BPLB2016-0080 B-878-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Tdy 4 4 09,1kro
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number:
BPLB2016-0080
Property Address:
42800 WASHINGTON ST B8
APN:
609040007
Application Description:
WASHINGTON APTS / 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
Date: 6/2/2016
Owner:
REDEVELOPMENT AGENCY CITY OF
/L1\ 78945 CALLE TAMPICO
"�►LA QUINTA, CA 92253
�,J,`' a 2 2016
COMMUf�
CITY
OF�QU"Tq�
ELOPMENTDEPARTMENT Contractor:
DM DOBKIN INC DBA MR ROOTER PLUMBING
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 thhBsiness and Professions Code,
and my License is in full force and effect.
License Class: C36 License No.: 928636 �.
/ N
Dat,Co r:
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 the14
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
the 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
(760)779-0190
Lic. No.: 928636
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one .3f 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 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 perfcrmance of the work for which this permit
is issued. My workers' compensation insurarce carrier and policy number are:
Carrier: Policy Number:
I certify that in the performance or 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 of a Labor Code, I shall forthwith
comply with those provisions.
Dafe:> applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIM-INAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,m0). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FC R 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 app ication 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 =he work being performed under or
following issuance of this permit.
2. Any permit issued as a result of this appl cation becomes null and void if work is
not commenced within 180 days from date o= 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 Sate 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 this city toente upon the
above-mentioned property for inspection purposes. / 7
r.
Date: Signature Grit or Agent):
DESCRIPTION
•• •
ACCOUNTFOAMOUNT PAID
PAID DATE
BSAS SB1473 FEE
101-0000-20306
$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
CONDITIONS
Type: PLUMBING
Subtype:
Status: APPROVED
Applied: 6/2/2016 MFA
Approved: 6/2/2016 MFA
Parcel No: 609040007 Site Address: 42800 WASHINGTON ST B8 LA QUINTA,CA 92253
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
ZIP
Details: INSTALL 30 GALLON GAS WATER HEATER PER 2013 CALIFORNIA BUILDING CODE
FAX
._._J Applied to Approved
CHRONOLOGY
CONDITIONS
CONTACTS
NAME TYPE
NAME
ADDRESSI
CITY
STATE
ZIP
PHONE
FAX
EMAIL
APPLICANT
DM DOBKIN INC DBA MR ROOTER
PLUMBING
P 0 BOX 3385
PALM DESERT
CA
92261
(760)777-7000
CONTRACTOR
DM DOBKIN INC DBA MR ROOTER
PLUIViBiiVG
P 0 BOX 3385
PALM DESERT
CA
92261
(760)777-7000
OWNER
REDEVELOPMENT AGENCY CITY OF
78945 CALLE TAMPICO
I LA QUINTA
I CA
1 92253
(760)777-7000
Printed: Thursday, June 02, 201610:39:09 AM 1 of 2 i
SY57EM5
Printed: Thursday, June 02, 201610:39:09 AM 2 of 2 OTIfflYSTEMS
CLTD
DESCRIPTION
ACCOUNT
CITY
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
TOTALS:i0
Printed: Thursday, June 02, 201610:39:09 AM 2 of 2 OTIfflYSTEMS
Prescriptive Certificate of Compliance: Residential CF -IR -ALT -DR
Residential Alterations
Project Name: I Climate Zone: Permit #:
WATER HEATING
• I certify that this Certificate of Compliance documentation is accurate and complete.
-List new•h installed water heaters and boilers -for both donsestic hot water heaters (DWH) and ln+dronic space heating_ Newl.v installed
DWH heaters and boilers insist be gas. r. or nese the existin rel t) -pe.
• I certify that the energy features and performance specifications for the building design identified on this Certificate of Compliance "
Water Heater
TypdFi,el Type'ion
Distribution Type
(�� NumtxY In Tank E.rergy Factory
External Tank
enforcement agency for approval with this building permit lication.
Recirculati System Capacity (gal) nwrmal Efficiency
R-VInsuatlue3
O
OL
°�.
► O . 1'0
Address: tkence:
15 101 2 I �, ,^e- Su i �e. C o D- to3�
O1S
i 30 9 . W
11.
ck
t 3
In
1. Indican Tvpe (Storage Gas. Heat Ptunp. Instantaneous. etc.)
2. Recirculating stistenu serving tnuttiple dwelling units shall ineet the recirculation requironents of f l*n).
The Prescriptive
requirements do not allow the installation of a recirculating water heating system for single dwelling units_
3. The external water heating tank and pipes shall be insulated to otter( the rr uirennents off 150(j).
Contractor or Homeowner (Documentation Author's/Responsible Building Designer's Dedaration Statement) '
• I certify that this Certificate of Compliance documentation is accurate and complete.
• 1 am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the building design
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 (ie California Code of Regulations.
. Tbc 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 lication.
Name:
Si nature
Company: Date:
Ir o ar �I�w•S�f� �j a
Address: tkence:
15 101 2 I �, ,^e- Su i �e. C o D- to3�
City/staterZip:
ps� Phone
°�2a-1 I ��-(�l -3--m-otge
t e