BMCH2014-108378-495 CALLE.TAMPICO
LA QUINTA, CALIFORNIA 92253
TAtit 4 a w
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number:
BMCH2O14-1083
Property Address:
78325 TERRA COTTA
APN:
93021
Application Description:
REPLACE 40 GALLON ELECTRIC WATER HEATER
Property Zoning:
Application Valuation:
LA QUINTA, CA 92253
Applicant:
A R S AMERICAN RESIDENTIAL SER
965 RIDGE LAKE BLVD STE 201
MEMPHIS, TN 38120
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, C42, A License No.: 765155 �� i
Date: 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 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
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 fora
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 Name:
Lender's Addre:
VOICE (760) 777-7125
FAX (766) 777-7011
INSPECTIONS (760) 777-7153
(910)271-9700
Llc. No.: 765155
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 ork 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 become subject to the
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with those provisions.
Date: f%i �y Applicant:
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 y�n�e above-
mentioned property for inspection purposes. I
Date: J ' I& ' Ff— Signature (Applicant or Agent)
Date: 9/16/2014
Owner:
ANNA MARTIN
W
78325 TERRA COTTA COURT
Cr
LA QUINTA, CA 92253
c
o
Q N
z
LU
�a
Contractor:
Q
LL w
O
v
LU
A R S AMERICAN RESIDENTIAL SER cn
c� Z
965 RIDGE LAKE BLVD STE 201
MEMPHIS, TN 38120
(910)271-9700
Llc. No.: 765155
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 ork 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 become subject to the
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with those provisions.
Date: f%i �y Applicant:
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 y�n�e above-
mentioned property for inspection purposes. I
Date: J ' I& ' Ff— Signature (Applicant or Agent)
FINANCIAL ••
•
T r DESCRIPTION r t,w'ACCOUNT
QTY
AMOUNT
PAID'
PAID DATE
WALL HEATER
1010000-42402
0
$24.71
$24.71
9/16/14
�_ `; tPAID BY p•�. { r a„
*'?+ METHOD
'.'`RECEIPT #
CHECK #'
CLTD BY
' RESCUE ROOTER
CHECK'
R1209
6395
SKH
;;DESCRIPTION z x .w :,.,
; '� ACCOUNT °'
QTY;
'AMOUNT
PAID - `'
PAID DATE
WALL HEATER PC
101-0000-42600.
0
.$12.09,
$12.09
9/16/14
P416ii, k- yi
?-' ;.RECEIPT,#
CHECK #
CLTD BY
,METHOD
,'
RESCUE ROOTER
CHECK
R1209
6395
SKH
Total Paid forMECHANICAL: $36.80 , $36.80
x- DESCRIPTION }y�R rk
: ACCOUNT c+ '
QTY
a 'PAID .
'PAID DATE
4
,,'AMOUNT
PERMIT ISSUANCE
101-0000-42404 1
0
$91.85- "
$91.85
9/16/14
l" PAID BY •
n METHOD `' �` •' "'}
r' RECEIPT# �' '
' ` CHECK # c+
"CLTD BY'
.,
RESCUE ROOTER
CHECK
R1209
6395
SKH
Total Paid for PERMIT ISSUANCE: $91.85 ' $91.85•
TOTALS:
i
Description: REPLACE 40 GALLON ELECTRIC WATER HEATER
Type: MECHANICAL Subtype: Status: SUBMITTED Applied: 9/16/2014 SKH
Parcel No: 93021 Site Address: 78325 TERRACOTTA LA QUINTA,CA 92253 Approved:
Subdivision: Block: Lot: Issued:
Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled:
Valuation: $0.00. Occupancy Type: Construction Type: Expired:
No. Buildings: 0 No. Stories: 0 No. Unites: 0
Details: WATER HEATER CHANGE OUT - 40GALLON/ELECTRIC [2013 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO
FINAL INSPECTION. 2013 CALIFORNIA BUILDING CODES.
DESCRIPTION ACCOUNT QTY AMOUNT' PA ,
t. - - ', ID I„ PAID DATE RECEIPT # METHOD PAID BY CLBTD
WALL HEATER 101-0000-42402 0 $24.71 $24.71 ,,9/16/14 R1209 6395 CHECK RESCUE ROOTER SKH
Printed: Tuesday, September 16, 2014 2:38:06 PM 1 of 2 _ CB?SYS7EM5
SEQID+ sINSPECTION.TYPE.: INSPECTOR'.',,'r, SCHEDULED: COMPLETED RESU
LTi :REMARKS NOTESY "
DATE DATE
MECHANICAL FINAL** _
PARENT PROJECTS
REVIEWS
... RETURNED ._" STATUS +.. REMARKS NOT - -�
`REVIEW TYPE w «, .REVIEWER,` SENT DATE DUE DATE L ES'
• 4 F ;DATE _ , m
BOND
INFORMATION
ATTACHMENTS
7 yPernift
Details'
PERMIT
NUMBER'
--
SMEH
e 1 o:
o�of
La,-QUifita
DESCRIPCLTD
TION{ + }
x.� ACCOUNT " 4.'QTY
.$ AMOUNT
�' PAID ,.
PAID DATE;
RECEIPT#'
.`CHECKq!'METHOD
.PAID BY }.BY
WALL HEATER PC
101-0000-42600
0
$12.09
$12.09
9/16/14
R1209
6395CHECK
RESCUE ROOTER
SKH
Total Paid forMECHANICAL:
$36.80
$36.80
PERMIT ISSUANCE101-0000-42404
0
$91.85
$91.85
9/16/14
R1209
6395
CHECK
RESCUE ROOTER
SKH
Total Paid for PERMIT ISSUANCE:
- $91.85
$91.85.
..
TOTALS:
$128.6S
$128.6S
SEQID+ sINSPECTION.TYPE.: INSPECTOR'.',,'r, SCHEDULED: COMPLETED RESU
LTi :REMARKS NOTESY "
DATE DATE
MECHANICAL FINAL** _
PARENT PROJECTS
REVIEWS
... RETURNED ._" STATUS +.. REMARKS NOT - -�
`REVIEW TYPE w «, .REVIEWER,` SENT DATE DUE DATE L ES'
• 4 F ;DATE _ , m
Printed: Tuesday, September 16, 2014 2:38:06 PM 2 of 2 Cr
SYSTEMS
BOND
INFORMATION
ATTACHMENTS
Printed: Tuesday, September 16, 2014 2:38:06 PM 2 of 2 Cr
SYSTEMS
Bin #
City Of La Quinta
-Building &r Safety. Division
P.O. Box `1504, 78-495 Calle Tampico .
La Quints, CA 92253 - (760) 777-7012 "
Building Permit Application and Tracking-Sheet
Permit #
Project Address:
, $3 Z5 14ft t (..� � c.-t-
Owner's Name: PtOWN M �J
A. P. Number:
Address: 7 -J3 Z f Te r.- 1 C •`fib 49"-
9`Legal
LegalDescription:
City, ST, Zip: L.A Qul� t.� $ 12
Contractor: ¢ r
Telephone: iG
p 'Z � (i Z
Address: 5 2 0 ` N12 S T
Project Description: VJ ti e
City, ST, Zip: R "v % C.A9 3 i 1
40 ( eta
Telephone: , s 13%it g 1)1 1
:.:::..........:.. •...;:-:.
State Lic. # : �p ep^ tI S�
City Lie. #-.
Arch., Engr., Designer:
Address:
City, ST, Zip.
Telephone:
::A.>.:::::;.;::;::"<:.;,•:! :
Constructioni Type: Occupancy:
State Lic. #:
`..
:.<"r:�<>.>;:�:>•<;;;.s-�<-.>:;-.;:ww:�_<.�a";
Project type (circle one): New Add'n . Alter Repair Demo
Name of Contact Person: DM+/�t /
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: 1,7--D2 '742 (#11
Estimated Value of Project: 1-705—
%p5—
APPLICANT:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKNG
PERMIT FEES.
Plan Sets
Plan Check submitted
Itein
Amount
Structural Cates.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance •
Title 24 Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2p' Review, ready for correctionsfissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'rd Review, ready for correctionsfissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees