BPLB2015-008878-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253'
I
T4t!t 4 4 Qumr(u
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BPLB2015-0088
Property Address: 48614 VISTA PALOMINO
APN: 602200026
Application Description: KWIATKOWSKI / CHANGE OUT (1)10 GALLON GAS WATER HEATER
Property Zoning.
Application Valuation: $1,090.00
Applicant: FFATOMMY ROOTER PLUMBING INC
80975 INDIOBLVD##C3 2015
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: C36 License No.: 930139,.
Date: :.3 — Contracts
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 Address:
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/26/2015
Owner:
MICHAEL KWIATKOWSKI
48614 VISTA PALOMINO
LA QUINTA, CA 92253
Contractor:
TOMMY ROOTER PLUMBING INC
80975 INDIO BLVD #C3
INDIO, CA 92201
.(760)574-4444
Llc. 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
orkfor which this permit Is issued.
I have and will maintain workers' compensation insurance, as required by
Sec on 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
comply
—with those provisions., �) fin/ 1
Date: V Applicant: �nJ\
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.
Date.' lD – Signature (Applicant or Agent)
FINANCIAL . 1
ffYDESCRIPTION*r !"�°`� ' `�r`ACCOUNT;"�;b QTYS AMOUNT " ° �st�� ` PAID; °..r,: PAID,DATE.
„x -r: �.� r, ... ,. r ,t Vis?
BSAS SB1473 FEE 101-0000-20306 0
$1.00 $0.00
*PX.. , dr w^« t+,+'*Ig^e.ties, .., z, i,. ns..r+a.y w az"try 41.- f .r « •c t .
r. PAID BY .� a ?. '; METHODS 1}t� ' 4 �t wS RECEIPTktt�,CHECK:#
2 Ott rdCLTD;BY
` Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $1.00 $0.00
'�'=etiy UESCRIPTION':��p? a},t
�+ s,iAMOUNT'w
PAID;
,,:ra'.,A000UNTF`�fCITY
kPAID•DATE'
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
s 'zMETHOD � S
'. � `L RECEIPT # * '
"CHECK
CLTD BY.,. ;
:.
pi
Total Paid for PERMIT ISSUANCE: $91.85 $0.00
DEr
SCRIPION
a
CITY
AMOUT'�.,
`PAID
DATE'
4
,",......N
kPAI
WATER HEATER/VENT
101-0000-42401
0
$12.09
$0.00
METHODF K�
RECEIPT #
'# .0 x «g"
CHECK
CLTD. BY
^
:r e
'xts DESCRIPTIONa
�s;
m`ACC OUNT 'r'"4 "
TYi
�f.
s AMOUNT,
+ PAID ��
tPAID DATE'
ie .d . •2 :o.. ri. a.{ h
'.L. .*l1 :Jf S
"
.;....1�
WATER HEATER/V((--ENT PC
101-0000-42600
0
$7.25 '
$0.00
.b y.s "X r.•S µ 1 wMY�L. iaL �-F x M
PAID.BY
f. b4'}tE ••S�{ f-. f' J ISN 4
METHOD
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# �„
M f�•iw.
CHECK #
Q ...
CLTD BYa
r 2 i1 sr '"
<�� t . c
, a S.RECEIPT ."'
Total Paid forPLUMBING FEES: $19.34 $0.00
TOTALS:• ••
k
Description: KWIATKOWSKI CHANGE OUT (1) 10 GALLON GAS WATER HEATER
Type: PLUMBING Subtype: Status: APPROVED
Applied: 6/26/2015 SKH
Approved: 6/26/2015 SKH
Parcel No: 602200026 Site,Addr-ess: 48614 VISTA PALOMINOLA QUINTACA 92253
Subdivision: TR.29306 Block:. Lot: 66
issued:
Lot Sq Ft: 0 Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $1,090.00 Occupancy Type: Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0 No. Unites: 0
AMETYPE1rt
Details: WATER HEATER CHANGE OUT - 40GALLON/GAS [2013 ENERGY] CARBON MONOXIDE ALARM(S) TOBEINSTALLED PRIOR TO FINAL
INSPECTION. 2013 CALIFORNIA BUILDING CODES.
Applied to Approved
ADDITIONAL SITES
CHRONOLOGY
CONDITIONS
-PAID
6 � CLTD
''DESCRIPTION ACCOUNT�.,
CITY
DATE'l-�RECEIPT'#��i:�!CHECK�#"
r
IETHC� PAID BY a'
METHOD PA
"By:17
AMETYPE1rt
CONTACTS
BSAS SB1473 FEE 101-0000-20306
0
'j,
APPLICANT
TOMMY ROOTER PLUMBING INC
80975 INDIO BLVD #0
INDIO
CA
92201
CONTRACTOR
TOMMY ROOTER PLUMBING INC
80975 INDIO BLVD #C3
INDIO
CA
92201
-
OWNER
MICHAEL KWIATKOWSKI.
48614 VISTA
PALOMINO
LA QU I NTA
CA >
92253
Printed: Friday, June 26, 2015 2:40:02 PIVI .1of2 CB?wSYSTEMS
4
-PAID
6 � CLTD
''DESCRIPTION ACCOUNT�.,
CITY
DATE'l-�RECEIPT'#��i:�!CHECK�#"
r
IETHC� PAID BY a'
METHOD PA
"By:17
BSAS SB1473 FEE 101-0000-20306
0
$1.00
$0.00
Total Paid for BUILDING STANDARDS ADMINISTRATION
$1.00
$0.00
BSA:
-
Printed: Friday, June 26, 2015 2:40:02 PIVI .1of2 CB?wSYSTEMS
4
iNgDESCRIPTION
7, .'
', T
P ;':
PAID. DATE;
.RECEIPT #•
#
METH. OD
z' PAID B.Y,�
'
DAT
PLUMBING FINAL"
BLD
-;CHECK
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: $112.19 $0.00
PARENT PROJECTS
REVIEWS
'7- T�
�SfATUS`-"
SENT�D E,D
c
BOND INFORMATION
ATTACHMENTS
Printed: Friday, June 26, 2015 2:40:02 PM 2 of 2 CRWSYSTEMS
INSPECTIONS
I E' I PE OR
'SCHEDULED, :COMPLETED1
e 41 'k�DATE
DAT
PLUMBING FINAL"
BLD
PARENT PROJECTS
REVIEWS
'7- T�
�SfATUS`-"
SENT�D E,D
c
BOND INFORMATION
ATTACHMENTS
Printed: Friday, June 26, 2015 2:40:02 PM 2 of 2 CRWSYSTEMS
Prescriptive Certificate of Com liantim Residential CF-IR-ALT-DHNV
Residential Alrercitions Page I of 2
Project Name, Climate Zone: N.nnit #:
General Iniorihation
Site Address:" Enfon:enidntA enc : Datta:
-Building T 'Siri" le Family O Multi Family- Project T Replacement or Chan a Out of Water Heater
WATER HEATING
I certify that this Certifleate of Compliance documentation is accurate and complcte.
Lis' newly installed water heaters'and'boilers for both do nesde hot 'wafer healers (DVH) and hq'dronic space hearing.- Newly installed
DWN heaters'and boilers must• be gas, proparte, or.use the existin tel ' e.
Distribution 7`yp
Water Heatir Npmbet In Tank Energy Fni ttx of
Typrlfvel Ty(7et (Stmda d' System Capacity (gall Thermal Efficiency
: .Recirciladn )s
External Tank
Insulation
R-Valuc?
t�
• The building design features idetitlfled on this eertifi ate of Compliance an consistairt with the iriforislation pri5vided to doCu'rnegt this
building 'design on the other applicable Compliance forms, workshcots, calculations, plans and specifications submitted to the
enforcement a enc . fora oval with this building permit a licrition:
Nano:
L- Indicate 7jne (Storage Gas:'Heal FwV, Inslarrtaneous, ere.)
2. Recirculating.. systems serving multiple dwelling (tilts shall meet the. recirculation requirv#ents of _ §150(n).
requirements do not allow the Installation of a reclrralaling water heating sysrem jar single dwelling units
3. The. emernal-water-hearing tank and p1pesthall be insulared to meet the re uiretnents o 150 ' .
The .Prescriptive
Contractor or Homeowner (Documentation Author'sdRespensible Building Designer's I) dal adena Stateftient)
I certify that this Certifleate of Compliance documentation is accurate and complcte.
•, f am eligible under. Division 3 of the Califomie` Business and Professions Code to accept responsibility for the building design
Identified on this Certificate of Compliance.
• •l certify that the energy fentutt:s and performance specifications fof the building design identified on this Certificate of Compliance
conform tb the requirements of Title -24, Patt,l and 6 of tlie'Califormia Code of Regulations,
• The building design features idetitlfled on this eertifi ate of Compliance an consistairt with the iriforislation pri5vided to doCu'rnegt this
building 'design on the other applicable Compliance forms, workshcots, calculations, plans and specifications submitted to the
enforcement a enc . fora oval with this building permit a licrition:
Nano:
Company:
Address: 1
License: '
Citylstatezip
Phone:
��
w4l
06/06/2013 TRU 15!09 FAX La Quinta Bldg 6 Safety
• Bin � •
. Y Of La Quinta
8uf1tlhrg.8r Safety Dhtklri
t'ermtr # P.O. Box 1504, 78.495 Carne Tatalpjw
0 Qtdnta,. CA 9.2253 - (760) 777-7012
BUdding Permit Application and Tracking Sheet
Owner's Nam:
A. ?.Number.,. .
Address
Lags( ]?rscri aotx .
1Y, IT, Zip:
. Corihactor. v
p
Addresn:
city. ST, zip.
Tetophone: +
Ajrk, Edg•, Desiper:
Add=
City, ST, Zip:
Telephoto:
Statc Lia. �;
Nam of Contact pm=
i
Tolonc # of Con>gct
9 Sobtnittal
Plan Sots
3truttent Calm.
Truss Cales,
i
Title 24 CdM
Flood platn Platt
• Grading Pian
Slitrtrontactor I.fst
Grant Deed
H.O.A. Approval
i
iN)3[01iSB.+
Planµing Approval
i
Pub. Wks. APpr
school Fees
Persou_
LK 0
2001/001
Total Permit FCC9
Construction Typo:
Oca�anay;
�-
Prof W 47 (circle Ono), New Add'a Alton Repair Demo
3q. Ft.:
9 Storic9:
I N•Urrit ,
139timated Volae of Project;
APPLICANT: DO NOT WFdTE 13ELOW THIS UNE
lt6a'�i
TRACIK,)TIG
P$Rlt2Y� FEES
Pian Check submitted
Item
A mottnt
Rehegtd, ready for corrections
plan CI►edt Tlepos r
CaUed Contac Person
PIaD Check $aiauce
MISS pleked up
'CmcsirnctioD -
.
Plays Mabrnitted
14IacAaulcal
2" Review, t ;t4yfor MMceQe,%r sue
Electrical
.
Called CotttnetPerson
Plumbing
Plans otcked up
S.IvI 7i,
Pians resoi mltttd
Grading
Review, ready fol• tormcdourtsm
.Developer Impact Fee
Called Conlaet Person
Date orpermit issue
Total Permit FCC9
PLUMBING WORD( OR_ OERANVOICE
TOMMY ROOTER 21029
HELPING THE DESERT
ONE FRIEND AT A TIME Co.
Pfnmhlng,DrafnCleanfrrg&letterSpecfanst fE1V_# �7
BD975 Indio Blvd., 1139Auth.# Nwl
Indio, CA 92241
760-574-4444 !n �j
Fax 78D4442717 (/
NIVJUV.TOMh1YRooTER.CoM Out
CA UC. #SSO133
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ITEMOR PART DESCRIPTION'
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