BPLB2014-1005VOICE (760) 777-7125
78-495 CALLE TAMPICO Ct 0 D � KMIIC(/
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011.
COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 7/28/2014
Application Number: BPLB2014-1005 Owner:
Property Address: 79350 SIERRA VISTA JON GAW
APN: 604440035 79350 SIERRA VISTA
Application Description: WATER HEATER CHANGE OUT 50 GALLON LA QUINTA, CA 92253
Property Zoning:
Application Valuation: .$2,675.00
A
I .
JUL 2 S 2014
Applicant:
A R S AMERICAN RESIDENTIAL SER
965 RIDGE LAKE BLVD STE 201
MEMPHIS, TN 38120
CITY OF LA QUINTA
Tv nEVELOPMENT DEPARTMENT
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: 66.. Cy42, A License No.: 765155
4000,
Date: +%— 7 ly . 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
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 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
Contractor:.
A R S AMERICAN RESIDENTIAL SER
965 RIDGE LAKE BLVD STE 201
MEMPHIS, TN 38120
(910)271-9700
Llc. No.: 765155
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:
Carrier: _ Policy Number: _
_ I certify that in the performance of the work for which this permit is issued,
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 theyebor Code, I shall fo hwith
comply with those provisions. �„
et
gate: —7-2- 0 i Yr 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, ant
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 relati g to building.
construction, and hereby authorize representatives of this city to ent po he above/
mentioned property for inspection purposes. �
Date: l _"ZyW- Signature (Applicant or Agen
-Prescri tive Certificate of Compliance: Residential- CF-IR-ALT.-DHW '
Residential Alterations
Project Name: a A4,W) Climate Zone: Permit #:
General Information
Site Address: -7 O Si,64AA ✓+Sff4 Enforcement Agency: Date: -2Y-I1
Building Type: O Single Family O Multi Family I Proiect Type: O Replacement or Change Out of Water Heater
WATER HEATING
• 1 certify that this Certificate of Compliance documentation is accurate and complete.
List newl'Y installed water heaters and boilers for both domestic hot water heaters (DWH) and lnrlronic space heating.
Newl)• installer.'
DWH heaters and boilers ntttst be gas. propane. or use dee existingfieel tYpe.
conform to the requirements of Title 24, Part 1 and 6 of the California Code of Regulations. .
DisuiNxion Type
Water Neater NumtxY In Tank F.trergy Factor ur
TYPE Type' (Standard. Recirrtulati )= System Capacity (gal) Thrnnal Effw it nay
&Lcmat Tank
Intutatiou
R -Value
CPAs 4-0
Name;
Si6tiature:
Ile
Ctxnpar►y: Date:
JQ>rsc,�� 2a.T62-A?--/y
Address: license:
is 12 ' vs v //1 r> 6"J
Ciry/Statozp: Pho":
11Z V :supe t,* g2 r�7 9th/ ;V/ 83 71
1. Indicate Type (Storage Gas. Heat Pump. Instantaneous, etc.)
2. Recirculating systems serving multiple dwelling units shall meet the recirculation requirements of §/An).
The Prescriptiw
requirements do not allow the installation of a recirculating water heating system for single -dwelling units.
3. The external water heating tank and pipes shall be insulated to meet therequirements of § 1
Contractor or Homeowner (Documentation Author'stResponsible Building Designer's Declaration Statement)
• 1 certify that this Certificate of Compliance documentation is accurate and complete.
• I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the building desien
identified on this Certificate'of Compliance.
• l certify that the energy featand performance specifications for the building design'identified on this Certificate of of ures e
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, calculations. plans and specifications submitted to dee
enforcement for approval with this buddingpermit application.
Name;
Si6tiature:
Ile
Ctxnpar►y: Date:
JQ>rsc,�� 2a.T62-A?--/y
Address: license:
is 12 ' vs v //1 r> 6"J
Ciry/Statozp: Pho":
11Z V :supe t,* g2 r�7 9th/ ;V/ 83 71
Bin #
City of La Quinta .
Building &r Safety Division
P.O. Box 1504, 78-495 Calle Tampico.
La Quinta, CA 92253 - (760) 777-7012
Building.Permit Application and Tracking Sheet
Permit #
Project Address: "� q Sa 1 J 1 ST�
Owner's Name: N
A. P. Number:
Address: S E S I3
Legal Description:
City, ST, Zip: L,A C+ q 2 2.f- 3
Contractor:L
c.---ws IZO 1'6�
Telephone: ,Z ,2 2
Project.Description: W/H Q q -e /h e n' -
Address: 5;k O VJ C. N b G S,
City, ST, Zip: R l v E0.S OI: 4J.1Sb-i
Telephone:
311115-11 .....:.......................
State Lic. # : -7 j S City Lia #; t '' 3V-1
Arch., Engr., Designer:
Address:
� 2
City, ST, Zip:
Telephone:
;::>:•>•.;:;•><:•;,::>:::
;:«7:':':^>.•. »>'r•;>. 5»:i'
f M v
Construction Type: Occupancy:
State Lic. #:
Project type circle one . New Add'n Alter Repair Demo
Name of Contact Person: du3f4 N
Sq. Ft.:
# Stories:
#Units:
Telephone #,of Contact Person:
Estimated Value of Project: .2 4-7 .�
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACMG
PERMIT FEES.
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Cli.eck Deposit
Truss Cala.
Called Contact Person
Plan Check Balance
Title 24 Cala.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mcchanical
Grading plan
2' Review, ready for correctionslissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'rd 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