/20/2016 ECON
No. Buildings: 0
No. Stories: 0
No. Unites: 0
Details:
i
;.. , , ,,,,
ADDITIONAL
...
FINANCIAL INFORMATION '.
_. _ _
Printed: Wednesday, July 06, 2016 12:04:30 PM 1 of 3
e : m INPECTIONS .......... ..
.� _- — — —
—P. . . . . . . . . . . .ARENT PROJECTS ,. - ,:,
Printed: Wednesday,'July 06, 2016 12:04:30 PM 2 of 3
#:CHECK#
CLTD
DESCRIPTION
ACCOUNT
QTYAMOUNT
: PAID
PAID,DATE
RECEIPT
METHOD;.
PAID BY
.
201606231
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$1.00
6/23/16
WEB885
903141257
CREDIT
RUTH RODRIGUEZ
ECON
6
Total Paid for BUILDING STANDARDS ADMINISTRATION
$1.00 $1.00
BSA:
201606231
Credit Card Fee
101-0006-43505
6
$2.47
$2.47
6/23/16
WEB885
903141257
CREDIT
RUTH RODRIGU.EZ
ECON
6
Total Paid for Credit Card Fee: $2.47. $2.47
201606231
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$91.85
6/23/16
WEB885
903141257
CREDIT
RUTH RODRIGUEZ
ECON
6
Total Paid for PERMIT ISSUANCE: $91.85 $91.85
201606231
WATER HEATER/VENT
101-0000-42401
0
$12.09
$12.09
6/23/16
WEB885
903141257
CREDIT
RUTH RODRIGUEZ
ECON
6
WATER HEATER/VENT
201606231
101-0000-42600
0
$7.25.
$7.25
6/23/16
WEB885
903141257
CREDIT
RUTH RODRIGUEZ
ECON
PC
.
6
Total Paid for PLUMBING FEES:. $19.34 $19.34
e : m INPECTIONS .......... ..
.� _- — — —
—P. . . . . . . . . . . .ARENT PROJECTS ,. - ,:,
Printed: Wednesday,'July 06, 2016 12:04:30 PM 2 of 3
:• •' •
` Attachment Types CREATED '"'„OWNERS .� , DESCRIP..TION �* < rfi_PATHNAME SUBDIR ” ETRAKIT ENABLED
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DOC • 6/23/2016 EtrakitContractor Scan 2.pdf 1
DOC 6/23/2016 ' EtrakitContractor Scan l.pdf 1
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