BPLB2015-006178-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
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COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/15/2015
Application Number:
BPLB2015-0061
Owner:
Property Address:
55727 BRAE BURN
RAY LEONARD
APN:
775280008
55727 BRAE BURN
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Application Description:
LEONARD RESIDENCE/WATER HEATER CHANGE OUT
LA QUINTA, CA 92253
Property Zoning:
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Application Valuation:
$1,895.00
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Applicant:
Contractor:
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TOMMY ROOTER PLUMBING
INC
TOMMY ROOTER PLUMB
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80975 INDIO BLVD #C3
80975 INDIO BLVD #C3
2
INDIO, CA 92201
INDIO, CA 92201
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(760)574-4444
Llc. No.: 930133
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.: 930133
Dfe:L"� — dL D Conf�
ct�r
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
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).:
( 11, 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 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' e
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, l shall forthwith
COMA!! Withthoseprovisions.
Date:" 1 d �' (s Applica�n� �/ V
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 — S— Signature (Applicant o Agent)
FINANCIAL INFORMATION
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 for BUILDING STANDARDS ADMINISTRATION BSA $1.00 $0.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid forPERMIT ISSUANCE: $91.85 $0.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
WATER HEATER/VENT
101-0000-42401
0
$12.09
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
WATER HEATER/VENT PC
101-0000-02600
0
$7.25
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid for PLUMBING FEES: $19.34 $0.00
TOTALS:• i0
Description: LEONARD RESIDENCE/WATER HEATER CHANGE OUT
Type: PLUMBING Subtype: Status: APPROVED
Applied: 4/15/2015 MFA
Approved: 4/15/2015 MFA
Parcel No: 775280008 Site Address: 55727 BRAE BURN LA QUINTA,CA 92253
Subdivision: TR 28341-2 Block: Lot: 8
Issued:
Lot Scl Ft: 0 Building Scl Ft: 0 Zoning:
Finaled:
Valuation: $1,895.00 Occupancy Type: Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0 No. Unites: 0
Details: WATER HEATER CHANGE OUT— 75 GALLON/GAS [2008 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL
INSPECTION. 2013 CALIFORNIA BUILDING CODES.
Printed: Wednesday, April 15, 2015 9:59:41 AM 1 of 2
CMLl LJ SYSTEMS
Total Paid for PLUMBING FEES: $19.34 $0.00
PARENT PROJECTS .
Printed: Wednesday, April 15, 2015 9:59:41 AM 2 of 2
SYSTEMS
CLTD.
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #:.'
METHOD
PAID. BY :: w.
BY
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
Total Paid forPERMIT ISSUANCE:
$91.85
$0.00
WATER HEATER/VENT
101-0000-42401
0
$12.09
$0.00
WATER HEATER/VENT
101-0000-42600
0
$7.25
$0.00
PC
Total Paid for PLUMBING FEES: $19.34 $0.00
PARENT PROJECTS .
Printed: Wednesday, April 15, 2015 9:59:41 AM 2 of 2
SYSTEMS
Preseri tive.Certi6rate of Compliance; Residential CF-IR-AL"1'-DMV
Residential Alterations page i of 2
project Natrie: t,Ln Climate Zone: Permit #:
General I n foriitatio n
Site Address: Enforcement Agency: Date:
BuildingT. e: Single Family 1] Multi Fumil Project Type: 13 Replacement or Chane Out of Water Heater
WATER HEATING
List newly installed water heaters and boilers for both domestic hot water heaters (DIM) and hydronic space hearing. Newly installed
DWH heaters and boilers must be as, proper or csse rhe exisring fiiel type.
Watcr Hcater
TykRtel Types
Distribution Type
. (Standard
Recircu titin )r
Number in Tank
stem Capacity (gal)
Energy Factor of
Thermal Efficiency
External Tank
insulation
R -Value
. `lire building design features identified on'this Certificate of Compliance are consistent With the iirfvrimation provided to document this
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enforcement agency for approval with this building. permit applicatiorr_
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Address-,
License:
City/Statdzip:
Phone:
1. indicate Type (storage Gas,'Heat Pump, Instantaneous, ete.)
2. Reclrrulating systems serving multiple dtvellirig units shall meet the recirculation requirements af.§150(n).
requirements do nor allow the installarion of a recirculating water hearing sysre,n far single dwelling units.
3, no external water -healing Wk -and ' i es shall be insulated to meet the re uirentents pL§ )S ').
The Prescriptive
Contractor or Homeowner (Documentation Author's/Responsible Building Designer's Declaration Statement)
a 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.
e I certify that the energy featutrs and performance specifications for the building design Identified on this Ccrtiftcate of Compliance
conform to the requirements of Title 24, Patti and 6 of Cho California Code of Regulations.
. `lire building design features identified on'this Certificate of Compliance are consistent With the iirfvrimation provided to document this
building design on the other applieuble compliance forms, worksheets, calculations, plans and specifications submitted to the
enforcement agency for approval with this building. permit applicatiorr_
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Address-,
License:
City/Statdzip:
Phone:
06/06/2013 THU 15:09 FAX La guiata Bldg & Safety.
®001/001
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QttMag.lst' Wety MIM
P.O, Box 1504, 78495 Calle Tampico
0 Qlhntd,,CA 92253 - (760) 777.7012
wilding Permit Application and Tracking Sheet
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Address: ' `co'jectD.scrtption
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Addreas:
City, ST, Zip:
Telephone Convtmcdon Typt: Ooa�ency:
State Lia #: Prgject type (airvle oast): Now Add'n Altt r Repak Demo
Name of ContactPer.,on:
Sq, Ft: ii $torlev #•Units
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Telephone # of Contact Person: Q $stimated Vslut of Project: r
APPLICANT: DO NOT WMTJ_ BELOW THIS LINE
d 86mittat 'd 0=14 'TRACIOAtG
Plop Secs Man C6rzk submitted IYctn Amount
Stroctaral Coles 1 Reviewed, reaSy for earreedons 'Nan Cbeck Deposit
Trues Colo. Called Contact Person Plan Meek Ealanee-
72de 24 Cities, Flans pielud up Can4tructiao
Road plain plan Plans resubmitted Mec6aulsal
GraAfng Pian T4 Review, tvzdy for cort'ectlonsliesue Tlecdricst
86eoataetor Litt Caked Coatacf Person Pbmbini
Crrant Deed Plass picked up
11.04 Approval Pians resubmltted Grading
T HOUSE:- ""Aeylew, i "ay For cormetiouefi9 g Developer Impact Fee
PlsnpiggApproval Caped Contact person AUX.
pvb. Wks. A Apr Date orperm It issue
8ehoM Foes
Total Permit Fees