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BPLB2014-104078-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Titit 4 4 Q" COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT Application Number: BPLB2014-1040 Property Address: 55215 FIRESTONE APN: 775151021 Application Description: REPLACE (1) 50 GALLON GAS WATER HEATER Property Zoning: to Application Valuation: $800.00 Applicant: O STATEWIDE SERVICES INC DBA STA 83780 CORTE SOLICE M COACHELLA, CA 92236 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 forceand effect. i License Class: C3366 License No.: 936147 Date: J� Contra c 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 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 Addre! VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Owner: CREEDEN, HEATHER E 1545 KENMORE RD PASADENA, CA 91106 Contractor: STATEWIDE SERVICES INC 83780 CORTE SOLICE COACHELLA, CA 92236 (760)984-0126 Llc. No.: 936147 Date: 11/25/2014 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' comper cation, as provided for by Section 3700 of the Labor Code, for the performance vygclLfor which this permit is issued. Ilhave 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 that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith complywiththose provisions. Date l ° Applicant: 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 ci to enter upon the above- mentioned property for inspection purposes. Date t '� Signature (Applicant or Age t. / C= 0 CD 7 D on to DBA STA CTS � C2 O M a sem. M 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' comper cation, as provided for by Section 3700 of the Labor Code, for the performance vygclLfor which this permit is issued. Ilhave 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 that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith complywiththose provisions. Date l ° Applicant: 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 ci to enter upon the above- mentioned property for inspection purposes. Date t '� Signature (Applicant or Age t. / 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 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 for PLUMBING FEES: $19.34 $0.00 TOTALS:• 00 Description: REPLACE (1) 50 GALLON GAS WATER HEATER Type: PLUMBING Subtype: Status: SUBMITTED Applied: 11/25/2014 SKH Approved: Parcel No: 775151021 Site Address: 55215 FIRESTONE LA QUINTA,CA 92253 Subdivision: TR 21381-3 SEE ASSESSORS MB 769-41 Block: Lot: 8204 Issued: 40 FOR CMS Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $800.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 IL NAME Details: WATER HEATER CHANGE OUT - 50 GALLON/GAS [2013 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2013 CALIFORNIA BUILDING CODES. STATE -ZIP Printed: Tuesday, November 25, 2014 2:10:28 PM 1 of 2 SYSTEMS CHRONOLOGY CONDITIONS CONTACTS NAME TYPE NAME ADDRESS1 CITY STATE -ZIP PHONE FAX EMAIL APPLICANT STATEWIDE SERVICES INC DBA STA 83780 CORTE SOLICE COACHELLA CA 92236 CONTRACTOR STATEWIDE SERVICES INC DBA STA 83780 CORTE SOLICE COACHELLA CA 92236 OWNER CREEDEN, HEATHER E 1545 KENMORE RD I PASADENA CA 91106 Printed: Tuesday, November 25, 2014 2:10:28 PM 1 of 2 SYSTEMS PARENT PROJECTS Printed: Tuesday, November 25, 2014 2:10:28 PM 2 of 2 Cg?—W— SYSTEMS rY INSPECTIONS SEQID INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED DATE DATE RESULT REMARKS NOTES PLUMBING FINAL*" y 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 TOTALS:00 PARENT PROJECTS Printed: Tuesday, November 25, 2014 2:10:28 PM 2 of 2 Cg?—W— SYSTEMS INSPECTIONS SEQID INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED DATE DATE RESULT REMARKS NOTES PLUMBING FINAL*" PARENT PROJECTS Printed: Tuesday, November 25, 2014 2:10:28 PM 2 of 2 Cg?—W— SYSTEMS Bin # Permit # Project Address: l �j d- ( 5 �1 A. P. Number: Contractor �aE-Ulo I d. Address: ef� City, ST, Zip: _ gip.{ t 10 City of La Quinta Building &r Safety Division P.O. Box 1504, 78-495 Calle Tampico !� Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet toys Owner's Name: y Address: Gj j J v-1e,4c.)• t City, ST, Zip: La Q L �n l-49 01 a -d- 3 Telephoned Project Description: ' Telephone State Lic. # : 4 J�3C/7 City Lie. 9 -- Arch., Engr., Designer: I Address: City., ST, Zip: Telephone: P State Lic.sr ? z s' aa.���'.���y '�a >;;� Construction Type: Occupancy: Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person: 1 Q Sq. FL: # Stories: # Units: Telephone # of Contact Person: Estimated Value of Project: 1 APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'd 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 god 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:- '"' Review,lready for correctionsfissue Developer Impact Fee Planning Approval Called Contact Person A,I,p,p, Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees Prescriptive Certificate of Com Residential A erasions Project Name: General Information Residential, Climate Zone Site Address: ,>- 1 Enforcement Building Type: Mingle Family ❑ Multi Family Proiect Typt CF-IR-ALT-DHW Permit #: I Date: or Change Out of Water Neater WATER HEATING - I certify that this Certificate of Compliattce documentation is accurate and complete. List new•h• installed water !eaters .and boilers for butt domestic hot Nater heaters (DWH) and Inrlronic space heating. Hew•h• installed DIVH heaters and bailers must be gas. propanr, or use dee e.vistin el npe. DisuiN tion Type Water Heater Number In Tank Fsergy Factor ix Typelfixl Type (Standard. System Capacity (gal) Thermal Efficiency Rrcirtv External Tank Insulation R -Value 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, lations. plans and specifications submitted to the enforccmew agency for approval with this building permit application. Na �l Siena Compare Date: 1. Indicate 7'pe (Storage Gas, Heat Pump. Instantaneous, etc.) 1. Recirculating systems serving multiple dwelling units shall meet the recirculation requirements of VArt). requirements do not allow the installation of a recirculating Nater heating system for single dwelling units. J. The e_vernal water heating tank and p4pes shall be insulated to meet the requirements o 1 The Prescriptive Contractor or Homeowner (Documentation Author's/Responsible Building Designer's Declaration Statement) - I 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 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 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, lations. plans and specifications submitted to the enforccmew agency for approval with this building permit application. Na �l Siena Compare Date: Address License'. Ciry/Stat Photo: L I, C�4 .. i