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BPLB2016-0115G 78-495 CALLE TAMPICO 'LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application Description: Property Zoning: Application Valuation: - c&'�v 4 4 Q" - DESIGN & DEVELOPMENT DEPARTMENT BUILDING PERMIT BPLB2016-0115 60548 DESERT SHADOWS DR 764330005 FURGLSON / CHANGE OUT (1) 50 GALLON GAS WATER HEATER $1,460.00' Applicant: TOMMY ROOTER PLUMBING INC 80975 INDIO BLVD #69 INDIO, CA 92201 OCT C5 2016 CIUNTA COhiMUNITYDEVe1GPMENTDEPARTMENT 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 Date:'" 1 u S LO Contracto ' 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.). (1 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 contractors) 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. Q. Lender's Name: Lender's Address: VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 9/26/2016 Owner: VICKY FURGLSON 60548 DESERT SHADOWS DR LA QUINTA, CA 92253 Contractor: TOMMY ROOTER PLUMBING INC 80975 INDIO BLVD #B9 INDIO, CA 92201 (760)574-4444 Llc. No.: 930133 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' . ensation, as provided for by Section 3700 of the Labor Code, for the performance e rk for which this permit is issued. ca"''have and will maintain workers' compensation insurance, as required by t,tti 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 INSURANCE COMPANY Polity Number: TOWC765159 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. ca -C' .� A Date: ) -� �ApplicarLt���c 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. Date: Signature (Applicant or Agent): Date: 9/26/2016 Application Number: BPLB2016-0115 Owner:. ;Property Address: 60548 DESERT SHADOWS DR VICKY FURGLSON APN: 764330005 60548 DESERT SHADOWS DR Application Description: FURGLSON / CHANGE OUT (1) 50 GALLON GAS WATER HEATER LA QUINTA, CA 92253 f Property Zoning:. , Application Valuation: $1,460.00 . Applicant: Contractor: TOMMY ROOTER PLUMBING INC TOMMY ROOTER PLUMBING INC 80975 INDIO BLVD #69 80975 INDIO BLVD #139 INDIO, CA 92201 INDIO, CA 92201 M (760)574-4444 -------------------------------------------------------------=-----------------------•-------- Llc. No.: 930133 Detail: WATER HEATER CHANGE OUT- 50 GALLON/GAS [2013 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2013 CALIFORNIA BUILDING CODES. FINANCIAL INFORMATION DESCRIPTION ACCOUNT CITY AMOUNT BSAS SB1473 FEE 101-0000-20306 0 $1.00 Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 DESCRIPTION ACCOUNT CITY AMOUNT PERMIT ISSUANCE 101-0000-42404 0 $91.85 Total Paid for PERMIT ISSUANCE: $91.85 DESCRIPTION ACCOUNT CITY AMOUNT WATER HEATER/VENT 101-0000-42401 0 $12.09 DESCRIPTION ACCOUNT CITY AMOUNT WATER HEATER/VENT PC 101-0000-42600 0 $7.25 Total Paid for PLUMBING FEES: $19.34 06/06%2013 THU 15109 FAX za Quiata Bldg 6 Safety ®0011001 Qty of La Qu[nta ,;: Bt►lk hor Safety DMft NM* # P.O. Bax 1504,78-495 CO Tmwko !;a Quftmv CA 92253 • (760) 777.7012 Budding Permit Appocatlon and Tracking Sheet i d s L i si7s Owner't Nw= ' D ps on: pity, ST, ZIP 53 Coatraatw M i`n r , T T4 PwjodD&wripd=: Add e= v �` f3 C*,ST, Al. r— 1 Sao � 1 Te(t�phono;� � o L� vJ • Sca U.. # e.: C) cx Lie N; Amh., HW E�Mper: Address: city, ST. Zip: Teltphone�� . t)ocalpanay: , l'M= type (circle onc): New Add'n Alter Rep* Demo Name OfCoitkPer M: C V 1�-"�fit.: -a Stories: B.CJnita C> Laphone OW Camtact Persou 0 5'1 �lU vase of. ee� _ APF CANT: Do NOT wfil# OMOW THIS 1.11 8ol�(ltaiReOd itoc'tl TRACitTA1G lam, A9TTBF.�i9 Pitta ' mu cheek nwtted . Item Amoaat $iracipra{ Gbita. Reviewed, rva dy for cnrredione .Plan Cbwk Dtpotdt lkvas CAIti. 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IL r �r _ � (Stor..�e .Z.�ec�l�ufutTiig' 1�A►+�p: /�;�'iitrt��� _ :-r'..'::: .. .� . �.:. i�ccu�at7Qn�xrxNuin!�1d0�'-`��f!�;"�ie?:s19+t3ilcrinlfve :tytrlM�`:sxrt�iilg"�rnrr7tfplw• dWadr`rig; riitifs.Jh6b'�i•►iesl'':Ylte` reg ftrt}ite do not aNMfo�+rihe I altatfon of 4.XCOCUIa fng wales-, htatLtg �tl, (t 3 "FhG'�tta.Mpv4Mfor•h fgt -f44 J Shall be inudated to meet the ffllL�nECIIIJO IS I a,`:i ,'tqpl ' , or Hotrnowner Atom Autbor's/tteapoesibte Su Debigeter'� `'certtj�ittat this Cctfft eta o r Comprat2GCdoc+mentetion is & carisplatd.: r. •; .... •-. i.: am sli$ibla uttde[: Di�is 3. 'Qf,the..tral.ifomia- 9ushiess and. Professions Code to accept naibitity for the b� it tg' flSaagn :>�., tdrntif{ed on this Cbrtif>IguU� • d rti 'that t f .en3]'... Compllance... _ Perfoctiwiia a pcc i1g gs' ttsand s i4�tcaiio7u'fortkaiittil+di 'i%si identift oti titin C"CtPf�ete' iance. ,....:_ Cpnfoim.to tht tCquttamentt cat M •:' `itu hulloing desi�tiT;At' P'i5ttc:24, Partl ai:d 6 iSfttte` CSl�fti34iin Cod�of Regttiatlotia� .^ r 2 I etltiPicd otr t}iis<(`ertifii ata of Cs¢irtpits�a— tei'' xGMJzlte3it with tfk Finati�tr prb csd b e(tia r 1}u7 mg'd"esignoil"thb ajipti lfie camp3itirtct fortns::'woiltehects. cake►lations,:;pistts..aced,_specifsCsttipn;.su fitb o the ° enfotrt a enc.. foc•a v with thia:buildin !lent%n - `� r• "' �- N : _...: - ...- :.-...;..I;: .... - T . •iV .. W. - '.L.. — ol. .... .. . IL CO y �Y Addrm: OC 013.3 City/stateop:.; .. t.;_:.,: -.. phone!