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BPLB2015-0060A-455 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: BPL62015-0060 COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT Property Address: 43610 GALAXY DR APN: 609560006 Application Description: KERLEY RESIDENCE/HOT WATER HEATER CHANGE OUT Property Zoning: Application Valuation: $1,180.00 Applicant: ' TOMMY ROOTER PLUMBING INC 80975 INDIO BLVD #C3 INDIO, CA 92201 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: _ License No.: 930133 [^/ Daft � �� — (� Conn /^' ctor:2) l 1C� 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).: (_J 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 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 VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777=7153 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 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 t 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 r^those provisions. D�: �d� —)rte- Appli¢a 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. mennttiioned^property for inspection purposes. Dat" e� v Signature (Applicant or Aglft Date: 4/15/2015 Owner: MICHAEL KERLEY 43610 GALAXY DR LA QUINTA, CA 92253 © w Au ~ O C z o Contractor: a0 v TOMMY ROOTER PLUMBING INC Loco 80975 INDIO BLVD #C3 Gr o UJUJ INDIO, CA 92201 a (760)574-4444 Lic. No.: 930133 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 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 t 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 r^those provisions. D�: �d� —)rte- Appli¢a 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. mennttiioned^property for inspection purposes. Dat" e� v Signature (Applicant or Aglft FINANCIAL INFORMATION DESCRIPTION: ~ACCOUNTQTY 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„ 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 forPLUMBING FEES: $19.34 $0.00 TOTALS:00 Description: KERLEY RESIDENCE/HOT WATER HEATER CHANGE OUT Type: PLUMBING Subtype: Status: APPROVED Applied: 4/15/2015 MFA Approved: 4/15/2015 MFA Parcel No: 609560006 Site Address: 43610 GALAXY DR LA QUINTA,CA 92253 Subdivision: TR 23773-5 Block: Lot: 6 Issued: Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $1,180.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 Details: WATER HEATER CHANGE OUT— 50 GALLON/GAS [2008 ENERGY] CARBON MONOXIDE ALARM(5) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2013 CALIFORNIA BUILDING CODES. Applied to Approved'. Printed: Wednesday, April 15, 2015 9:50:27 AM 1 of 2 CN?sYSTFMS Printed: Wednesday, April 15, 2015 9:50:27 AM 2 of 2 CRWSYSTEMS INSPECTIONS SEQID INSPECTION.TYPE INSPECTORSCHEDULED. COMPLETED DATE DATE: R. RESULT REMARKS NOTES PLUMBING FINAL" BLD 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 TO00 Printed: Wednesday, April 15, 2015 9:50:27 AM 2 of 2 CRWSYSTEMS INSPECTIONS SEQID INSPECTION.TYPE INSPECTORSCHEDULED. COMPLETED DATE DATE: R. RESULT REMARKS NOTES PLUMBING FINAL" BLD Printed: Wednesday, April 15, 2015 9:50:27 AM 2 of 2 CRWSYSTEMS Prescri tive::Certif eate of Com lianee: Residential CF-1ItALT-DMd Residential Alterations Page I ora Project Name; . 1( Climate Zone: Permit #: General Inforination Site Address: Enforecttieni A enc : J Date: .Puilding TyeS29 Single Family ©Multi Family Project T %2eplacement o[ Chane Out of Water neater WATER HEAITNG • 1 certify that this Certificate of Compliance documentation is accurate and complete. ' List newly installed water hearers and bailers for both domestic hot water healers (DWH) and Jtydmnic space heating. Newly installed DWHhearers and boilers must be as, propane, or use the existingfitel type. Water Heater Distribut-' Type Type'Fdel Typer(Standard, Recirculudn) Number In Tank Energy Factor or S stem Capncify (gal) Thermal Efficiency conform to the mquirements of Title 24, Partl and 6 of the"California Code of Regulatlons. External Tnnk Insulation R -Value building design on the other applieabio compliance forrns; workAfttg. caleulatiom,'plans and specifications submitted to the enforcement agency for apMyal with this building rmit a lication. N mc: i tuc� Ck CS Company: Date: Address: Licrnse: City/State/Zip; 1 \� �)-aD �b 1. Indicate Type (Storage Gas, Heal Pump, Instantaneous, etc.) 2. R.ecircutaling systetm serving multiple dwelling unit's shall ineet the recirculation .requirements of §1.50(n). requirements do not allow the Irtstdilalion of a recirculating water hearing sysre» r for single dwelling runts. 3. The e.Vernal water -heating tank and les shall be insulated to meet the re uirernents of 6150 'l. The ' Prescriptive Contractor or Homeowner (Documentation Author's/Responsible Building Designer's Declaration Statetrieigt) • 1 certify that this Certificate of Compliance documentation is accurate and complete. ' . I am eligible under Division 3 of the California` Business and Prof-mions Code to rccept responsibility for the building design identified on this Certificate of Compliance. e I certify that the energy features and performance specifications for the building design identified on this.Certificate of Compliance conform to the mquirements of Title 24, Partl and 6 of the"California Code of Regulatlons. a The building design features identified on this Certificate of Compliance am consistent with the information provided to document this building design on the other applieabio compliance forrns; workAfttg. caleulatiom,'plans and specifications submitted to the enforcement agency for apMyal with this building rmit a lication. N mc: i tuc� Ck CS Company: Date: Address: Licrnse: City/State/Zip; 1 \� �)-aD Phone: J 06/06/2013 THU 15:09 .FAX La gtzinta Bldg 6 Sa:ret:y. Q001/001 Bin # City of La 'Quinta BUM190 Safety Division Permit # P.O. Bou 1504, 78.495 We Tampico Ca Quints,. CA 92253 - (760) 777.7012 milli - Building Permit Application and Tracking Sheet Pro*tAdaress: ((� qJ( Owner's Name; eY`� A. P. Number. Address: Legal Dm a don: Qty, ST, Zip: a� Coritrsctor.� al one• �.b Address: L� �� tttjectlscrlprion: City, ST, Zi. __ Ttslt phone l0 n . - r= State Lic, #: city Lie. 91 C (i Arch., Bug., besigper. Addrem: City, ST> Zip: Telephone: g` Consfizction Type: Occup:moy; Shste Lie. #: '� _, ?inject type (circle one): New Add'n Altor Repair Demo Name of Coma pmon; C2\ Q�``Q Sq. FG: #Stories: #Units: Tcie{ihone ii of Co7ttact PeiSOp [) �. Rstimated Value of erect APPLICANT, Do Nbi WRITE BELOW THIS LINE N Submittal Req'd Iteem TRACMNG SPEIiMfI FM Plan Seta PIan Ctieck submitted Item Amonut Struetara! Gales Reviewed, ready for earmetfons .Plan Cbtek Deposit Trues Czlcs. Caked Coutaet Person Plan Cheek >ktaee CttIe 24 {kj� vans plekcd up Consiroctton Flood plate plan Plans resubmitted A4echauical Grading plan 2°" Review, readyfbr Colsecdouslissue Electrical 9i1bt0H aemr list Called Contact Person Platabing Graot bc,cd Ptaas picked up RRA. Approval Piaus resubmitted Grading lY3it?USE' VXVIew,readyfor correeflonsliMe Developer Impact Fee Planning Approval Called Contact Person Pub. Wks• Appr Date of permit Issue sebool pees Total Permit Fees