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BPLB2017-003178-49S CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application Description Property Zoning: Application Valuation: Applicant: JEFFREY ADAM WILSON 78180 CALLE NORTE LA QUINTA, CA 92253 j► Twyl ^& �wQ,IArw DESIGN & DEVELOPMENT DEPARTMENT BUILDING PERMIT BPLB2017-0031 78180 CALLE NORTE 770011018 WILSON / CHANGE OUT (1) 50GALLON GAS WATER HEATER $1,000.00 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.: 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 ppo) I,as owner of the property, or my employees with wages as their sole ensation, 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 Peypr he did not build or improve for the purpose of sale.). 1 as owner of the property, am exclusively contracting with licensed contractors o 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 VNntractors' State License Law.). am exempt under Sec. C. fo his reason WDo.te: "I /j/1 CONSTQUCTION LENDING AENCY I hereby affirm under penalty of pe ry that there' a construction lending agency for the performance of the work for which ti rmit is'issued (Sec. 3097, Civ. C.). Lender's Name: Lender's Address: -VOICE (760) 777-7125 FAt(760 777-7011 INSPECTIOIQ(760 - z &te: 2/16/2 J c7 Owner: O -11 m O WILSON,J & C TRUST co 78180 CALLE NORTE O LA QUINTA, CA 92253 � ob ZOO ti O a Contractor: OWNER BUILD Llc. No.: , 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: Carri Policy Number: _ certify that in the performance of the work for which this permit is issued, I sha t 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. Dqapt r2— 6 . l7 APPlicadoxiiii-J— w -V 'A- W J h 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 actor 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 inform cor ect. I agree to comply with all city and county ordinances and elating to building construction, and hereby authorize representatives of thi ci o ente upon the above-mentioned property for inspection purposes. Vv Date: oc 6 Signature (Applicant or A_ Date: .2/16/2017 Application Number: BPLB2017-0031 Owner: Property Address: 78180 CALLE NORTE WILSON J & C TRUST APN: 770011018 78180 CALLE NORTE Application Description: WILSON / CHANGE OUT (1) 50GALLON GAS.WATER HEATER LA QUINTA, CA 92253 Property Zoning: Application Valuation: $1,000.00 Applicant: Contractor: JEFFREY ADAM WILSON OWNER BUILD 78180 CALLE NORTE LA QUINTA, CA 92253 ----------------------- --------------------------------------- Llc. No.: ------------------------------- Detail: WATER HEATER CHANGE•OUT - SOGALLON/GAS 12016 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION.- 2016 CALIFORNIA BUILDING CODES. Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00 FINANCIAL DESCRIPTION ACCOUNT CITY AMOUNT BSAS SB1473 FEE 101-0000-20306 0 $1.00 Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 DESCRIPTION ACCOUNT CITY AMOUNT PERMIT ISSUANCE 101-0000-42404 0 $96.27 - Total Paid for PERMIT ISSUANCE: $96.27 DESCRIPTION. ACCOUNT CITY AMOUNT WATER HEATER/VENT 101-0000-42401 0 $12.67 DESCRIPTION ACCOUNT CITY AMOUNT WATER HEATER/VENT PC 101-0000-42600 0 $7.60 Total Paid for PLUMBING FEES: $20.27 DESCRIPTION ACCOUNT CITY AMOUNT TECHNOLOGY ENHANCEMENT FEE .502-0000-43611 0 $5.00 Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00 Bill #arty. of. La Q uln to Building 8z: Safety Division Permit, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Project Address: ! 810 0 ^%U 2 T-6 Owner's Name: . �(�%2 F�� ' �Q _ I,t/t 'L.1 u ^I A. P. Number: Address: ($ 0 C4 (L A o /L - -E Legal Description: City, ST, Zip: L4 Q v , , Aq Cq q X X 5 .? r ont act C r: 0 J- r L �!1 r LS � �,w 70 � 6S U Telephone: n I P ele o e. 73 P Address: 7,9- f �p (�a 1 (e Project Description: City,ST,Zip: LA -T4V)P4f1.. ./V..CW CA C,kea 9,-6, Telephone: 7 vl fv 3 G State Lic. # : City Lic. Arch., Engr., Designer: Address: City, ST, Zip: Telephone: Occupancy: Constructiontru tion Type: an eY• Stato ic. # Project,type one): New Alter r Re aii- Demo. Name of Contact Person: J e L , t j d ^j Sq. Ft.: 3U 0 Ca 7# Stories: f # Units: Telephone # of Contact Person: ?,)1 36 5'O Estimated Value of Project: l O U Q . U U APPLICANT: DO. NOT WRITE BELOW THIS LINE H Submittal Req'd Recd 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 upConstruction ' Flood plain plan Plans resubmitted Mechanical Grading plan 2°" Review, ready forcorreclions/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. 1i.0.A. Approval Plans resubmitted' Grading IN HOUSE:- '"! Review, ready.for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees, Total Permit Fees P.O. BOX 1504 LA QUINTA, CALIFORNIA 92247-1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT PROPERTY OWNER'S PACKAGE (760)777-7012 FAX (760) 777-7011 Disclosures & Forms for Owner -Builders Applying for Construction Permits IMPORTANT! NOTICE TO PROPERTY.OWNER Dear Property Owner: An application for a building ermit has been submitted in your name listing yourself as the builder of the property improvements specified at Wi o C.4LLE No/z t -d t_4 4,, ,,,�,r G,¢ 9 153 We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder: We will not issue a building permit until you have read, initialed your understanding of eachprovision, signed, and- returned this form to us at our official address indicated. An agent of the owner, cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION DIRECTIONS: Read and initial each statement below to signer you understand or verify this information. . . 1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder". uilding permit that erroneously implies that the property owner is providing his or her own labor and material personally. 1, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for. those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. V2. I understand building permits are not required to be signed by property owners unless they are responsible for the onstruction and are not hiring a licensed Contractor to assume this responsibility. 3. 1 understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect yself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her na own. P. me instead of my 4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on ermits and contracts. 5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value f my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" *6-ml under state and federal law. understand if I am considered an "employer" under state and federal law, I must register with the state and federal rnent, withhold payroll taxes, provide workers' compensation disability insurance; and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to.serious financial risk. 7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential tructures cannot legally build them with .the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does. not -exceed four within any calendar year, or all of the work iserformed under contract with a licensed general building Contractor. p Xina, I understand as an Owner -Builder if I sell the• property for which this permit, is issued, I may be held liable'for any cial or personal injuries'sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue ervice, the United States Small.Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1- 800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the arty legally: and financially responsible for proposed construction activity at the following address: 78l,'o Cr~ztC Afoertg&U,,�, c.4- `Ia.-S'? pI agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all plicable laws and requirement$ that govern Owner -Builders as.well as employers. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I provided on this form Licensed contractors are regulated by laws designed to protect the public. If you contract with )ave omeone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner -Builder and. wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing th met mit Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable t ie a cy is required to be presented when the permit is issued to verify the property owner's signature. Signature of property K Date: ') /16 //'7 Note: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner -Builder. AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner -Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of Authorized Agent: Address of Authorized Agent: Tel No I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the. owner's driver's license, form notarization, or other verification acceptable to the agency is required to be presented when the permit is issued to verify the property owners signature. Property Owner's Signature: Date: t. - J Mi- t. - J STATE OF'CALIFORNIA RESIDENTIAL ALTERATIONS — WATER HEATER CEC-MR-ALT-01-E (Revised 06/14) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE CF111-ALT-014 WATER HEATER Prescriptive Residential Alterations for Water Heater (Page 1 of 2). A. GENERAL INFORMATION Site address: V2UGl� — Building Type: ❑ Single Family Dwelling Multi Family Dwellings City, Zip Code: j Climate Zone: 1 IS G. WATER HEATING SYSTEMS Section 150.2 b 1G 01 02 03 04 05 06 07 t 08 09 10 11 12 13 14 15 Water Water Water t# of Water Fuel Rated Rated' Heating Heating Standby Exterior Back -Up Central Dwelling Heating Heating Heater Water Heater Type Input Input Efficiency Efficiency Loss (Y'o) Insul. Solar DHW System Unit DHW System System Type Heaters Storage Type Value Type Value R -Value Savings Distribution System Identification Type in Volume Fraction Type Distribution or system (gal) Type Name M11017 -k-6 okw r 50 wu, �c WATER HEATING SYSTEMS Water heating compliance for an alteration is described in Section I50.2(b)1G. For single dwelling a gas or propane water heater, with a storage tank of 60 gallons maximum or instantaneous (tankless) can be used. Dwelling Unit distribution systems are limited to Standard trunk and branch or demand recirculation for gas or propane water heater. Demand recirculation is not allowed for electric water heater. If there is no natural gas connected to the building, an electric water heater may be replaced with another electric water heater. However, changing from gas to electric is not allowed. Multi -family central systems must use certified equipment as defined under Section 110.1 and 110.3. NOTE: If the proposed installation does not meet the requirements allowed specifically for alterations, use form CFIR-NCB-01 to document the water heater alteration. Instructions for sections with column numbers are given below: 1. Water Heating System Identification or Name: enter a unique name for the Water Heating System. 2. Water heating system type: Domestic Hot Water (DHW), Hydronic, Combined Hydronic, or Central. DHW is for domestic hot water, hydronic is a water heating system used for space heating only; combined hydronic are when the water heater will provide both space conditioning and domestic hot water. 3. Water heater type: For non -central systems only Small Storage or Small Instantaneous are allowed. For central systems pick from Large Storage, Small Storage, Heat Pump, Boiler, Large Instantaneous, Small Instantaneous or Indirect. CERTIFICATE OF COMPLIANCE CF1R-ALT-01-E WATER HEATER Prescriptive Residential Alterations for Water Heater (Page 2 of 2) 4. Number of water heaters in system: In single-family and multi -family with water heaters in. each dwelling units the value is 1. For multi -family central systems serving multiple dwelling units enter the total number of water heaters. 5. Water heater volume (gal): tank capacity in gallons. For individual water heaters for a dwelling unit this will be 60 gallons or less. If instantaneous, enter n/a. For multi -family central systems enter the total storage volume. 6. Fuel Type: Gas, Propane, Electric (Only if natural gas is not available) 7. Rated Input Type: Enter the equipment input rating type, for gas or propane fired units are Btuh, for electric fired system the units are kW. 8. Rated Input Value: Enter the numeric value of rated input. 9. Heating Efficiency Type: Energy Factor, AFUE, or Thermal Efficiency. From product literature or a California Energy Commission directory. 10. Heating Efficiency Value: Enter the value from product literature or a California Energy Commission directory 11. Standby Loss (percent): Applies only to large storage water heaters, Enter n/a for small storage or instantaneous water heaters. 12: Exterior Insulation R -Value: Enter the R -value if exterior insulation on the storage tank is installed 13. Back-up solar savings fraction: If compliance requires a back-up solar system, indicate the solar contribution (e.g., 0.30). External calculations are required. 14. Central DHW Distribution System: For multi -family buildings with using a central distribution system a demand recirculation system with at least two distribution loops must be installed. This requirement applies to any building with eight or more units. If the system is non -central or project is individual units enter n/a. 15. Dwelling Unit DHW Distribution Type: For a Central DHW this field shall be Standard. If non -central then pick from Standard, Demand Recirculation — Manual Control, Demand Recirculation — Sensor Control. If.non-centralelectric water heater this must be Standard, no recirculation system shall be installed. DOCUMENTATION AUTHOR'S DECLARATION STATEMENT • I certify that this Certificate of Compliance documentation is accurate and complete. Name: J61,f2E\'ALV L� Owner . ❑ Authorized agent oContractor Signatur Company : Contracto license #: Address: 7 Y (8 o (ck (w Nod k Phone: 9 o ( 7 .f a City/state/zip: — .L� C,4 S__? Date: 02 1'6 // 7 For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300.