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BPLB2015-0084
78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT Application Number: BPLB2015-0084 Property Address: 47165 VIA ANTIBES APN: 643160022 Application Description: POULSEM RESIDENCE WATER HEATER CHANGE OUT Property Zoning: Application Valuation: $800.00 Applicant: ?FJ Lr=L1 ALL STAR WATER HEATERS INC 30300 PUERTO VALLARTA WAY N 2 3 2015 MENIFEE, CA 92584 LU CITY OF LA QUINTA COMMUNITY DEVELOPMENT DEPARTMENT 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.: 812894�— Dat�f� 2 �7 Contractor OWNER LDE EEGiTiATION 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 ) 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.). (__j 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 Name: Lender's Address: VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 6/23/2015 Owner: RONALD POULSEM 47165 VIA ANTIBES LA QUINTA, CA 92253 Contractor: ALL STAR WATER HEATERS INC 30300 PUERTO VALLARTA WAY. MENIFEE, CA 92584 (951)301-0067 LIc. No.: 812894 • 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 becom o the workers' compensation provisions of Section 3700 of r Code, I shall fo ith__ comply with those provisions. . Date./LlL-.24—lf 'Applicant: WARNING: FAILURE'TO SEC E WORKERS' COMPENSATION COVERAGE 15 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: oll _f_<l/ Signature (Appli or FINANCIAL INFORMATION s . il"L' ,-QTY `E `*AMOUNT, ” ' g„DESCRIPTION :'%r PAID � p F r PAID DATE � ,ACCOUNT Y A BSAS SB1473 FEE 101=0000-20306 ' 0 $1.00 $0.00 k E' 0 ' ab : PAID_BY t :; a �F ,z� METHOD s,¢ F RECEIPT # CHECK # .,. CLTD BY q - Total Paid for BUILDING STANDARDS ADMINISTRATION BSA $1.00 $0.00 4. € `" r:gDESCRIPTION s. 'ACCOUNT QTY'Y „,AMOUNT °Y -PAID PAID DATE' xi PERMIT ISSUANCE 101-0000-42404 0 $91.85 $0.00 # PAID BY METHOD r` EIPT #, ��w * m CHECK # u CLTD BY G dx �' %. a. � s fisc Total Paid.forPERMIT ISSUANCE: $91.85 $0.00 DESCRIPTION �* ' ` ACCOUNT` �' 4 � � ;QTY' " AMOUNTr, PAIf)'DAT6 * rv� r y ti E u9 WATER HEATER/VENT 101-0000-42401 0 $12.09 $0.00 a R D BY PAI RECEIPT # ; # '¢ CLTD 1k i a CHECK srfk DESCRIPTION r '`: ACCOUNT '' ; t� QTYK ':..t� tsAMOUNTPAID*j PAID'DATE 41 WATER HEATER/VENT PC 101-0000-42600 0 $7.25 $0.00 ,METH RECEIPT# CHECK# CTD BYta f SOD- � Total Paid forPLUMBING FEES: $19.34 $0.00 TOTALS:i0 Bin # L-1 City of La Quinta Building 8r Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012. Building Permit Application and Tracking Sheet Permit # �P k-&2-© 1.11c,06 Project Address: Owner's Name: l A. P. Number: Address: Vt' A Legal Description: City, ST, Zip: U A1/ o C�Z� Contractor: Ql Tele P ho e: Address: Project Description: City, ST, Zip: co,a� Te lePhon a a a State Lic. # : Arch., Engr., Designer: City Lic. #: Address: City., ST, Zip: Telephone: le one: P n Co stru ction T YP e: Occupancy: Occu Y•' State Lic. # Project hPa (circle one New. Add' nAlter Repair air Demo Name of Contact Person: ` 10 Sq. Ft.: #Stories: # Units: Telephone # of Contact Pers n. rj Estimated Value of Project: O', Off" APPLICANT: DO NOT WRITE BELOW THIS LINE I Submittal Req'd Rec'd TRACKING I 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 2qd 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:- 3' 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 r ... .... ... . .. .6. A.:QEW RALOWN". .. .F..a..m.....i.l..i.-...Q........................... ........................ ..... ..w....e....l. ." .................. ... ... Sire address ....... . ........... . . . . . . . . . . . . . . . . . . . . . . . . . . l.ng. h;fi -7..-......�. ITy Ld— -ng1p.... OMultFamily Dwellings s o.td �x .A iha6one:Z .. ........ . ......... .................. ....... ........... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ....... . ...... .... w: A.....4...... :7 ..... .... . :... . # .. Fuer' -w H.d atng ........ ..rcy '.., : n tkal:: Dwellin Heating: ... ...... ........ Heating eater Meat" input Input Efficiency . 'LosROM nsuf.or Solarp DHCWe System Unt DHW Type .Heaters.:::-i ........ s.W..t.. c.,g.-e I .. .-T�pg Value 'Type Value RNalue Sayings btti n System , Type in -- Volume T Type bfiib •n or w ..... . 1-1 Ty -p-e .... ....... ........ .. ......... ...... ...... ...... .... ... ..... W Vw .... ... . . ... . ..... ........ .. .. 4.11 ......... .... .. . . ........... ... ......... W e tg ing..compliance Arinstantaneous,", ,,be�Ui.... . i....w..i.lI e 'S Section Unit"; u—�46 0t 9`4 n-w-w-,it-'teI systems. h r FnTnatura..'gas�.connecte ellmgzg4o,p. srr Aqtl:.e�.i feies idteti . ..... ... rqC,, Lame 6. ..... ..... *, i t ora�e.,t P4 . x -forxos..,. t e ..... .. ni k`6f g0 gallons - propaneW4te . iiaxlmum r. e M _!;M!pyM5N .. .... 9 a V. m. -I. . w ... ...... w .., .4 . . .. systems::rnust,Use,certi i e*4 quipmen. .as� fie d d ion.- OiA ' :not,, ,the OTMF1R=NC6 01 to document the water beater alte[ation_; 'Instructions for=s166 i Water Heating System iderrtification .. er heating system, . e:; Romesttc .. .... ... or .,en er.,Se�.,Oniqu: Hot;UVater; OH name.for the Water Heating System ' 0t,Water,; - hVd-: ionclsa�Vater ........ ,. L3t . used for space heating only; ' combinedsystem rbfitcareww en..,.t ........... ...... T.W.Pp BoilerU.�,.,::L ........... ...... . ........... ...... .... .. ...... ........... .. ...... .. ...... ....... 6d -fd be ... ........ . . .. ... .... . ....... .................. CERTIFICATEOF COMPLIANCE_ CIFIRAILT-0-1: HEATER Prescriptive e"hit Residential Water 'Heater ..... ... 0 ... .......... .... ....... . ....... . ...... ... ..... .............. ...... ........ .... .............. ...... ..... ..... 4. YOM: 0�� nits . a,,systoirrit qk fj 6q*�@q;f M4447 I -W-4 er -&rite i serving lmotplc Aw'e" !punrts— h .... .. ... ...... t tot# .. ...... ... .. . ent0:1 e4 "d I' ---gallons........... . Ili, IF -thii -.60" NJ ua, ateffea morw Welting -o :multrfam lycentral n#Msf.eqferAhe,,t!#?j*qr Me, ............ 6`.: FuetType. Gas, Propane Electric (Only if natural gas isnot available) :: •• - Rated -Enterthf.-gq M- -p ,jmpui:tit% -�-Vy'pe;.. .Orpr..qp.. ane fll� e Y##M th6lUhits are kW: 9.: Heating EffiaencyType Energy Factor, AF.UE or.TFiermal;Ef>iciency <From;product literature or a`Calrfornia Ener" '-: omin on", I ,:10. Heating Effie}envy Value Enter the value from product literature or'a Cal�fomia Energy Commission;directory r..:':.11, Standby loss (percent) Apptiesronty�,to largestorage water heaiers,,EnternJa forsmaif storage or mstantaneou_s,waterheaters;. • 12 ExtenorYlnsulation. .. . . . . . . . . . op ins ........... ......... 10-111111 eXanic isinstaildid 13. Back-up solarsavmgs fraction of compliance requires .. . .- .. p k ...P. Ip.._....I..._._.t_ e.-. .-e..,sQ .ar contribution .. �O... .. . 0.30.�)!:!.. w.tkdr 6 1��calculations.1 - wired. ..q ::. :-.. .... .: 14. Central .. ... ysepormutk any,h u§ - .gfoYy� tli,atleast jtwo , .... ' ' ie loaps; . .. ... ... Ou ThAP?9�Xq,4nyU.; iqgmdi ornoreu ,j ty ift�ismomcentq�q .... �-- .... D HW IAI. --and R Vri t, -Distfi .... .......... "-C 00%0 et" lotion,;:Sensor Gontrol::lf,,;non-.central e OL ed t !Aa .. . ...... .. STATEMENT, . .. .... ...... .. .... .... ..... ..... ... .... .. ........ 'rniffl4hce ............ ... 40; e.;:*.... y. Otthk t*Wi X -o ocu ra e 4h 'jmmp ........ .................. -.- ........... d" ... .. ' ..... ....... ....... .... ........ ...... . .. ..... ........ ..... ...... .... .. .... - Name:,t:: A' h d crit oContraetor Si natu? .. ... en� . .. - ---- - ........'... - . . .. . .. . . . .................. . - .. .... .. ..... ................ . .... Company t . � .. :.P�Oicen Address30300 Puerta Valletta bne . -9513010067......... Ct/State/ZimMenifeeC90:z; . A ... —Z. .. .......... ........ ...... ..... w. ............. .... ...... — :x—, vm* 4ouassistahce or:q :11� Standards, contact the:Ene ... . .... ...... .72-3.300.' .... . ........... ...... .... .... gy lfq�!ineat.-I-g OG -7 .. .... ...... ...... ......... ......... ...... .... .. r� " P.e,%1'Y1.It., DE?ta,1�5 0.PERMIT NUMBER .... City of LaQuin.t`a BPEB2®��5�a84. Description: POULSEM RESIDENCE WATER HEATER CHANGE OUT Type: PLUMBING Subtype: Status: APPROVED Applied: 6/23/2015 EVA Parcel No: 643160022 Site Address: 47165 VIA ANTIBES LA QUINTA,CA 92253 Approved: 6/23/2015 EVA' Subdivision: TR 26152 Block: Lot: 148 Issued: Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled: . Valuation: $800.00 Occupancy Type: y Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 Details: WATER HEATER CHANGE OUT - 40GALLON/GAS [2013 ENERGY] CARBON MONOXIDE ALARMS) TO BE INSTALLED PRIOR TO FINAL ' INSPECTION. 2013 CALIFORNIA BUILDING CODES. ADDITIONAL -SITE FINANCIAL •' + • . Printed: Tuesday, June 23, 2015 11:03:32 AM 1 of 2 _ CRWIYSTEMS CHRONOLOGY CONTACTS :NAME TYPE ;NAME'-: ADDRESSl - CITY_` STATE ZIP PHONE ' FAX APPLICANT ALL STAR WATER HEATERS INC 30300 PUERTO MENIFEE CA 92584 (760)564-4193 VALLARTA WAY CONTRACTOR ALL STAR WATER HEATERS INC .30300 PUERTO MENIFEE CA 92584 (760)564-4193 VALLARTA WAY OWNER _ RONALD POULSEM . _ • 47165 VIA ANTIBES I LA QUINTA I CA 1 92253 1 (760)564-4193 FINANCIAL •' + • . Printed: Tuesday, June 23, 2015 11:03:32 AM 1 of 2 _ CRWIYSTEMS p, = �', ACCOUNT ''; QTY;- 'AMOUNT PAID."'„ `PAIDDATE.: RECEIPT #, •CHECK #.s ^ "` BY a;' CLTD". ,'DESCRIPTION y ... uOW Vie++43- ,METHOD ,,PAID , 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 for PLUMBING FEES: $19.34 $0.00 TOTALS:00 PLUMBING FINAL" PARENT PROJECTS REVIEWS _-m.__ ..._...•_.. - _ .... ..... Printed: Tuesday, June 23, 2015 11:03:32 AM 2 of 2 i. SYS7Elv1S