BPLB2016-0078 J-678-495 CALLE TAMPICO ,
LA QUINTA, CALIFORNIA 92253
Application Number: BPLB2016-0078
Property Address: 42800 WASHINGTON ST J6
APN: 609040007
TwNp °F 4Qu'"fw
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Description:. WASHINGTON ARTS/ PLUMBING
Property Zoning:
Application Valuation: $400.00
Applicant:
DM DOBKIN INC DBA MR ROOTER PLUMBING
P 0 BOX 3385
PALM DESERT, CA 92261
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
n Date: 6/2/2016
(,r / Owner:
REDEVELOPMENT AGENCY CITY OF
.t.,iV 2 2016 78945 CALLE TE.MPICO
LA QUINTA, CA 92253
CITY OF LA QUINTA
COPAPAUNITYDE IELOPtO,ENTDEPARTh?ENT
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 License No.: 928636
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 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:
DM DOBKIN INC DBA MR ROOTER PLUMBING
P 0 BOX 3385
PALM DESERT, CA 92261
(760)779-0190
Llc. No.: 928636
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certifiote of consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the performance
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 subject to the workers'
compensation laws of California, and agree =hat, if I should become subject to the
workers' compensation provisions of Section 3700 of Labor Code, I shall forthwith
comply with those provisions.
Date: r Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIN11NAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,)00). 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 tc the Building Official for a permit subject to
the conditions and restrictions set forth on 4his 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 ove ner, 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 t i 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 anc state that the above information is correct.
I agree to comply with all. city and county D-dinances and state laws relating tp building
construction, and hereby authorize represe-itatives of this city to enter upon the
above-mentioned property for inspection purposes.
Date: JilgoIJ UIL
L Signature (Applicant or Agent):
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 for BUILDING 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: WASHINGTON APTS / PLUMBING
Type: PLUMBING
Subtype:
Status: APPROVED
Applied: 6/2/2016 MFA
Approved: 6/2/2016 MFA
Parcel No: 609040007 Site Address: 42800 WASHINGTON ST J6 LA QUINTA,CA 92253
Subdivision: PM 12323
Block:
Lot: 1
Issued:
Lot Scl Ft: 0
Building Scl Ft: 0
Zoning:
Finaled:
Valuation: $400.00
Occupancy Type:
Construction Type:
Expired:
No. Buildings: 0
No. Stories: 0
No. Unites: 0
CA
Details: INSTALL 30 GALLON GAS WATER HEATER PER 2013 CALIFORNIA BUILDING CODE
(760)777-7000
CONDITIONS
CONTACTS
NAME TYPE
NAME
ADDRESSl
CITY
STATE
ZIP
PHONE
FAX
EMAIL
APPLICANT
DM DOBKIN INC DBA MR ROOTER
PLUMBING
P O BOX 3385
PALM DESERT
CA
92261
(760)777-7000
CONTRACTOR
DM DOBKIN INC DBA MR ROOTER
PLUMBING
P O BOX 3385
PALM DESERT
CA
92261
(760)777-7000
OWNER
REDEVELOPMENT AGENCY CITY OF
78945 CALLE TAMPICO
I LA QUINTA
I CA
1 92253
1 (760)777-7000
Printed: Thursday, June 02, 2016 10:35:21 AM 1 of 2 C
SYSTEMS
PARENT PROJECTS
BOND INFORMATION
Printed: Thursday, June 02, 2016 10:35:21 AM 2 of 2
SYSTEMS
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 for BUILDING STANDARDS ADMINISTRATION $1.00 $0.00 ,
BSA:
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
• _ 00
PARENT PROJECTS
BOND INFORMATION
Printed: Thursday, June 02, 2016 10:35:21 AM 2 of 2
SYSTEMS
Prescriptive Certificate of Compliance: Residential CF-IR-ALT-DHW
Residential Alterations
Project Name: Climate Zone: Permit #:
WATER HEATING
- l certify that this Certificate of Compliattce documentation is accurate and complete.
- 1 am eligible under Division 3 of the California Business and Professions Code to acccpt responsibility for the building design.
-List nem -h• installed water !eaten and boilers -for both donestic hot water heaters (DWH) and !nv/ronic space heating. Nem -1.y installed
DWH !seaters and boilers must be gas. e. or use the existin eel I) -pe.
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
Watcr Hcniter
TyPdF-:I Type
Distribution Type
(�� Numb Lr In Tank
E—gy Fwtorur
E'Insula ion tc
Insulation
Rc�ytculati )r Systcm Capacity (gal)
Ibcrmal Elf.cic ncy
R -Value
0, C,
t O
fLlb
a
1 �O
O
�t1•
CAS
1 30
a
1. /ndicate Tope (Storage Cas. Heat Prune, Instantaneous, etc.)
2. Recirculating systener serving multiple, dwelling units shall meet the recirculation
requirements of JlAn).
The Prescriptive
requirements do not allow the installation of a recirculating mater -heating ststem for single dwelling tunits
3. The a vernal muter heating tank and pipes shall be insulated to meet the requirements o
150U).
Contractor or Homeowner (Documentation Authoes/Responsible Building Designer's Declination Statement)
- l certify that this Certificate of Compliattce documentation is accurate and complete.
- 1 am eligible under Division 3 of the California Business and Professions Code to acccpt responsibility for the building design.
identified on this Certificate of Compliance.
- l 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, calculations..plans .and sped tcarions submitted to the
enforcemati for rover! with this buildin emit licatiort.
Name:
Si nature: `
company: Date:
Address: occas:
161 n Sto &%--\ I S� i 2, C a-�
CityJStatelZip: Phone:
IPo�Q� 1Jeae1- C}—
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