BPLB2015-012678-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T4tit 4 4& Qum&�
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number:
BPLB2015-0126
Property Address:
54527 RIVIERA
APN:
775031030
Application Description:
HUNT/ CHANGE OUT (1) 50 GALLON GAS WATER HEATER
Property Zoning:
Application Valuation:
$900.00
Applicant:
STATEWIDE SERVICES INC DBA STATE WIDE PL
36947 COOK STREET SUITE
104
PALM DESERT, CA 92211
PALM DESERT, CA 92211
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 s : C36. A License No.: 936147
Date: Contractor•
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).:
(1 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.).
(_J 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 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:
�l illlli lilil IIII I'll
Date: 11/5/2015
02
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 w for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by
Se ion 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: Polity 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 3 00 of the LC? l abor Code, I shall forthwith
comply with those provisions. ^ �---�
,1
Date: _ Applica '
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 la�/s relating.to building
construction, and hereby authorize representatives of this i 'Enter upon the
above-mentioned property for inspection purposes.
&_
Date: Signature (Applicant or Agen :
Date: 11/5/2015
Owner:
JAMES B HUNT
54527 RIVIERA
LA QUINTA, CA 92253
Contractor:
n
ro � I CD
C p
STATEWIDE SERVICES INC DBA S_'TATEIWID�E PL
36947 COOK STREET SUITE 104
PALM DESERT, CA 92211
I Jn
a Z o 0
(442)666-8858.
M
9 D c n
Llc. No.: 936147
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'
compensation, as provided for by Section 3700 of the Labor Code, for the performance
of the w for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by
Se ion 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: Polity 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 3 00 of the LC? l abor Code, I shall forthwith
comply with those provisions. ^ �---�
,1
Date: _ Applica '
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 la�/s relating.to building
construction, and hereby authorize representatives of this i 'Enter upon the
above-mentioned property for inspection purposes.
&_
Date: Signature (Applicant or Agen :
a' r ( DESCRIPTION 4 � z. ' - .. s r� _ z - "� I - I i = 5
WINCCOUNT Q�TY� MOUNT PAID IPAIDIDATE�
g
R+..:- �5`.?:A a .. A,sv k<, �. tli _.i3.'`%`r�E%s:,>�'` .-mr#n-'-sNu,'-ssr"�"m>
BSAS SB1473 FEE 101-0000-20306
0 $1.00 $0.00
"- ' R '3 �' Y S R �z� k+`.. �`°: rFX "
ETHOD '�
?u,
��RECEIRT # f�� `"`CHECK#� C TDBY
Win.
r'�t•3;�.
�
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 $0.00
r[ ¢.-•4''h id MEN
ESCRIPT[ON
E'�1.4Yn
�4TY
2gyb'is .k ''fvA
Y
5
- b .•v: l aF
9` ui�
2Y.Sai3� -.i M { r'' ..,r
%RE ..;.
000UNT<;
A� N .PAI
s.:?AIDDATE
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
. tIN,'"
PAID,BY�
��.,:;.5.`..'t:9'hCT
Y d" ,i Eti
y
..'f`. " m .,.' - ..
RECEIPT #
�. ';"�u'%a^ Po'> ✓€. € z"'
HECK#
CLTD BY f
[.
,,METHOD
.�x"W.�.s.kl�S�Y,>x�.f
X'R'
O. LT`dF1...E.•.:'.C.fi
= . ; Total Paid for PERMIT ISSUANCE: $91.85 $0.00
��.�DESCRIPTION
��R ACCOUNT ��
QTY
AMOUNT��
PAID`
PAIDD TE
': .3 ., . ,ary .. f r...:s-„b" i, r.+rr?„x , ...,•..n .. . >
4.;Y Mf-'�-: i"m.-A.kssm2a;a�
"{�
..dY�.--14"i"�c'`29�.ksiR"'t9�H.K, f`2v�
sEk �4vD-a�`v; t 2,P�',r4 iR, ��'"�s
WATER HEATER/VENT
101-000042401'
.0
$12.09
$0.00
.�.,`
PAIDK BY
` V1ET OD
RECEIP #
14
C #
CLTD BY
.:J-- .�r.. Y.��.-%�,f�..'.2.�:'2:.., as
�:.":_ ..� a?'yE3°EX9��� s3e➢i�S 'e#°4
-
,E.:. s��`LLk..*.<.�.. �',N2�kT.. ,nf:o !x4if�
E`a5..^..'ei':3 �k':Xef"<i...Y:.e`��`V.["rk�:
����.-iR�`,hz.Alo.
QTY sUNT
s
AMO
MR PAID
PAID;DATEx
;t r> ;3v<k+.DESCRI?TION,xA�CCOUNT
WE .:
re- �+ f!.., •^g;:WC�d
WATER HEATER/VENT PC
101-0000-42600
0
$7.25
$0.00y
.''a't3x
PAID�BY_��:u.�..
"�,.''. Sp
vi
r
K�#
fir"
CLTOBX
.,�..seRECE�.,.��CH
Total Paid for PLUMBING FEES: $19.34: '$0.00
Description: HUNT / CHANGE OUT (1) 50 GALLON GAS WATER HEATER
Type: PLUMBING Subtype: Status: UNDER REVIEW
Applied: 11/5/2015 SKH
Approved:
Parcel No: 775031030 Site Address: 54527 RIVIERA LA QUINTA,CA 92253
Subdivision: TR 24317-1 Block: Lot: 2
Issued:
Lot Scl Ft: 0 Building Scl Ft: 0 Zoning:
Finaled:
Valuation: $900.00 Occupancy Type: Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0 No. Unites: 0
APPLICANT
Details: WATER HEATER CHANGE OUT - 50GALLON/GAS [2013 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL
INSPECTION. 2013 CALIFORNIA BUILDING CODES.
CHRONOLOGY
CONDITIONS
NAME TYPE
- : NAME
ADDRESSI
CONTACTS
CITY
STATE_
ZIP
PHONE,,
FAX
EMAIL
APPLICANT
STATEWIDE SERVICES INC DBA STATE
WIDE PL
36947 COOK STREET
SUITE 104
PALM DESERT,
CA
92211
CONTRACTOR
STATEWIDE SERVICES INC DBA STATE
WIDE PL
36947 COOK STREET
SUITE 104
PALM DESERT
CA
92211
OWNER
JAMES B HUNT
54527 RIVIERA
LA QUINTA
CA
92253
FINANCIAL INFORMATION
Printed: Thursday, November 05, 2015 8:28:12 AM 1 of 2
sysrrnns
PARENT PROJECTS
ATTACHMENTS
Printed: Thursday, November 05, 2015 8:28:12 AM 2 of 2
. SYS7Eti13
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
PARENT PROJECTS
ATTACHMENTS
Printed: Thursday, November 05, 2015 8:28:12 AM 2 of 2
. SYS7Eti13
Bin # City of La Quinta
Building az Safety Division
P.O. Box 1504, 78-495 Calle Tampico
Permit # La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
FA.
t Address: ' j/(i� ' Owner's Name:wa Vy
Number: Address: SCj 9,lDescription: City, ST, Zip: si
Contractor: i ' L Telephone _ `•„w'w'
Address: 3 -7 O Project Description:
City. ST, Zip: D /O.
Tele hone.
•�Y•• i•YK• Sj�h :;...Y,.MJ�.O''.r/ 'M..,SC L,Y .
� :~�>,� y \..:vg�;yg!vrsc ;a; �
.
State Lic. # 3
City Lic. #:
Arch., Engr., Designer.
-"
Address:
,.-
City., ST, Zip:
Telephone:
�„_:•4 ' :;'.�<:zRr Construction Type: Occupancy:
`::�t'i�C.Siv: i:\ �i."4:Cij��:^: C•Ltxv`,.
Project type (circle one): New Add'n Alter Repair Demo
'
Name of Contact Person:
Sq. Ft.:
n Stories:
# Units:
Telephone # of Contact Person:
9
Estimated Value of Project:
r�
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Cbeck submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Cbeck Deposit
Truss Calcs.
CalledContact Person
Plan Check Balance
Title 24 Cales.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
god Review, ready for correctionsfissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:
"d Review, ready for carrectionslissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
•Pcekri tive Certificate of Com !tinea; Residential.:: .: CF=IR-ALT-DHW
Residential Atter tions Page i of 2
Project.Natne: Climate Zone: Permit M
General Infornra ion 00
Site Address: t (// 6ACI Enforcement Agency: Date
Building T in le Family ❑ Multi Family Project Type: ❑'Re lacert>ent or Change Out of Water Heater
WATER HEATING
List net44r installed water heaters and boilers for bush domestic hot a+ater heaters-(DWH) and indronic space heating. NeKfi• installed
MH heaters and boilers must be gas. propane. or itse the existingel h
Water Fkater
Distribution Type
F�cternal Tank
Number In Tank Energy Factor or Insulatiou
TypdT,-q Type .
Res
System Capacity (gal) Thermal Efficiency R-Vatuer
Company: �1 /� � Aare:
Ucenw
A07�3 7 :9 V� , I
i
1. Indicate Type (Storage Gas, Heat Ptwrp: Instantaneous, etc.)
2. Recirculating systems serving multiple dwriling units shalt meet the recirculation requirements of §IS(l(n). The Prescriptive.
requirements do not allow the installation of a recirculating water heating system for single dwoelling units.
3. The eeternal water heating tank and pipes shall be insulated to meet the requirements o
Contractor or Homeowner (Documentation Author'sMesponsible BuiMing 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.
• 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 I and 6 of the California Code of Regulations.
• The building design features identified on this Certificate of Compliance arc consistent With dee information provided to document this
building design on the other applicable oormpliance forms, Aofkstwets. cal ulainoas plans and specificattorts submitted to the
enforccmerd agency for approval with this building rc application.
N
Si
Company: �1 /� � Aare:
Ucenw
A07�3 7 :9 V� , I
Ciryp C'(
Bin #
Cj�y Of La Quinta
Building & Safety Division
`
P.O. Box 1504, 78-495 Calle Tampico
City Lic. g:
Permit #
La Quinta, CA 92253 - (760) 777-7012
Arch., Engr., Designer:
Building Permit Application and Tracking Sheet
Project Address: L
t (/(✓L
Owner's Name: r
A. P. Number:
City., ST, Zip:
Address: Is
t'
Legal Description:
Telephone:
City, ST, Zip:
Contractor
lL4
telephone -7(6
w"
/: � /•'
A eifireecc• S< Z % Y / i
0 /a / I n / ,
n
Proiect Description: L!9
1,4011--1
City, ST, Zip:
Telephone: 7
State Lic. B :
City Lic. g:
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
Construction Type'. Occupancy:
.Stat 1C. #'
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft:
n Stories:
#Units:
Telephone # of Contact Person
9 a/,,) c,
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
31
SubmittalReq'd
Recd
TRACKING
PERMIT FEES
Plan -Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calrs.
Called Contact Person
Plan Check Balance
Title 24 Cales.
Plans picked up
Construction
Flood plain plan'Plans
resubmitted
Mechanical
Grading plan
god Review, ready for correctionsfissue
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, ready 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
a
9