BPLB2016-0081t
78-495 CALLE TAMPICO 4 4a VOICE (760) 777-7125
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011
.COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 6/2/2016
Application Number: bPLB2016-0081 Owner:
Property Address: 42800 WASHINGTON ST ST DEVELOPMENT AGENCY CITY OF
APN: 6090400231178945 CALLE TAMPICO
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
J 0 2 2016 IN/ QUINTA, CA 32253
�COMMUh9T ITYOF� QUUIIWA� )
MENTDEPAR7ti!L;� ; 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 the Business and Professions Code,
and my License is in full force and effect.
License Class: C36 License No.: 928636
�r !*& Contractor:
actor:
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
hereby affirm under penalty of perjury that there is a construction lending agency for
:he performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
-ender's
-ender's Add
(760)779-0190
Llc. No.: 928636
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury oneof the following declarations:
I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 3?00 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, l
shall not employ any person in any manner :.o 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 3700of the Labor Code, I shall forthwith
comply with those provisions. 7
Date. a k Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE 15 UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100.300). 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 ;his 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 tie City of La Quinta, its officers, agents, and
employees for any act or omission related t,o 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 o dinances and state laws relating to building
construction, and hereby authorize represeitatives of this city to enter upon the
above-mentioned property for inspection pirposes.
Dat Sign�tur ant or Agent):
FINANCIAL INFORMATION
DESCRIPTION ACCOUNT QTY AMOUNT `PAID
PAID:DATE
BSAS 581473 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
PAIO.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: 609040023 Site Address: 42800 WASHINGTON ST ST INDIO,CA 92203
Subdivision: PM 12323
Block: •
Lot: 2
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
P 0 BOX 3385
Details: INSTALL 100 GALLON GAS WATER HEATER PER 2013 CALIFORNIA BUILDING CODE
CA
FINANCIAL INFORMATION
Printed: Thursday, June 02, 201610:40:55 AM 1 of 2 CR?WSYSTEMS
CONDITIONS
CONTACTS
NAME TYPE
NAME
ADDRESSI
CITY
STATE
ZIP
PHONE FAX EMAIL
APPLICANT
DM DOBKIN INC DBA MR ROOTER
P 0 BOX 3385
PALM DESERT
CA
92261
(760)777-7000
PLUMBING
CONTRACTOR
DM DOBKIN INC DBA MR ROOTER
P O BOX 3385
PALM DESERT
CA
92261
(760)777-7000
PLUMBING
OWNER
REDEVELOPMENT AGENCY CITY OF
78945 CALLE TAMPICO I
LA QUINTA
I CA
1 92253
1 (760)777-7000.
FINANCIAL INFORMATION
Printed: Thursday, June 02, 201610:40:55 AM 1 of 2 CR?WSYSTEMS
INSPECTIONS
Printed: Thursday, June 02, 2016 10:40:55 AM 2 of 2 J , 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
TOTALS:00
INSPECTIONS
Printed: Thursday, June 02, 2016 10:40:55 AM 2 of 2 J , SYSTEMS
Prescriptive Certificate of Compliance: Residential CF-IR-ALT-DHW
Residential Alterations `—
Project Name: Climate Zone: ' Permit #-
WATER HEATING
Contractor
- I certify that this Certificate of Compliance documentation is accurate and complete.
list new•h• installed water heaters and boilers -for both domestic hot water heaters (DWH) and h.Wrwnic space heating. Newly installed
DWH heaters and b oilers must be as. t. or Ilse rite existin tel n .
Water HeaterDWAbutionType
t
TyprJFud Type
(Standard. Number In Tank Energy Factor or
Rccirculati ) System Capacity (gal) m Mx al E(fi.clency
External Tank
ion
R -Value'
enforcement ency for approval with this building it applimion.
Name:
r�
Signatum
Can�'M ' Date_
r.. p l kA VV%b , (o
la-
Ad&m: n License:
�S � C� -, � b .fir ►� �/►1-� C
citylstaterzip:
Vh � Phone:
"(�-i� C�1- �I �-a— l 1 C —A-�► d 19 0
1. Indicate Tvpe (Storage Cas. Heat Pivap. Instantaneous. e1c.)
2. Recirculating stistents serving tnultiple dwelling units shall meet the recirculation requirements of §/An).
requirements do not allow the installation of a recirculating water heating system for single dwelling Emits
3. The a vernal water heating tank and pipes shall be insulated to nteet the requirements of § 150(i) -
).
The Prescriptive
Contractor or Homeowner (Documentation Authoes/Responsible Building Designer's Declaration 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.
- 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, calculations. plans .and specifications submit(od to- the
enforcement ency for approval with this building it applimion.
Name:
r�
Signatum
Can�'M ' Date_
r.. p l kA VV%b , (o
la-
Ad&m: n License:
�S � C� -, � b .fir ►� �/►1-� C
citylstaterzip:
Vh � Phone:
"(�-i� C�1- �I �-a— l 1 C —A-�► d 19 0
t.
Iain #
City of La Quinta
Building &r Safety Division
78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Soeet
Permit #
Project Address: �a.�j(JV waS�/N� S.F.
Owner's Name:07
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
Contractor: M ,) N Y1^ I
Telephone:
Address:va,-e
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.............
Project Description:nSia�tw C (•� �—
'
City, ST, Zip: l pkCXy-\ k Za,t (
LN&
h A V
Telephone:
one• �( 1 l V
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Ciu)
ynny``
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V
State Lic. # : fla-516 3 G
City Lic. #.:
Uti f M ,
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
e.
'.
Cn truction TY
e:oOccupancy:
P
State te Lic.#:
Project type (circle one • New Add'n Alter Repair Demo
Name of Contact Person: �
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person 6L 0 ` � v (P
Estimated Value of Project:
V
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check B dance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2nd 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:.-
'"! Reyierv, ready for corrections/issue
Developer InVact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees,
Total Permit Tees