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BPLB2015-009178-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 T4t(t 4 4Qabtrw COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT Application Number: BPLB2015-0091 Property Address: 53875 AVENIDA DIAZ APN: 774151019 Application Description: SANDEN / CHANGE OUT (1) 40 GALLON ELECTRIC WATER HEATER Property Zoning: Application Valuation: $900.00 Applicant: STATEWIDE SERVICES INC DBA STA 36947 COOK STREET STE 104 PALM DESERT, CA 92211 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. /1 License Class: C36 License No.: 936147 Date: _l ~ Contract 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 Name:, Lender's Addres VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 7/16/2015 Owner: SANDON BRADY 4611 EDISON ST C C� LOS ANGELES, CA 92253cz n L ;� p�r Contractor: STATEWIDE SERVICES INC DB'A STA N 36947 COOK STREET STE 104' a V PALM DESERT, CA 92211 (442)666-8858 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 of Teyork for which this permit is issued. I have and will maintain workers' compensation insurance, as required by n 3 Set 700 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 the Labor Code, I shall forthwith comply with those provisions. Date:-� �l Applica 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 I ws rter upon the to building construction, and hereby authorize representatives of this cit enhe above- mentiiooned property for inspection purposes. Date Signature (Applicant or Age f FINANCIAL INFORMATION DESCRIPTION ACCOUNT QTY ` AMOUNT PAID PAID DATE BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid forBUILDING STANDARDS ADMINISTRATION BSA; $1.00 $0.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE PERMIT ISSUANCE 101-0000-42404 0 $91.85 $0.00 PAID.BY . METHOD RECEIPT # CHECK # CLTD BY Total Paid for PERMIT ISSUANCE: $91.85 $0.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE WATER HEATER/VENT 101-0000-42401 0 $12.09 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY' AMOUNT PAID PAID DATE WATER HEATER/VENT PC 101-0000-42600 0 $7.25 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid for PLUMBING FEES: $19.34 $0.00 TOTALS:• 00 Description: SANDEN / CHANGE OUT (1) 40 GALLON ELECTRIC WATER HEATER Type: PLUMBING Subtype: Status: UNDER REVIEW Applied: 7/16/2015 SKH Parcel No: 774151019 Site Address: 53875 AVENIDA DIAZ LA QUINTA,CA 92253 Approved: Subdivision: SANTA CARMELITA AT VALE LA QUINTA Block: 199 Lot: 7 Issued: UNIT 19 Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $900.00 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. ADDITIONAL CHRONOLOGY CONDITIONS PHONE . FAX EMAIL', NAME TYPE NAME - - ' ADDRESSI CONTACTS CITY STATE ZIP APPLICANT STATEWIDE SERVICES INC DBA STA 36947 COOK STREET STE 104 PALM DESERT CA 92211 CONTRACTOR STATEWIDE SERVICES INC DBA STA 36947 COOK STREET STE 104 PALM DESERT CA 92211 OWNER SANDON BRADY 4611 EDISON ST LOS ANGELES CA 92253 FINANCIAL INFORMATION Printed: Thursday, July 16, 2015 8:33:58 AM 1 of 2 CN� SYSTEMS INSPECTIONS SEQID INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED RESULT REMARKS NOTES DATE DATE PLUMBING FINAL" BLD PARENT PROJECTS BOND INFORMATION Printed: Thursday, July 16, 2015 8:33:58 AM 2 of 2 CRWSYSTEMS CLTD DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY 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 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 for PLUMBING FEES: $19.34 $0.00 TOTALS:•0 INSPECTIONS SEQID INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED RESULT REMARKS NOTES DATE DATE PLUMBING FINAL" BLD PARENT PROJECTS BOND INFORMATION Printed: Thursday, July 16, 2015 8:33:58 AM 2 of 2 CRWSYSTEMS •� .. .• •Pcescri tiyeC'ertificate of Compiiaatt:e; Residelitiai..: .: �` ::° �.- � •C] Residential AI rations Pm'et:t.Name: Climate Zone: Permit lf: ape 1 of 2 General Information / Site Address. / W &Enforcement a Date: Buildin T : ❑Sin le milO Multi Family Project T e lacement or Change Out of Water Heater WATER HEATING • 1 certify that this Certificate of Compliance documentation is arcuate and complete. List nem4v installed inciter heaters and !oilers for beth domestic hot eater heaters-(DWH) and lmtlronic space heating. New•lc installed D.WH heaters and boilers atust be gas. propant, or use the existingfilu Itype. building design on the other applicable compliance forms, workshom calculations. plans and spocificattau subtnitted to the Water Heater TY� +Tyx' p;str;buion TypeExl6ml R c rculain ay Nurnba in Tank EAagy Factor or System Capacity (gal) Thaawl Efficiency Tank Insulation It -Value' `�l3��. Ci Ap- 1. Indicate 7jre (Storage Gas. Heat Plump. Instantaneous, etc.) 2. Recirculating systems saving multiple dwelling units shall meet the recirculation requirrtments of §150(n). The Prcxriptivr,, requirements do not allow the installation of a recirculating mater heating latent for single dwelling units. I The external mater heating tank and pipes shall be insulated to nwer the requirements of §1 i). Contractor or Hom w�ner (Documentation Author's/Responsible Building Designer's Declaration Statement) • 1 certify that this Certificate of Compliance documentation is arcuate and complete. • I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the building design identifted 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 24, Part I and 6 of the California Code of Regulations. • The building design features identified on this Certificate of Compliance arc consistent with the information provided to document this building design on the other applicable compliance forms, workshom calculations. plans and spocificattau subtnitted to the enforcement agency for approval with this building it licmiaL N tbn:triQ: S' Date: `7=40,,jU `�l3��. Ci Ap- Bin # City Of La Quints Buiiding e Safety Division P.O. Box 1504, 78-495 Calle Tampico Permit # La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Project Address: 7 t f „Q--) lQ' z Owner's Name: U SG( A. P. Number: Address: S /� Legal Description: City, ST, Zip: to i✓ / L -a +•%v hn�... Contractor Telephon -°s�9%•�^''�^ Address: Project Description:. City, ST, Zip ' Submittal e . Tele hone v '10 �r ti •:: w.:..,�r�sr�r�� PERMIT FEES State Lic. #: City Lic. 9--- ;Arch., Arch.,Engr., Designer: Address: Item City., ST, Zip: Structural Calcs. Telephone: � <,:, y;, , ��a `^:.'.`-;�:�� .��w.;:>�� 2v4� Construction Type: Occupancy: Plan Check Deposit State Lic. #: "<'w;'r�: y �� ;s" '�' s�� Project type circle one • New Add'n Alter Repair Demo Name of Contact Person: V t (� Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: ��/ Estimated Value of Project: APPLICANT: DO NOT WRITE 1191 n T141 -Q 1 INF H Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Rcvicwcd, rcady for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Tide 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan l°d 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:- 3.1 Review, ready for correctlonstime Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees 1111c%O=I =U. JUL 16 2015 CITY OF LA COMMUNITY DEVELOPMENT U