BPLB2015-0090`6 4VOICE (760) 777-7.25
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT
INSPECTIONS (760) 777-7_53
BUILDING PERMIT
a
Date: 7/13/2015
Application Number: BPLB2015-0090 Owner:
Property Address: 79297 SIGN OF SPRING MICHAEL DEBATES
APN: 600420035 79297 SIGN OF SPRINGS ,
Application Description: DEBATES RESIDENCE WATER HEATER CHANGE OUT LA QUINTA, CA 92253
Property Zoning:
Application Valuation: $1,000.00
Applicant:
CAMPESINOS UNIDOS INC
P 0 BOX 39
BRAWLEY, CA 92227.
3�30lyrvnW���
iN� �ibaadlN ��� VIP
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: B. C36 License No.: 6181
Date: ` � r(� 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 3
of the Business and Professions Code) or that he or she is ekempt 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 Name:
Lender's Address:
Contractor:
CAMPESINOS UNIDOS INC
P 0 BOX 39
BRAWLEY, CA 92227
(760)344-4500
Llc. No.: 618140
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 workEs'
compensation, as provided for by Section 3700 of the Labor Code, for the performence
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 subjectto the worker'
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
co�r%yw ith those provisions.
Date: Appl�ic
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP -0
ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CDDE,
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 permi-
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 wort is
not commenced within 180 days from date of issuance of such permit, or cessaticin 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 bu.ilding
construction, and hereby authorize representatives of this city to enter upon the above•
me\t1l0J�ed propert/y for inspection purposes.
Date: ,(� Signature (Applicant or A `
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Total Paid'forPERMIT ISSUANCE ; ::" ' /$91 85 $9,1:85 '
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DESCRIPTIONS
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R7675
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Total Paid forPLUMBING;F'EES ',-' $55 60 ,.'- $55.60 ,
Bin #
City of La Quint'a
Building a Safety Division
P.O. Box 1504, 78-495 Calle Tampico
00La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: -79P/2- 17;�h G D s�r;Owner's
Name: G 11 (?
A. P. Number:
Address: 7�77
Legal Description: /
Contractor& �/l t
--� %1,Os %t
City, ST, Zip: 4� VV% 'p %Z��
t
. / N"'
Telephone: ��vr_ 6S �7� �•r•;'•:�::��-;���4x.��;,:
Address: (�� 3
Project
Project Description:
City, ST, Zip: , t✓ ��� 7
a C
Telephone:X
> >:>: :.:.::.:r.:.:,:rv::•. K:.::::
State Lic. #
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
P
f.�y.?<,v>
.....................:
Construction Type: Occupancy:
State Lic. #:v;a
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. FL:
# Stories:
# Units:
Telephone # of Contact Person: 76 0 : �
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 Calcs.
Plans picked no
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2"! Review, ready for correctionslissue
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 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
Description: DEBATES RESIDENCE WATER HEATER CHANGE OUT
Type: PLUMBING Subtype: Status: ISSUED
Applied: 7/13/2015 EVA
Approved: 7/13/2015 EVA
Parcel No: 600420035 Site Address: 79297 SIGN OF SPRING LA QUINTA,CA 92253
Subdivision: TR 31311 Block: Lot: 62
Issued: 7/13/2015 EVA
Lot Sq Ft: 0 Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $1,000.00 Occupancy Type: Construction Type:
Expired: 1/9/2016 EVA
No. Buildings: 0 No. Stories: 0 No. Unites: 0
Details: WATER HEATER CHANGE OUT - 40GALLON/GAS [2013 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL
INSPECTION. 2013 CALIFORNIA BUILDING CODES. -
FINANCIAL INFORMATION
Printed: Monday, July 13, 2015 9:50:55 AM 1 of 3
- SYSTEMS
ADDITIONAL
CHRONOLOGY'
CONDITIONS',
NAME TYPE
� NAME"
..tADDRESSi
;CITY
STATE
ZIP; - ¢PHONE f FAX` EMAIL
APPLICANT
CAMPESINOS UNIDOS INC
P O BOX 39
BRAWLEY
CA
92227
(760)565-8072
CONTRACTOR
CAMPESINOS UNIDOS INC
P O BOX 39
BRAWLEY
CA
92227
(760)565-8072
OWNER
MICHAEL DEBATES
79297 SIGN OF
LA QUINTA
CA
92253
(760)565-8072
SPRINGS
FINANCIAL INFORMATION
Printed: Monday, July 13, 2015 9:50:55 AM 1 of 3
- SYSTEMS
}DESCRIP,TION
"' 4'>
"'
":
,•'F
ACCOUNT
CITY
AMJOUNT
PAID
PAID'DATE
RECEIPT#•
T,CHECK#;,z
a
METHOD
PAID BY,
BY
s
BSAS 561473 FEE
101-0000-20306
0
$1.00
$1.00
7/13/15
R7675
6721
CHECK
CAMPESINOS UNIDOS
EVA
INC
Total Paid for BUILDING STANDARDS ADMINISTRATION $1.00 $1.00
BSA:
PERMIT ISSUANCE '
101-0000-42404
0
$89.79
$89.79
7/13/15
R7675
6721
CHECK
CAMPESINOS UNIDOS
EVA
INC
PERMIT ISSUANCE
101-0000-42404
0
$2.06
$2.06
7/13/15
R7676
CASH
CAMPESINOS UNIDOS
EVA
INC
Total Paid forPERM1T ISSUANCE: $91.85 $91.85
GAS SYSTEM, 1-4
101-0000-42401
0
$12.09
$12.09
7/13/15
R7675
6721
CHECK
CAMPESINOS UNIDOS
EVA
OUTLETS
INC
GAS SYSTEM, 1-4
101-0000-42600
0
$24.17
$24.17
7/13/15
R7675
6721
CHECK
CAMPESINOS UNIDOS
EVA
OUTLETS PC
INC
WATER HEATER/VENT
.101-0000-42401
0
$12.09
$12.09
7/13/15
R7675
6721
CHECK
CAMPESINOS UNIDOS
EVA
INC F
WATER HEATER/VENTCAMPESINOS
101-0000-42600
0
$7.25
$7.25
7/13/15
R7675
6721
CHECK
UNIDOS
EVA
PC
INC
Total Paid forPLUMBING FEES: $55.60 $55.60
TOTALS:
PARENT PROJECTS
Printed: Monday, July 13, 2015 9:50:55 AM. 2 of 3
CRWlYSTEMS
30ND
INFORMATIC
ATTAruAACRITC
Prescriptive Certificate of Compliance: residential CF-IR-ALT-DHW
Residential Alterations Page I of 2
Project Name: Climate Zone: Permit #:
General Information
Site Address:
Enforcement A enc : t,.,l v,,ot a Date: - ✓$'
Building T Sin le Ffamily ❑ Multi Family
Project T Re lacemcnt or Change Out of Water Heater
WATER HEATING
•rI certify that this Certificate of Compliance, documentation is accurate and complete.
'responsibility.
List newly installed water heaters and boilers for both domestic hot nater Beaters (D WH) and h dronic space heating.
DWH heaters and boilers must be gas. pro ne: or use the existing uel type.
New/r installer!
Disuibutiar Type
Water. Heater Numbc7ln Tank Etiergy.Factorcx
Type/Fuel Type' (Standard. i System Capacity (Sal) Thermal Efficiency ,
Recinculati )
External -Tank
Insulation
R -Value•
l G /
i6
enforccruent'i9ency for approval with this building permit application.,
Name: ,,S�Signature:
1. Indicate Type (Storage Gas, Heat Ptunp. Instantaneous. etc.)
2. Recirculating systents serving multiple dwelling units shall ineet the recirculation requirements of • §150(n).
requirements do not allow the installation of a recirculating Nater heating sistem for single dwelling units.
3. The erterna/ Nater heating tank and pipes shall be insulated to nteet the re uireinents off 15
The Prescriptive
Contractor or Homeowner (Documentation Author's/Responsible Building Designer's Declaration Statement)
•rI certify that this Certificate of Compliance, documentation is accurate and complete.
'responsibility.
• 1 am eligible under Division 3 of the California Business and Professions Code to accept for the building design
identified on this Certificate of Compliance.
• 1 certify that the energy features and performance specifications for the building design identified on this Certificate of Com_ pliancn-
conform to the requirements of Title 24. Parti and 6 of the California Code of Regulations..
• The building design features identified on this Certificate of Compliance are consistent with the information provided_ to document this
building design on the other applicable compliance forms, worksheets, calculations. plans and specifications submitted to 'the
enforccruent'i9ency for approval with this building permit application.,
Name: ,,S�Signature:
Company: \
Date:
Address`.
- 3
License:
61 pyqc)
City/StatorLip:
Orr
Phone: