BPLB2017-00564
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 1 hereby affirm under penalty of perjury one of the following declarations:
(commencing with Section 70001 of Division 3 of the Business and Professions Code, and _ I have and will maintain a certificate of consent to self-insure for workers'
my License is in full force and effect. compensation, as provided for by Section 3700 of the Labor Code, for the performance
License Class: C36 License No.: 930133 a work for which this permit is issued.
qq� 1 have and will maintain workers' compensation insurance, as required by
Date: � �o�ip ' ContractoZ. C ��� 700 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: NORGUARD INSURANCE COMPANY Policy Number: TOWC851139
_ 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.
Date: — n � Applica2t:
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.
VOICE (760) 777-7125
78-495 CALLE TAMPICO
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FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 DESIGN &DEVELOPMENT DEPARTMENT
INSPECTIONS (760) 777-7153
BUILDING PERMIT
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Application Number: BPLB2017-0056
Owner:
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Property Address: 79360 DESERT STREAM DR
OSCAR LAVANCHY
APN: 604321002
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Application Description: LAVANCHY / 40GAL WATER HEATER CHANGE OUT
92253
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Property Zoning:
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Application Valuation: $1,300.00 t
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Applicant:
Contractor:
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TOMMY ROOTER PLUMBING INC
TOMMY ROOTER PLUMBIN9
At
80975 INDIO BLVD #69
INDIO, CA 92201
80975 INDIO BLVD
INDIO, CA 92201
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(760)574-4444
Llc. No.: 930133
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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.).
(1 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.).
(_J 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:
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 represematives of this city to enter upon the above-
mentioned property for inspection purposes.
Date: Ll _A(el—n Signature (Applicant or Agen
Date: 4/5/2017
Application Number: BPLB2017-0056 Owner:
Property Address: 79360 DESERT STREAM DR OSCAR LAVANCHY
APN: 604321002
Application Description: LAVANCHY / 40GAL WATER HEATER CHANGE OUT 92253
Property Zoning:
Application Valuation: $1,300.00
Applicant: Contractor:
TOMMY ROOTER PLUMBING INC TOMMY ROOTER PLUMBING INC
80975 INDIO BLVD #69 80975 INDIO BLVD #69
INDIO, CA 92201 INDIO, CA 92201
(760)574-4444
Llc. No.: 930133
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Deta i l:
FINANCIAL INFORMATION
DESCRIPTION ACCOUNT QTY AMOUNT
BSAS SB1473 FEE 101-0000-20306 0 $1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION
ACCOUNT
QTY.
AMOUNT
PERMIT ISSUANCE
101-0000-42404
0
$96.27
Total Paid for PERMIT ISSUANCE: $96.27
DESCRIPTION
ACCOUNT
QTY
AMOUNT
WATER HEATER/VENT
101-0000-42401
0
$12.67
DESCRIPTION
ACCOUNT
QTY
AMOUNT
WATER HEATER/VENT PC
101-0000-42600
0
$7.60
Total Paid for PLUMBING FEES: $20.27
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
06/06/2013 THU 15:09 FAX La Quintn Eldq 6 Safeihy
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Tohtl hmtt Fees
Prescri tive.:Certificace of Cljm .fiance: Residenlfial
Residentiul Alterations _ _ 7
CF•1K-ALT-DHNV
Page I of 2
e Zone: PBrltt:t #
WATER BEATING WF! and hydroniC space heats: Newly lost'
ist nervfy ln3talled water heaters and boilers for both danesrtc hot water heaters (Q i'
DWH heaters:and boilers tnttst be as, ro acre, or.��se the a riadn 'tl e, s . ;F�ctemril"rod
D►stribtuion .Type Numberbt Tank Fttergy'Fnctorof r •; lnsututioo
Wats Heatei Thermal Sf(icilascy
trttel i` , � (Standard. System CaP�uy (FA) �•-� R=Values'
TYPE ype ccirciilailn
j
!..ln'li�ate Type l��r?0.4¢f�' 'Heat Pwnp: lnsfagtancot�e. e/C.1 : 9 1 rtptive
. e�RrsC
Z.`l2etlrrielatlrig rystenrs �trving' rRuldpte d►vellidg "ilii shalt octet 'the herfiiculatlan :n ui!ence!►rs d SO(d1 i7re':
requln►nents do not 4110VAC fn rtallatto" of a t+ ecirruldtfng:wdter heating $ystsM for single dwelling units«
3. iirrextenwl water heat' talk and 1 s shall be tnsulared to meet the re utrenaents o 1 S
Co++traclor or i1EQm�wrwr (DocumetItAL0012 Author's/Responsible 1511KG ttg D SMUer 9 pgcls: anon StabBdfeat):
I cettif!y tliat this Certificate of Compliance docinnentution is aeeuarta aad.eoVgAcU -
+ and professions Code to accept responsibility for im bulid!;% design
i asn•eligible under. Division 3 of the California' Business
identified on this Certificate of Compliance. •
• i' entire that the eaergy wA o and petf,,r ice specifications for the building design Identified on -his Certificate o(Comgliance
conform to the requirriim. is of Title 24, Parti and 6 of the C11,
alifotttla Code of Begin nt With
.
• The building design features identified on thik C'ertiflcate of Comtpilantc.07 consistent withinand silo EiC aqe s bd o the
building "dislgit on t2se other applicable compliance for ms, worksheet% calculations, *plans�
enforcement a ency for, approval. with this buildin t 11 ion.
`— Date
ompany'
l� C t.iccase: u .
caress.. _ Q6\C1 01
wi
OMMAIM,
Prescrl tive..Certificate of Com liance: Restdenflal gage 1 of a
Reside MatAlterations C4�mate Zone. fear it #;
pro'ect Name::
ATEA REATING yrl{ and hydronic s7ace heating; Newtv Mstr
't newly tnjwdled'*are r heaters and boilers for both dotnesrie hot tivater heptrrs (Q l' ;
VH'heaters:arrdboelers must be as, ro attr. or.11se the a risr(n tel r, ; ,.;F�etamalTan{
Distribution Type Number Irt Ta;rk Energy.,Factor of i Insiiiutioo
Water Heattr Thermal 6ffk-icMY
r (Sm„dard. Systam Capacity (gal) :: A=Ya(rte3
Type/pwd-Type It:Gcirciilaiin
I. hufi�alt 7yPe (gto►?�4e: C 'Heal PtunP: Instantoncotpc. ela-1 rPirscri live
Z.`Xeeirritlatlttie .Systrtns serving' r.uldp)e dwelling units •shall meet ?he retf tilatlrons' five�lr g nurir�f §lS0(n) Ire _': D
require►Rents do not allaw'the ►n rtallatton oJa recirridatingmaterhealing syste . fa.. .
3. The errenral watenheati tank and 1 s shall be insulated to inset the ►e ultrmrnts o ' IS
Contractor or Eiom�owner (Docuatentadon Author's/Regponsibte $ulldlttg Destper' • eiient);
9 Dec}aratioo State
certify that this CCrtificate of ComPlianct documentation is accurate and.eotrrpkte.. ? '
s ifomis' t3usiness
{ am eligible under. division 3 of the CO and Professions Code to accept responsibility for the bull.- design
identified on this Certificate of Cotnpl'rance. ldentifted on. this
ertiFy.that the energy features and perforrnar<ee specifications Por the building design CettifiCijle of Co,"rirpli�rtce
conform to the rcquiilements of Title 24, Part { and 6 of the Califotnla Cody of Etegtrlattons ' '
. IZre building design features identlfed on thw Certiflcate of Compl[ance.arc coasistant within in�a st[ospecifiCrsotivo[l9 sutijllit ed 'tot the
building'desslkn on the other applicable +ompliance forms, worksheets, calculations,'Plans
t nforcetxient agency fora rave{• with this bCA cx uild'in mtit lleation.
Na„ee:
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Address::
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City/ srar�i.� ' _ 'r „ tra ,-. ''1 l\\ --�
PLUMBING WORK
ORDER/INVOICE
TOMMY ROOTER
762
HELPING THE DESERT
ONE FRIEND AT A TIME Co.
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ITEM OR PART DESCRIPTIO14
a` PltnarDbig, Dart Clewing BtfefterSyecraHsiInv.
80975 Indio ENvd., #1319
Auth.
Indio, CAIM01
760.574-4444
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lARR1WTY
t] OOtdTRACT
MAKE tAOUEL SFRIALIAHalOER
❑ SERVICE OONTRACT
❑ NORMAL
V
❑ HES. 0 COENa.
TOTAL MATERIALS
0NOTOx1IIgETE
DESCRIPTION OF O•
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TO OUR CUSTOMERS: SwAcerurtarere0edtohavewolkslpsived.
ORAW CLEANING
_
Tits Is dere in order to proW you. the woekmen, and ws h- s and to
MCILFOOTAGEO
1
enablu us to glis ymur absoluke saHslactcq service. `fou are mWeotfi7Rf
to ammine malerlal and labor statement before workmen leave
ADDLFOtTIiRES
recpested
the 0, and 9 you find everythlog satb-factory, okay this Utiket. B write Js
PLUMBIMC LABOR
PARTS
unsatistactoty, m any way, please phone our office Imrneo'tatey.
A PEWTY WILL BE CHARGED AT THE RATE OF 10% PER MOD" ON
17.
UNPAID B"CESAFTSt30EIAYSOFWYOICEDATE.ANNUAPERGSHTAGE
.PROUX`TSMUT1191T
VIDEO INSPECTION
TOTAL LABOR RATE IM RETURN® CHECK FEE $MMD,
a t
I find 1he time and rmawrW charged above sagafactary and wee to pay
O EVER
WWARRANTY❑
1C[ same im presentation of Irnmre, arrJ further agree to pay reasonable
blltdl JETTER
❑ 5 Day ❑ 1 Year
cherg3ed for ooNclion In.luilrtg aUorn�eys fees inevent o1 my defaull.
LINBLEAK LDCAT30Pl
❑ 3 IAonih ❑ do
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❑ 6'M;ho
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"NOTICE TO OW ER'''.. on 7e1 acture Linemen Lori umr Be
PLVAPSEPTIC,6`REASE
OTHER
N&A"W u7n urk"wrUtr}or, elIc IRonr, aHhhll am a aim Pa.®on WO raw
rPe paperlr �1 h rut Pau Ixt19Wwn(m&wukW,tmadahuttraeM tS
WARRANTYCALLS
ARE SCHEDULED
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fe9amf ra tna tuft of 0 pumrs
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TOTAL
furistf rr .Aa 61)♦4o0nCDa .:.•
YMENTRECEIVED
X
X
'ACASH ❑ C,C. [:]BILL ❑ CHECK # ❑x
PAYMENT DUE
In�ials
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