BPLB2014-1044 A-278-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
c&tit 4 4 Qum&
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number:
BPLB2014-1044
Property Address:
42800 WASHINGTON ST ST ^2_
APN:
609040007
Application Description:
WATER HEATER CHANGE OUT - 40GALLON/GAS
Property Zoning:
®
PL
a C)
Application Valuation:
$400.00
Applicant:
DM DOBKIN INC DBA MR
ROOTER PL
P 0 BOX 3385
PALM DESERT, CA 92261
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: C36ff'1,l License No.: 928636 Q
Dao �a J j Contractor:
II , 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 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.).
(_) 1, 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
Lender's
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 12/2/2014
Owner:
REDEVELOPMENT AGENCY CITY OF
78945 CALLE TAMP,CO
LA QUINTA, CA 922 33
Contractor:
DM DOBKIN INC DBA MR ROOTER
P 0 BOX 3385
PALM DESERT, CA 52261
(760)779-0190
Llc. No.: 928636
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of t is following declarations:
I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 3700 cf the Labor Code, for the performance
of for which this permit is issued.
have and will maintain workers' corn pensation 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 -arrier 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 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 3700 of the Labor Code, I shall forthwith
comply with those provisions.
r r
Dat �% %' Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINFL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,000 . IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR N SECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOVAEDGEMENT
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 cancell:,tion.
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 rela in, to building
construction, and hereby authorize representatves of this ci ente pon the above.
mentioned property for inspection purposes. ,�
D!01_a' / Signature (Applicant or Agenr6) o
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WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of t is following declarations:
I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 3700 cf the Labor Code, for the performance
of for which this permit is issued.
have and will maintain workers' corn pensation 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 -arrier 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 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 3700 of the Labor Code, I shall forthwith
comply with those provisions.
r r
Dat �% %' Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINFL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,000 . IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR N SECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOVAEDGEMENT
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 cancell:,tion.
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 rela in, to building
construction, and hereby authorize representatves of this ci ente pon the above.
mentioned property for inspection purposes. ,�
D!01_a' / Signature (Applicant or Agenr6) o
Prescri�tive Certificate of Compliance: Residential CF -IR -ALT -DR)
Residential Alterations
Project Name: Climate Zein: Permit.#:
General Information
Site Address: Enforcement Agency: Date:
Building Type: t3:Single Family � Multi Family Project TYMAE;MeDlacement or. Change Out o Water Heater
WATER HEATING
• 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 responsibility for the buildingdesign
-List newly installed water !eaters and -boilersfor both domestic hot muter heaters (DWH) and h dronic .cprwe heating. Nem -Iv installed
DWH heaters and boilers must be as,r e. or use (lee esistin ref ti .
conform to the requirements of Title 24. Part I and 6 of iiie California Code of Regulations.
- The building design features identified on this Certificate of Compliance are consistent with the information provided to document this
Water Hater Distritwtion Type Numtx-r In Tank
E—gy Factor >x
External Tank
_
1sValue
Type/Type Rc(Stan��' System Capacity (gat)
Thermal Efficiency
1 -
30
b
N
Phone: .
N�-
I_ Indicate Tvpe (Storage Gas. Heat Pu nip, Instantaneous. etc.)
2. Recirculating systems serving multiple dwelling units shall meet the recirculation
requirements of §lAn).
lie Prescriptive
requirements do not allow the installation of a recirculating muter heating system for single
dKYUing units.
3. The a vernal mater heating tank and poes shall be insulated to nett the requirements of §
1
Contractor or Homeowner (Documentation Author's/Responsible Building Designer's Declaration 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 responsibility for the buildingdesign
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 24. Part I and 6 of iiie 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
enforcement agency for approval with this building permit application -
Name:
Sibm
v�
1 -
C&npanrw, ^ Date r I 1
Y
Address:
I ,,e, &AA
City/Stato2ip: W,
Phone: .
DESCRIPTION
FINANCIAL •1•
ACCOUNT CITY
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
CITY
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
CITY
AMOUNT
PAID
PAID DATE
WATER HEATER/VENT
101-0000-42401
0
$12.09
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
CITY
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:i0
Description: WATER HEATER CHANGE OUT - 40GALLON/GAS
Type: PLUMBING Subtype: Status: APPROVED
Applied: 12/2/2014 SKH
Approved: 12/2/2014 SKH
Parcel No: 609040007 Site Address: 42800 WASHINGTON ST ST INDIO,CA 92203
Subdivision: PM 12323 Block: Lot: 1
Issued.
Lot Sq Ft: 0 Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $400.00 Occupancy Type: Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0 No. Unites: 0
FAX EMAIL
Details: WATER HEATER CHANGE OUT - 30GALLON/GAS [2013 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL
INSPECTION. 2013 CALIFORNIA BUILDING CODES.
Printed: Tuesday, December 02, 2014 11:27:56 AM 1 of 2
CRSYSTEMS
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 (760)777-7000
CONTRACTOR
DM DOBKIN INC DBA MR ROOTER PL P 0 BOX 3385
PALM DESERT
CA
92261 (760)777-7000
OWNER
REDEVELOPMENT AGENCY CITY OF 78945 CALLE TAMPICO
LA QUINTA
CA
92253 (760)777-7000
Printed: Tuesday, December 02, 2014 11:27:56 AM 1 of 2
CRSYSTEMS
INSPECTIONS
SEQID INSPECTION TYPE INSPECTOR SCHEDULEDCOMPLETED
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
$91.85
$0.00
Total Paid for PERMIT 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
INSPECTIONS
SEQID INSPECTION TYPE INSPECTOR SCHEDULEDCOMPLETED
DATE DATE
RESULT REMARKS NOTES
PLUMBING FINAL**
ATTACHMENTS
Printed: Tuesday, December 02, 2014 11:27:56 AM 2 of 2
SYS TEMS
+aY*+Yo®+o
Bin # City of La Quinta.
' Building &r Safety Division
Permit # P.O. Box 1504, 78-495 Calle Tampico .
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Project Address:Lia-�Oo S+W Owner's Name:
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
Contractor: r (A YYN6
Telephone:
Address:j J ` C
Project Description:
p(�n`
City, ST, Zip: NOW-,
Tele hone U :M-0 l cl
- In V\ �
State Lic. # : 3
City Lic.
�.
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
' F>->> >`>? "=>" ` '"
......................................................
Construction Type: Gccupancy:
State Lic. #:
Project a circle one): New Addfi Alter Repair Demo
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
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cates.
Reviewed, ready for corrections
Plan ChecL' Deposit
Truss Cala.
Called Contact Person
Plan Check: Balance.
Title 24 Cala.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
god 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 IiOUSE:-
'`d Review, ready for correctionstssue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees