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BPLB2014-101278-495 CALLE TAMPICO 4 4a VOICE (760) 777-7125 FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 8/6/2014 Application Number: BPLB2014-1012 Owner: Property Address: 51405 AVENIDA BERMUDAS KATHERINE BOLIN APN: 773104020 51405 AVENIDA BERMUDAS Application Description: WATER HEATER CHANGE OUT LA QUINTA, CA 92253 Property Zoning: Application Valuation: $1,000.00 D [r -J Applicant: AUG U Z014 Contractor: CAMPESINOS UNIDOS INC CAMPESINOS UNIDOS INC P0BOX 39 P0BOX 39 BRAWLEY, CA 92227 COMMUNITY CITY LAQUINTA DEVELOPMENT DEPARTMENT BRAWLEY, CA 92227 (760)344-4500 Llc. No.: 618140 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 70001 of Division 3 of the Business and Professions Code, and my License is in full force and effect. Lice;(/S/p Class: B. C36 License No.: 6^1811440 XDat Q ,y Contract 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 allege? 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 I 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 Lender's Address: 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 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 comp with those provisions. �Iate: Applicla _ 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 city to enter upon the above- mentioned property for inspection purposes. Dat 6 r�y Signature (Applicant or Agent :."4 1 Prescriptive Certificate of Compliance: Residential CF-IR-ALT-DHW Residenthd Al er tions Page I of 2 Project Name: _ O t h Climate Zone: JS Permit #: General Information Site Address.5'7) � OPtlI w 'e>f+� a Enforcement A e c h Date: Building Type: ❑ Single Family ❑ Multi Famity Project T Re lacement or Change Out of Water Heater WATER HEATING • 1 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 List newh• installed water heaters and boilers for loth domestic hot seater heaters (D WH) and h dronic spare heating. DWH healers and boilers must be gaSs. pro ne, or Luse the e.eistin ttel type. Mewl.y installed Distribution Type Number in Tank Water Heater Type(Fuel Type' (Standard.) . System Capacity (gat) ecirarlati Energy Factor ur Thermal Efficiency External Tank ion- R VInsuatue' enforcement agency for approval with this budding permitapplication.* Nam6_�/�y Signature: _ Company: Date: 0-:s Address- -37 License: City/StaterLip: �QwA� C� Phone: �� 1. Indicate Type (Storage Gas. Heat Ptump. Instantaneous. etc.) 2. Recirculating systems serving multiple dwelling units shall meet the recirculation requirements of §lAn). requirements do not allow the installation of a recirculating water heating s,•sten for single dwelling units. 3. The e.,ternal ittiter heating tank and pipes shall be insulated to »teen tire requirements of § 150U). The Prescriptive Contractor or Homeowner (Documentation Author's/Responsible Building Designer's Declaration Statement) • 1 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. • 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) 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 permitapplication.* Nam6_�/�y Signature: _ Company: Date: 0-:s Address- -37 License: City/StaterLip: �QwA� C� Phone: �� FINANCIAL •1• DESCRIPTION ACCOUNT .. QTY AMOUNT PAID PAID DATE BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $1.00 $0.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE 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 QTY AMOUNT PAID PAID DATE WATER HEATER/VENT 101-0000-42401 0 $11.92 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY 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 • 1 0.1 $0.00 Bin # 0ty of LA Quinti Building 8t' 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-{Q� �j �+Qy�� 9,_Y- `R gAi)S Owner's Name:ko-+ l,Q Tli n h A. P. Number: Address: 5 t' 4 f O S f } N',MI k�p r (n Lk Legal Description: City, ST, Zip: Contractor: //�//�ry� .ly1%1w .c�.�S telephone: Address: f -o, BQS 31 Project Description: City, ST, Zip: On _ c 2) p C 0.� (7 u LI ® GA -5. Telephone: 76o- 0y„qs01> >::::;:s:>:x:t ;•::ti;:%:: »:!:<; :::>::::;<:-h,;: F State Lic. # : �' p �i City Lic. M. Arch., Engr., Designer: Address: City, ST, Zip: Telephone: }:; 4� �;yr9-'r.#t l v' h,ctcl%Y"• r. fl r�??iii: ``� `<.: ......ProJect .. .. Construction type: Occupancy: . tYPa circle one): New Add'n Alter Repair Demo State Lic. #: Name of Contact Person: Sq. FL: #Stories: # Units: Telephone # of Contact Person: Estimated Value of Project: �� APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 20' Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. A.O.A. Approval Plans resubmitted Grading IN HOUSE:- ''' Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees .n ° Date Paid: Wednesday, August O6 2014 Paid By: CAMPESINCIS UNIDOS INC CashienP1U Pay Method: CHECK 6501 ML PermitTRAK $146.38 BPLB2014-1012 Address: 51405 AVENIDA BERMUDAS Apn:773104020 $146.38 BUILDING STANDARDS ADMINISTRATION BSA $1.00 CASH OVER $35.74 CASH OVER 101-0000-42300 0 $35.74 PERMIT ISSUANCE $90.57 PERMIT ISSUANCE 101-0000-42404 0 $90.57 PLUMBING FEES $19.07 WATER HEATER/VENT PC 101-0000-42600 0 $7.15 WATER HEATER/VENT 101-0000-42401 0 $11.92 Date Paid: Wednesday, August O6 2014 Paid By: CAMPESINCIS UNIDOS INC CashienP1U Pay Method: CHECK 6501