BPLB2016-010078-495 CALLE TAMP.I.CO
LA QUINTA, CALIFORNIA 92253
To^4d 44Qumfw
DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
.Application Number: BPLB2016-0100
Property Address: 46445 WASHINGTON ST
APN: 643182020
Application Description: , MARIA NELSON / WATER HEATER
Property Zoning:
Application Valuation: $1,000.00.
Applicant:
CAMPESINOS UNIDOS INC
P 0 BOX 39
BRAWLEY; CA 92227
JUL 2 7 1016
CITY OF LA QUINTA
(�atvltlNff 1lDE�lDFi�7ENT DEPARTI�1Eh�
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- B C36 License No.: 618140
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 applicarit 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 Na
Lender's
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/27/2016
Owner:
FERNANDO NELSON
, 92253
Contractor:
CAMPESINOS UNIDOS INC
P O'BOX 39 .
BRAWLEY, CA 92227
(760)344-4500
Llc. No.: 618140
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of 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
o work for which this permit is issued.
is; 1 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: INSURANCE COMPANY OF THE WEST Policy Number: WSD503258S
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 that, if I should become subject to the
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
compl ith those provisions.
I" IN —
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 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 cancellation.
I certify that I have read this application and state 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 to enter upon the
above-mentioned property for inspection purposes.
FINANCIAL INIF611MATIOU,
w DESCRIPTION ACCOUNT CITY AMOUNT
BSAS SB1473 FEE 101-0000-20306 0
$1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
PERMIT ISSUANCE
101-0000-42404
0
$91.85
Total Paid for PERMIT ISSUANCE: $91.85
DESCRIPTION
ACCOUNT
CITY
AMOUNT .
WATER HEATER/VENT
101-0000-42401 _
0
$12.09
DESCRIPTION
ACCOUNT
CITY
AMOUNT
WATER HEATER/VENT PC
101-0000-42600
0
$7.25
Date: 7/27/2016
Application Number:BPLB2016-0100
Owner:
Property Address:
46445 WASHINGTON ST i
FERNANDO NELSON
APN:
643182020
Application Description:
MARIA NELSON / WATER HEATER CHANGE OUT
92253.
Property Zoning:
Application Valuation:
$1,000.00
Applicant:
Contractor:
CAMPESINOS UNIDOS INC
CAMPESINOS UNIDOS INC
P 0 BOX 39
P 0 BOX 39
BRAWLEY, CA 92227
BRAWLEY, CA 92227
(760)344-4500
Llc. No.: 618140
Detail: WATER HEATER CHANGE
OUT - 40GALLON/GAS [2013 ENERGY) CARBON MONOXIDE
ALARMS) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2013
CALIFORNIA BUILDING CODES.
J
Description: MARIA NELSON / WATER HEATER CHANGE OUT
Type: PLUMBING Subtype: Status: APPROVED
Applied: 7/27/2016 RSE
Approved: 7/27/2016 RSE
Parcel No: 643182020 Site Address: 46445 WASHINGTON ST LA QUINTA,CA 92253
Subdivision: TR 2043 Block: Lot: 1
Issued:
Lot Sq Ft: 0 Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $1,000.00 Occupancy Type: Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0 No. -Unites: 0
Details: WATER HEATER CHANGE OUT - 40GALLON/GAS [2013 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL
INSPECTION. 2013 CALIFORNIA BUILDING CODES. r
T
ADDITIONAL SI
ES
Printed: Wednesday, July 27, 2016 8:11:57 AM 1 of 2
CRW.IYSTEMS
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NAME TYP k , 3v x.Kz ., N k.,r
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CITY} STATE ZIP HONE'... „FAX EMAIL
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APPLICANT
CAMPESINOS UNIDOS INC
P 0 BOX 39
BRAWLEY
CA
92227
CONTRACTOR
CAMPESINOS UNIDOS INC
P 0 BOX 39
BRAWLEY
CA
92227
OWNER
FERNANDO NELSON
11
1 92253
Printed: Wednesday, July 27, 2016 8:11:57 AM 1 of 2
CRW.IYSTEMS
k
INSPECTIC
:)ARFNT PRO
ATTACHMENTS
Printed: Wednesday, July 27, 2016 8:11:57 AM 2 of 2
SYSTEMS
'AMOUNT'
fir';
PAID;DATE
RECEIPT# •
#�
>-
: ;DESCRIP,TION
- ACCOUNT ',
x
ti;.QTY:
.'ePAID.` s
.CHECK
.METHOD
:
0 BY
��
Wa_
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$91.85
7/27/16
R17403
DEBIT
JOSE COTERO
RSE
Total Paid for PERMIT ISSUANCE: $91.85 $91.85
WATER HEATER/VENT .
101-0000-42401
0
$12.09
$12.09
7/27/16
R17403
DEBIT
JOSE COTERO
RSE
WATER HEATER/VENT
101-0000-42600
0
$7.25
$7.25
7/27/16
R17403 .
DEBIT
JOSE COTERO
RSE
PC
Total Paid for PLUMBING FEES: $19.34 $19.34
•TAL $112.19
INSPECTIC
:)ARFNT PRO
ATTACHMENTS
Printed: Wednesday, July 27, 2016 8:11:57 AM 2 of 2
SYSTEMS
Prescriptive Certificate of Compliance: Residential CF-IR-ALT-DHW
Residential Alterations Page I of
Project Name: -e�> D Climate Zone: Permit #:
General Information
Site Address:
Enforcement Agency: tn, Yle, I Date:
Building TypeARrSingle Family ❑ Multi Fa'm'ily
Project T e laceme<nt or Change Out of Water Heater
WATER HEATING
• 1 certify that this Certificate of Compliance documentation is accurate and complete.
List newly installed water heaters and boilers for loth domestic hot hater heaters (DWH) and h.Wronic space heating. New/F installed
DWH heaters and boilers must be gaSs. propane, or use the existingfieel type.
Type/Fuel Type'
Distribution Type Number In Tank Energy Factor or
itimrlrculati (Standard. )t System Capacity (gal) Thermal Efficiency
InsuExternal Tank
R -Value's
w As
e„n cs� O
enforcement agency for approval with this budding permit application.
Name:
Signature:
Company:
Date: J %
Address':
License:
City/State/Zip: y� \
1. Indicate'Type (Storage Gas, Heat Ptunp, Instantaneous, etc.)
2. Recirculating systents serving multiple dwelling units shall meet the recirculation requirements of §/An).
requirements do not allow the instalixion of a recirculating Hater heating system for single dwelling units.
3. The external Nater heating tank and pipes shall be insulated to meet therequirements of § 150U),
77ie Prescriptive
Contractor or Homeowner (Documentation Author's/Responsible Building Designer's Declaration Statement)
• 1 certify that this Certificate of Compliance documentation is accurate and complete.
• I am eligible under Division 3 of the Califomia 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, Parti and 6 of the Califomia 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 budding permit application.
Name:
Signature:
Company:
Date: J %
Address':
License:
City/State/Zip: y� \
phone:
Bin #
of La Quinta
Building U Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
d 1 Building Permit Application and Tracking Sheet
Permit #
�L Fj 2D 1 10-1
Project Address: raj v 1�
Owner's Name:
A. P. Number:
Address: q t. (,v 6L641 h { O S
Legal Description:
/� �� ,1
Contractor: 6vYY\ "'P� � hp S i
City, ST, Zip -1 i VJ�
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✓ L �V res>:.:.>•.;; :'{;k:;;, ::;ii yS7d :;
Telephone: (� O � %
Address:
Project Description:
City, ST, Zip: Y�qw
Telephone: ) 0-3 �i-Ls a
< ••
.« V..:
G c, Vey-
e..
State
State Lic. # : Ti O City Lic. #:
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
<.:r {:. ,:.:::> sk<<>w?::,
%"��s.;::>>::::>>:?:. �`
#?r<>.r<?r:
Construction Type:
Project type (circle one): New . Add'n Alter Repair Demo
State Lic. #:
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: % 1 O —Estimated
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
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 Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" 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:-
3'd Review, ready for correctionsfissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
14
Total Permit Fees