BPLB2014-1019 H-278-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Twit 4 4a Qu&Z
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BPLB2014-1019
Property Address: 42800 WASHINGTON ST H-2
APN: 609040023
Application Description: 30 GALLON GAS WATER HEATER
Property Zoning:
Application Valuation: $500.00
Applicant: 1
DM DOBKIN INC DBA MR ROOTER PL
P 0 BOX 3385
PALM DESERT, CA 92261
5
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 th Business and Professions Code,
and my License is in full force and effect.
License Class: C36 License No.: 928636
(IN
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 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 contractors) 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: 9/11/2014
Owner:
REDEVELOPMENT AGENCY CITY OF
P 0 BOX 1504
LA QUINTA, CA 9203
1 �Q1Q D D BKIN INC DEA MR ROOTER PL
S�Q 1 L BO 3385
1.11 P PA6 1 SERT, CA 92261
AM�NpO M o�(760)779-0190
Llc. No.: 928636
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of tie following declarations:
I have and will maintain a certificate :)f consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the performance
oft gwork for which this permit is issued.
for,
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 tl-e work for which this permit is issued, I
shall not employ any person in any manner so a. 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 37)0 of the Labor Code, I shall forthwith
comply with those provisions.
DI: � (I�) 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 3uilding 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 Gty 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 applica.ion 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 stale 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 thacityenter upon the abgve-
mentioned property for inspection purposes.
Date: Signature (Applicant or Agent)
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BSAS SB1473 FEE
101-0000-20306
0 $1.00 $0.00
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PAID DATE;
'PERMIT ISSUANCE
101-0000-42404
0
$90.57
$0.00
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Total Paid for PERMIT ISSUANCE: $90.57 $0.00
° a'* D:ESCRIPTI N a
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PAID DATT
E
.. -WATER HEATER/VENT
101-0000-42401
0
$11.92
$0.00
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PAID DATE
WATER HEATER/VENT PC�{�
101-0000-42600
0
$7.15
$0.00
�'.Tis�41S
PAID BY j s
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Total Paid forPLUMBING FEES: $19.07 $0.00
Description: 30 GALLON GAS WATER HEATER
Type: PLUMBING Subtype: Status: SUBMITTED
Applied: 9/11/2014 SKH
Approved:
Parcel No: 609040023 Site Address: 42800 WASHINGTON ST H-21NDIO,CA 92203
Subdivision: PM 12323 Block: Lot: 2
Issued:
Lot Sq Ft: 0 Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $500.00 Occupancy Type: Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0 No. Unites: 0
Details: WATER HEATER CHANGE OUT - 30GALLON/GAS [2013 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL
INSPECTION. 2013 CALIFORNIA BUILDING CODES.
ADDITIONAL SITES
FINANCIAL i i •
DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY CID
BY
BSAS SB1473 FEE 101-0000-20306 0 $1.00 1 $0.00
Total Paid forBUILDING STANDARDS ADMINISTRATION $1.00 $0.00
BSA:
Printed: Thursday, September 11, 2014 8:46:25 AM 1 of 2
SYSTEMS
CHRONOLOGY
CONDITIONS
CONTACTS
NAME TYPE
NAME
ADDRESSI
CITY
STATE
ZIP
PHONE FAX EMAIL
APPLICANT
DM DOBKIN INC DBA MR ROOTER PL
P 0 BOX 3385
PALM DESERT
CA
92261
CONTRACTOR
DM DOBKIN INC DBA MR ROOTER PL
P 0 BOX 3385
PALM DESERT
CA
92261
OWNER
RFnF%IF.[.OPMENT A(;FNr_Y PITY OF
P 0 BOX 104
LA 4.UINTA
CA
92203
FINANCIAL i i •
DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY CID
BY
BSAS SB1473 FEE 101-0000-20306 0 $1.00 1 $0.00
Total Paid forBUILDING STANDARDS ADMINISTRATION $1.00 $0.00
BSA:
Printed: Thursday, September 11, 2014 8:46:25 AM 1 of 2
SYSTEMS
INSPECTIONS
SEQID INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED
DATE DATE
RESULT REMARKS NOTES
PLUMBING FINAL"
CLTD
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID BY
BY
PERMIT ISSUANCE
101-0000-42404
0
$90.57
$0.00
Total Paid for PERMIT ISSUANCE: $90.57 $0.00
WATER HEATER/VENT
101-0000-42401
0
$11.92
$0.00
WATER HEATER/VENT
101-0000-42600
0
$7.15
$0.00
PC
Total Paid forPLUMBING FEES: $19.07 $0.00
TOTALS:.4 $0.00
INSPECTIONS
SEQID INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED
DATE DATE
RESULT REMARKS NOTES
PLUMBING FINAL"
Printed: Thursday, September 11, 2014 8:46:25 AM 2 of 2 , ,
�" �" � SYSTEMS
WATER HEATING
-List newh installed water heaters and boilers - for both domestic hot Nater heaters (DWH) and hvdronic space hearing. NeN•!t• installed
D1VH heaters and boilers nnar be as,prmop"anrOlPan e, or use the existing ret h
DistriNAion Type
Water Heater (Standard, Number In Tank Energy Factor or
TypdFud TypeSystem Capacity (gal) Thcnnal EffKiency
Rceirculat
Extcrnal Tank
Insulation
R -Value
1. Indicate 7tipe (Storage Gas. Heat Ptunp. Instantaneous, etc)
2. Recirculating systems serving multiple dwelling units shall meet the recirculation requirernents i7f §lAn).
requirements do not allow the installation of a recirculating %aur heating system for single dwelling units
3. The evernal %vier heating tank and poes shall be insulated to meet the requirements o 1
The Prescriptive
Contractor or Homeowner (Documentation Author's/Responsible Building Designer's Ded&ration Statement)
• I certify that this Certificate of Compliance documentation is accurate and complete.
• I am eligible under Division 3 of the California Business and Professions Code to accept respDn--ibility 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 Compliance
conform to the requirements of Title 24. Part 1 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, ions., plans and vocifrcatiau submitted to the
enforcement 4gency for approval with this budding permit application.
Name: Signature:
Df
f� —�r1
Cy� �CJ�! � I V►Mr\ � � Date:
lkvnse
City/StaPhone.
Zvy,�
:
Bin #
City of La Quinta
Building & Safety Division
P.O. Box 1504, 78-495 Calle Tampico.
La Quinta,CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: OJ WT7,n {vv-, S+k2i
Owner's Name:
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
Contractor:
telephone:
Address: -751()l Q�f S LA 1.
Project Description:nsl wG j `�A%
City, ST, Zip: F YV\ -
30 ewj a f 1. •hd+- V' -A K I-e ul
Telephone. '1 `� ��0 �°I O
f
State Lic. # : 01a-y') (o sb
City Lie. #;
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
p
`> > <=;><>'<z.>.z•;:<;•
.s..>:..:,.
Construction Type: _ Occupancy:
ocircle one): New Add'n Alter Repair Demo
Pject tyPa (
r ) eP
State Lie. #:
-
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone #,of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRAC*UNG
PEEMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Depos.t
Truss Cala.
Called Contact Person
Plan Check Balance •
Title 24 Cala.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2°" Review, ready for correctionsrssue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Decd
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN I10USE:-
3" Rc:vicw, 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