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BPLB2015-0004
78-495 CALLE TAMPiCO LA QUINTA, CALIFORNIA 922 Application Number: BPLB2015-0004 Tw�p 4lw4"' )MMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT Property Address: 55171 TANGLEWOOD APN: 775152079 Application Description: WATER.HEATER CHANGE OUT - 40GALLON/GAS Property Zoning: ' Application Valuation: $900.00, Applicant: STATEWIDE SERVICES INC DBA STA 73804 DINAH SHORE DRIVE PALM DESERT, CA 92211 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.: 936147 Dater 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).: ( ) 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 Lender's Address: VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 1/27/2015 Owner: COLLINS, JOHN 44 1550 LARKHALL CRESCENT NORT VANCOUVER, BC V7H2Z-2 Contractor: GV STATEWIDE SERVICES -INC DBA STA Z 73804 DINAH SHORE DRIVE Q --i PALM DESERT, CA 92211 (760)393-6115 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 o . rk 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, l 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 se/Section 37 of the Labor Code, I shall forthwith comply ith those provisions. Dai :e% ! — `5 Applicant. tLf!/ L 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 actor 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 cityto ter upon the above- mentioned, property for inspection purposes.. Date',` C• Signature (Applicant or Agenq:,= .J PE CE -RT -11 tic -qot Wate- r_rV,e H -1w EniBr_eRie-t 4a -LCV I nw-t Number: ------------ 7— i r ! ®! 1 �'� i r ��� 1 1 of Standby zcE� anc. h2r 75,010 3:t Eigefic Dicililn: fRL:I. or .0 .N;G, e For Silltiff 'gy -qtOTV-' B!,-;, z-5.00-1? gas ;tojrag _d jr to, -EF dtry F OSS w- 1`1 qtr For in-strintcr-EG-l' 92S "'"er "a St011a- 2. Alandater; Measures -D T BE Cs 'T S51W. di -e; 13: W -r- 6 nd anxc=-E-i; sraizer C -A- - c., ,j; c Lin f:5., lF.in § 150G): Water System Pipe ana� Ta�-k w lasula_LL mg Storage Tank inmLla-don [he I neral roti mai are L7J A. Stora --e Sas 7 -O,p C.Met-.allyv..'rapped wki,- jrsulation havin-E WISMOJcd o g7ca V,�a77j`;-!-'? , P, ualrirecl atom -g- .3 ro. Ill it -valhule is ir 'Med 0:1 in an' her te al ins -I -on R, insetan' Lemh=:n rn rL -,-r"U. '- i - d, o P- d, i C C rill S a piping a -a -di cqoLr:2 PvSte.7-1 1-1- L Wp =ria. 2 szvz, r-,�. and entire -irst i — o--- t and c! ld- war plpes Closes !C -.L -!IOL le - Sul! cer and ated -iength -0 Si. meets the reopre-Trien'Ll- I --,,r sfe�,=. 'widmnic he ming:- S- TS Oi h'3' Pipe kisulsdob.L - Standards Tlale 123rl-'-.: Maintenance. h t. -0i_- :and ase- n, C'. proiected 57om d2-.. rhr.- --,romi thd hot Water St} "Ce -.o the 'Kitchen t15-1 /lf)SD: If indicated On ihe dF-UR- aL! hor waltlt, yiolng in--ul2rcd per Standards Ta le -1 M -B. '2009 771- 2008 Reside -,di -17i COVION017C2 r0i rp DESCRIPTION .+rT a N.. FINANCIAL INFORMATION s "3 `ACCOUNT +;" x.` QTY iAMOUNT PAIDc PAIDDATE .-. BSAS SB1473 FEE 101-0000-20306 0 $1.00 ' $0.00 n ` PAID BYE i�' METHOD, i..,,t "" RECEIPT # x `,CHECK # yCLTD BY Total Paid forBUILDING STANDARDS ADMINISTRATION BSA 'y $1.00 $0.00 DESCRIPTION , w ; , $ us; <. ACCOUNT QTY' r AMOUNT .,' RxPAID =s' ' ;PAID DATE PERMIT ISSUANCE 101-0000-42404 0 $91.85 $0.00 S�� ,h r, a PAID -BY y, A Y '. z.. � ";cy"���METHOD gra ; r. F _. ' x RECEIPT # ;"':� x xy cr CHECK # tza CLTD BY Total Paid forPERMIT ISSUANCE: $91.85- $0.00 DESCRIPTION,, ° Fi ACCOUNTk g 3 QTYt AMOUNT p` M €, PAI'D PAID'DATE WATER HEATER/VENT, 101-0000-42401 0 $12.09 $0.00 " PAIDBY �� METHOD �'" RECEIPT # -1_ d 'CHECK # t' CLTDBY- ,DESCRIPTION 4 -,. },._ € ACCOUNTS t_. _. QTY` ""AMOUNT P4 PA PAID PAIODATE' WATER HEATER/VENT PC 101-0000-42600 0 $7.25 $0.00 -PAID BY �� ; . 4'f METHODS <i RECEIPT # a < 'CHECK #, CCTD BY, Total Paid for PLUMBING FEES: $19.34 $0.00 TO • •• Description: WATER HEATER CHANGE OUT - 40GALLON/GAS CONT Type: PLUMBING Subtype: Status: APPROVED Applied: 1/7/2015 SKH Approved: 1/7/2015 SKH Parcel No: 775152079 Site Address: 55171 TANGLEWOOD LA QUINTA,CA 92253 Subdivision: TR 21846-2 Block: Lot: G99 Issued: Lot Sq Ft: 0 Building Scl Ft: 0 Zoning: Finaled: Valuation: $900.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 'No. Unites:0 92211 (760)296-3843 Details: WATER HEATER CHANGE OUT - 40GALLON/GAS [2013 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2013 CALIFORNIA BUILDING CODES DRIVE GONDITONS FINANCIAL INFORMATION ,... Printed: Tuesday, January 27, 2015 9:42:26 AM 1 of 2 SYSTFMS LCOMMUNITy DEVELOPMENT uE► An i mtry 1 1 CONT NAME TYPE' %. NAME ADORESSi '. 'CITY" 'STATE ZIP° . - PHONE. FAX' <EMAIL ' APPLICANT STATEWIDE SERVICES INC DBA STA 73804 DINAH SHORE PALM DESERT CA 92211 (760)296-3843 DRIVE CONTRACTOR . STATEWIDE SERVICES INC DBA STA 73804 DINAH SHORE PALM DESERT CA 92211. (760)296-3843 DRIVE OWNER COLLINS, JOHN 44 1550 LARKHALL VANCOUVER BC V7H2Z2 (760)296-3843 CRESCENT NORT FINANCIAL INFORMATION ,... Printed: Tuesday, January 27, 2015 9:42:26 AM 1 of 2 SYSTFMS LCOMMUNITy DEVELOPMENT uE► An i mtry 1 1 PARENT PROJECTS .�....., i. „„ ... BOND INFORMATION ... .. ,,,, . ATTACHMENTS ILI PAID DATE, # s CHECK # 75 METHOD PAID BY:- DESCRIPTION ACCOUNT QTY AMOLfNT n: Mme, yPAID M» ..RECEIPT BY - BSAS SB1473 FEE 101-0000-20306 0. $1.00 $0.00.! Total Paid forBUILDING STANDARDS ADMINISTRATION $1.00 $0.00 BSA: PERMIT ISSUANCE 101-0000-42404 0 $91.85 ` .$0.00 Total Paid for PERMIT ISSUANCE: $91.85 $0.00 WATER HEATER/VENT 101-0000-42401 0 $12.09 $0.00 WATER HEATER/VENTPC 101-0000-42600 0 $7.25 $0.00 Total Paid forPLUMBING FEES: $19.34 $0.00 TOTALS:• i0 PARENT PROJECTS .�....., i. „„ ... BOND INFORMATION ... .. ,,,, . ATTACHMENTS ILI „ E NTS Printed: Tuesday, January 27, 2015 9:42:26 AM 2 of 2 C� - . SYSTEMS Bin # Qty of LQ Quints Building & Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking heet Permit # L �>,� - - - Project Address.. Owner's Name: A. P. Number: Address:� t `7 Legal Description: Contracto old City, ST, Zip: —axlri Telephon to oto Address. �j Project Description: City, ST, Zip: cco ," l t)(�-b(4 Telephon State Lic. # . City Lic. #: Arch., Engr., Designer: Address: City., ST, Zip: Telephone: «;Construction State Lic. # ,< Name of Contact Person: + , " Type: Occup ancy: Project type (circle one): New Add'n Alter Repair Demo Sq. Ft.: #Stories: T# Units: Telephone # of Contact Person: ©j w 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 Cales. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2°" Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- '"° Review, ready for correctionslissue Developer Impact Fee Planning Approval Called Contact Person A,I,P,P, Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees JAN 06 2015 : D . CITY OF LA QUINTA COMMUNITY DEVELOPMENT A"