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BPLB2015-0044n S 't 78-495 CALLE T'AMPICO LA QUINTA, CALIFORNIA 92253 Tw�t 4 .4 Qumrov COMMUNITY DEVELOPMENT DEPARTMENT Application Number: BPLB2015-0044 Property Address: 78750 NOLAN CIR CIR APN: 604233020 Application Description: NADOLSKI RESIDENCE/WATER Property Zoning: Application Valuation: $900.00 Applicant: STATEWIDE SERVICES INC DBA STA 36947 COOK STREET STE 104 PALM DESERT, CA 92211 a BUILDING PERMIT 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.: 9361 D ,Contra 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).: (_) ],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.). I Lender's Name: Lender's VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 3/13/2015 Owner: FRANCES NADOLSKI 78750 NOLAN CIRCLE LA QUINTA, CA 92253 Contractor: STATEWIDE SERVICES INC DBA STA 36947 COOK STREET STE 104 PALM DESERT, CA 92211 (442)666-8858 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: 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 thatillhould become subject to the workers' compensation provisions of Section 00 the Labor Code, I shall forthwith comply with those provisions. - Date.; Appli Rt. 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 04 relating to building construction, and hereby authorize representatives of this ' to nter upon the above. mentioned property for inspection purposes. Da"tett-40 Signature (Applicant dr ge T P-e� t cripjIve,erfir iC kAte of Residential AWarions Project -Name: Q I Residential Climate Zone: .CT-IR-ALT-DH.W- Ngc I of 3 Permit �#- General Information Site Addresf- 7q 0 N 0 ow C-1 Enforcement AgeN*y: -Building Typ'e.-I-L in le Family 0 M Uy ulti Fam, I Prqject Type:-KReplacerrcnt or Chan of Water Heater F. 2 S WATER HEATING List nem4 - r installed water heaters and boilers for b&th domestic hot water heaters- (-DWH) and hydronic space /tearing. Negly installed DIM heaters and bailers must be as, oruse the e-Yi4stingffiu li),pe. Water Heater DisuibutionT`ype Number.1n. Tank Energy Factor or TypdFvq Type' (Standard, S, capacity (gal) 11miml Efficwincy Recirntlatiripy System Exteinal Tank Insulation R-Vakie' conform to the requirements of Title 24. Pan I and 6 of the California Code of Regulations. • The building design leatums identified on this Certificate of Cor*ianoc are consistent with the information P[OvkW to document this building design on the other applicable'com*iw= forms. woticamm calculations, plans and speciricaftons submitted to the enforccment agency for approval with this building permit applicajoti. -4 Nanv--T V�, SiVU— C—PqW i �z�� ^ l'/i GAS Licensez eA/CityfSt=q a�v/ I. Indicate TYPe (Storage Gas. Hew Pump, instantaneous, etc.) 2. Recin4ulatitig systems serving multiple dwelling units shall iAeer the recirculation requirrments of §l An). requirenienis do not allow the installation of a rrcirrulating water heating system jar single dwelling runts. J- The eVernal water heating tank and pipes shall be insulated to meet the requirements of § 150a The Pre5criplive Contractor or Homeowner (Documentation Author's/Responsible Building Designer's Declaration Statement) • I certify that this Certificate of Compliance docunwntaiion is arcuate 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. • I certify that the energy features and performance specifications for the building deiign identified on this Certificate of Compliance conform to the requirements of Title 24. Pan I and 6 of the California Code of Regulations. • The building design leatums identified on this Certificate of Cor*ianoc are consistent with the information P[OvkW to document this building design on the other applicable'com*iw= forms. woticamm calculations, plans and speciricaftons submitted to the enforccment agency for approval with this building permit applicajoti. -4 Nanv--T V�, SiVU— C—PqW i �z�� ^ l'/i GAS Licensez eA/CityfSt=q a�v/ Phone:M 7W,67, Cd"'// UaQ_ FINANCIAL INFORMATION DESCRIPTION ACCOUNT MOUNT ��` _. . C ask' ;QTY .. " A - -". :. PAID PAID DATE BSAS SB1473 FEE 101-0000-20306 0 $1.00 $1.00 3/13/15 PAID BY , 'METHOD'._'., RECEfPT#,.� p ,�°CHECK#'CLTD BY NORAS SERVICES DEBIT R4006 MFA Total Paid forBUILDING STANDARDS ADMINISTRATION BSA' $1.00 31.00 DESCRIPTION " a` - ti s `� ,, ACCOUNT QTY� AMOUNT' :. F `PAID PAID DATE PERMIT ISSUANCE 101-0000-42404 0 $91.85 $91.85 3/13/15 PAID BYE s METHOD RECEIPT # CHECK # ' g CLTD BY NORAS SERVICES DEBIT R4006 MFA Total Paid forPERMIT ISSUANCE: $91.85 $91.85 ' . DESCRIPTION : R ' -` ACCOUNTz QTY ; - AMOUNT ' n ' PAID PAID DATE WATER HEATER/VENT 101-0000-42401 0 ..$12.09 $12.09 3/13/15 H = ^ PAID BY ; , , t ' ` .'METHOD' ',RECEIPT #F� `',CHECK # ` CLTD BY: NORAS SERVICES DEBIT R4006 MFA DESCRIPTION +°" ACCOUNT m,.< QTY AMOUNT "PAID PAID DATE WATER HEATER/VENT PC 101-0000-42600 0 $7.25 $7.25 3/13/15 PAIDBY METHOD r$' RECEIPT# CHECK# �CLTDBY NORAS SERVICES DEBIT R4006 MFA Total Paid forPLUMBING FEES: $19.34 $19.34 TOTALS: $112.19 $112.19 t Description: NADOLSKI RESIDENCE/WATER HEATER CHANGE OUT Type: PLUMBING Subtype: Status: UNDER REVIEW Applied: 3/13/2015 MFA Approved: Parcel No: 604233020 Site Address: 78750 NOLAN CIR CIR LA QUINTA,CA 92253 Subdivision: TR 23268 Block: Lot: 189 Issued: Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $900.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 Details: WATER HEATER CHANGE OUT- 40GALLON/GAS [2008 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2013 CALIFORNIA BUILDING CODES. ...... FINANCIAL INFORMATION Printed: Friday, March 13, 2015 10:21:12 AM 1 of 2 ORWlYSTEMS DESCRIPTION " , ACCOUNT QTY AMOUNT PAID PAID GATE RECEIPT # CHECK # METHOD PAID BY CLTD BY BSAS SB1473 FEE 101-0000-20306 0 $1.00 $1.00 3/13/15 R4006 DEBIT NORAS SERVICES MFA Total Paid. for BUILDING STANDARDS ADMINISTRATION $1.00 $1.00 BSA: PERMIT ISSUANCE 101-0000-42404 0 $91.85 $91.85 3/13/15 R4006 DEBIT NORAS SERVICES MFA Total Paid forPERMIT ISSUANCE: $91.85 $91.85 WATER HEATER/VENT 101-0000-42401 0 $12.09 $12.09 3/13/15 R4006 DEBIT NORAS SERVICES MFA WATER HEATER/VENT 101-0000-42600 0 $7.25 $7.25 3/13/15 R4006 DEBIT NORAS SERVICES MFA PC Total Paid for PLUMBING FEES: $19.34 $19.34 TOTALS: $112.19 $112.19 INSPECTIONS. nSEQID INSPECTION TYPE' . INSPECTOR SCHEDULED COMPLETED, RESULT;" 'REMARKS �-, �` , �'�' - , -NOTES DATE'T •°DATE` PLUMBING FINAL" BLD PARENT PROJECTS Printed: Friday; March 13, 2015 10:21:12 AM 2 of 2 SYSTEMS Bin # City of La Quinta Buffding 8t Safety Division P.O. Box 1504, 78-495 Calle Tampico Permit # La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Project Address: ,/ Owner s Name: �7 A. P. Number: Grading Address: State Lic. # : J LI—7 Legal Description: City Lic. #: 3" Review, ready for corrections/issue City, ST, Zip: Q Arch., Engr., Designer. Contractor: i $ Planning Approval Telephone: Address: `llJ't (, 1^ �, City., ST, Zip: ProjectDescription:(J City, ST, Zip: H.O.A. Approval Telephone:. Grading State Lic. # : J LI—7 City Lic. #: 3" Review, ready for corrections/issue Arch., Engr., Designer. Planning Approval Address: Called Contact Person City., ST, Zip: Pub. Wks. Appr Telephone: %> '''��x"�>'`' a •':: rtio•,v "^rte �;;�twy�.:?s?�^�`;�cti: ;;c3y r;; .ss� Construction Type: Occupancy: Project type (circle one): New Add'n Alter Repair Demo State Lie. #: Name of Contact Person: 1 Sq. FL: # Stories: T# Units: Telephone # of Contact Person: Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE N Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Total Permit Fees Item Amount Structural Calcs. Rcviewed, ready for corrections Plan Check Deposit Truss Catrs. Called, Contact Person Plan Check Balance 'Tide 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan god Review, ready for correctionsfissue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans nicked un c M r H.O.A. Approval Plans resubmitted Grading IN HOUSE:- 3" Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.LP.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees