BPLB2015-008778-495 CALLE TAMPICO, IV.% 7 �" VOICE (760) 777-7125
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011
COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 6/26/2015
Application Number: BPLB2015-0087 Owner:
Property Address: 79940 TANGELO THOMAS HILL .
APN: 776230020 P 0 BOX 719
Application Description: HILL / CHANGE OUT (1) 40 GALLON GAS WATER HEATER LA QUINTA, CA 92253
Property Zoning:
Application Valuation: $1,810.00
Applicant:
TOMMY ROOTER PLUMBING INC
80975 INDIO BLVD #C3
INDIO, CA 92201
M 3 0 2015
CITY OF LA QUINTA
COMMUNITY DEVELOPMENT DEPARTAIENT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing with Section 70001 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: ( — 3b Contractor:
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 fcr 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 isnot 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. - . BAP.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:
Contractor:
TOMMY ROOTER PLUMBING INC
80975 INDIO BLVD #C3
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'
compensation, as provided for by Section 3700 of the Labor Code, for the performance
e rk for which this permit is issued.
cthave and will maintain workers' compensation insurance, as required by
,300 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,
shall not employ any person in any manner sous 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.
Date: LAC) — (S Applicants,
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, an4
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 correc.
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: 3� b- G Signature (Applicant orA - :1
I
FINANCIAL PNFORMATION
P,fACCOUNT dN' ��,AMCIUNTe,, PAID.tk:i�,�;,i"PA6DATIf
BSAS SB1473 FEE 101-0000-20306 0
$1.00 $0.00
ici f !CHECK # CLTDBY':�
A BY, EIPT4
�vw',RE
Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $1.00 $0.00
DESCRIPTION
ACCOUNT"
!AMOUNT
PAID!,,-,
PAID DATE
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
f
,.METHOD
'RiCElPf
CHECK #
CLTD BY
Total Paid.forPERMIT ISSUANCE:. $01.85 $0.00
DESCRIPTION
-A
ACCOUNT''
QTY
AMOUNT
0
`PAI.D7
DATE
-,,-,,,Am
-PAID
WATER HEATER/VENT
101-0000-42401
0
$12.09
$0.00
4- "PAID BY
-'.METHOD,,
RECEIPT.-#
CHECK
CLTD BY,
-�.DESCRIPTION
ACCOUNTL,�
QTY
AM
AMOUNT"
PAID
.,
.PA,ID,;DATE
WATER HEATER/VENT PC
101-0000-42600
0
$7.25
$0.00
Y -, �.- . `,' 5:-' 1 MI.
"1 . .1i�
4 METHOD )µ4
11- 4 ,
. ECEI
� . - 11
CHECK#.,
CLTD BY-A
Total Paid for PLUMBING FEES: $19.34 $0.00
TOTALS: $112.19 $0.00
OF
Description: HILL / CHANGE OUT (1) 40 GALLON GAS WATER HEATER
Type: PLUMBING Subtype: Status: UNDER REVIEW
Applied: 6/26/2015 SKH
Approved:
Parcel No: 776230020 Site Address: 79940 TANGELO LA QUINTACA 92253
Subdivision: TR 24890-3 Block: Lot: 20
Issued:,
Lot Sq'Ft: 0 Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $1,810.00 Occupancy Type: Construction Type:
Expired.
No.. Buildings: 0 No. Stories: 0 No. Unites: 0
Details:. WATER HEATER CHANGE OUT - 40GALLON/GAS [2013 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLEDPRIOR TO FINAL
INSPECTION. 2013 CALIFORNIA BUILDING CODES.
Printed: Friday, June 26, 2015 2:23:07 P . M 1 of 2 03"WSYSTEMS
ADDITIONAL SITES
CHRONOLOGY
CONDITIONS
CONTACTS
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APPLICANT
TOMMY ROOTER PLUMBING INC
80975 INDIO BLVD #C3
INDIO
CA
92201
CONTRACTOR
TOMMY ROOTER PLUMBING INC
80975 INDIO BLVD #'C3
INDIO
-CA
92201
OWNER
THOMAS HILL
P 0 BOX 719
LA QU I NTA
CA
92253
Printed: Friday, June 26, 2015 2:23:07 P . M 1 of 2 03"WSYSTEMS
77 77 7
LTD
".DESCRIPTION:,
* ACCOUNT`
QTY
;AMOUNT
PAID
'is.
PAID DATE
RECEIPT#
CHECK#
METHOD
`',PAID BY +
'
:.
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 forPLUMBING FEES: $19.34 $0.00
TOTALS:00
SEQID ; .;INSPECTION TYPE -,INSPECTOR SCHEDULED COMPLETED' RESULT.' ' ".` .REMARKS NOTES
. * ,DATE,.. DATE` `
PLUMBING FINAL" BLD
PARENT PROJECTS
BOND INFORMATION
Printed: Friday, June 26, 2015 2:23:07 PM 2 of 2 C SYSTEMS
06/06/2013 THU 15:09 IMAX La Quinta Sldg 6 Safety ja001/001
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Sullding.erSafety DhisW
Permit #,pPA
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La Qdn4. CA 92255 - (760) 777.7012
wilding Permit Application and Tracking Sheet
Prc jwA Address: a t) . Owner's Name: �p
A. ?.Number
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A PEIJALTY WILL BE C11RiDUED 4T -4111E. -AM OF 111`% PER WITH Oil
UNPAID MAN= AMER SODA TSf)F.ItJVQiCEDAMANNUALPERCENTAGE
RATE 18%. RETURNED CHECK FEES;2SOQ' .'
find the t1rw and maleaial ehwped above irtisfacdwy and agree to pay
for same on pmsanlaliom of irn ii a, and,rurt w agres to pay reasonable
charged for colWlan Includlag attnneys fres in the event of my cWaWt.
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❑CASH ❑ C.C.❑BILL ❑ CHECK # ❑ X
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Prescrl tive..Certiticate of Compliance: Residential CF-tR-ALT-Dtrw
Residential Alterations Page I of 2 j
Project Name: 0 a l7 Climate Zone: Permit #
Generul information
Site Address: EnfolreM'ent A enc : .. Date:
Building Ty ii O Nfuiti Family Pfo'eca T R tacettient or Change Out of Water Heater
WATER HEATING
• I certify this this Ceri►ficate of Compliance documentation is accurate and complete. • '
List newly lhaWled water bearers anQ boilers for both dornestic hot water heaters (DiVH) and by -ironic space heating. Newly fnstalled
DWH heaters and boilers tnust•be gas, pro e, orjae.the.eristin htel w e.
Distribution Type
Water Heat' •. Npmber (n Tank
Typr/Fuel Type' Riicim d td. d. tem Capacity (gal)
'Energy Factor of
Thermal EETici�eney
conform to the requirements of Title i* Partl and 6 of ti4catilfomia Code of Regulations.
F.xtemal Tante
Insiilatlat
R-Valuo'
bulldirig design on the other applicable compliance forms..workshects, calculations, plans and specifications subniltted to the
enforcement a enc . fbr approval with this building permit application.
Company:
Date:
i� '11 ^ i.s
Address:
Licenses
o-1:1
(q3o 13
City/StatetZip_
Phone:
I: Indicate Type (Storage Qs, -Hear Pump. Instantaneous, e(r_)
2. Recirentatiq system serving ►nttltiple dwelling runts shall ineei the reciietdadon requirements of §150(n).
requirements donor allow the installatfon of a recirculating water heating system for single &veiling units.
3. lite ecternat•waterhearin tank and E!Res shall be insulated to meet the re uirements o ISt1 .
ne Prescriptive
Contractor or Homeowner (Documentation Author's/Responsible Building Designer's Declaration 5taterneitt)
• I certify this this Ceri►ficate of Compliance documentation is accurate and complete. • '
• I am eligible under Division 3 of the California' Husinem and Pre fesslons 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 design identified on this Certificate of Compliance
conform to the requirements of Title i* Partl and 6 of ti4catilfomia Code of Regulations.
. The building design features Identified on'this Certificnte of Compliance are consistent with tries 4iformation provi4cd to document this
bulldirig design on the other applicable compliance forms..workshects, calculations, plans and specifications subniltted to the
enforcement a enc . fbr approval with this building permit application.
Company:
Date:
i� '11 ^ i.s
Address:
Licenses
o-1:1
(q3o 13
City/StatetZip_
Phone:
v
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