BPL2016-012478-495 CALLE TAMPICO
•LA QUINTA, CALIFORNIA 92253
Application Number:
BPLB2016-0124
Property Address:
48509 VIA AMISTAD
APN:
646122030
Application Description:
URMANSKI RESIDENCE
Property Zoning:
Application Valuation:
$3,500.00
Applicant:�``��
CERTIFIED COMFORT SYSTEMS INC DBA HYDES
42-949 MADIO.STREET
INDIO, CA 92201
T4t�t 4, aCP Q"
DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
P
G°Q
OCT2 A 2016
CITY OFLA QUINTA
ComilUNITY DEVELOPMENT DEPARTMENT
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: C20, C36 License No.: 906115
- '. Q��
Dai,. -'P Contractqri'
I hereby affirm under penalty of perjury thA/I am ex t from the Contractor's State
License Law for the following reason (Sec 031.5 siness and Professions Code: Any
city or county that requires a permit to construc , 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, ormy 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.).
(_) 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
VOICE (760),7.77-7125
FAX (760) 777 -7011 -
INSPECTIONS (760) 777-7153
Date: 10/28/2016
Owner:
KAY URMANSKI
48509 VIA AMISTAD
LA QUINTA, CA 92253
Contractor:
CERTIFIED COMFORT SYSTEMS INC DBA HYDES
42-949 MADIO STREET
INDIO, CA 92201
(760)360-2202
Llc. No:: 906115
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 th k for which this permit is issued.
— -1 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 permitis
issued. My workers' compensation insurance carrier and policy number are:
Carrier: EVEREST NATIONAL INSURANCE COMPANY Policy Number: 7600015264
_ 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!"LID Applica
WARNING: FAILURE TO SECURE WORKERS' MPENSATI COVERAGE IS UNLAWFUL
AND SHALL SUBJECT AN EMPLOYER TO C INAL PEN IES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($ 0,000). I DDITION 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 issLed
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 buildir,
' construction, and hereby authorize representatives of this city to enter upon the abov�_-
mentioned roper y for inspection purposes.
Date:k(2 Signature (Applicant or Ag t):
Date: 10/28/201.5
Application Number: BPLB2016-0124
Owner:
Property Address: 48509 VIA AMISTAD
KAY.URMANSKI
APN: ' 646122030
48509 VIA AMISTAD
Application Description: URMANSKI RESIDENCE
LA QUINTA, CA 92253
Property Zoning:
Application Valuation: $3;500.00
Applicant:
Contractor:
CERTIFIED COMFORT SYSTEMS INC DBA HYDES
CERTIFIED COMFORT SYSTEMS.INC DBA HYDES
42-949 MADIO STREET
42-949 MADIO STREET
INDIO, CA 92201
INDIO, CA 92201
-'
(760)360-2202
Llc. No.: 906115; -
Detail:.WATER HEATER CHANGE OUT - 50GALLON/GAS [2013 ENERGY] CARBON
MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION.
2013 CALIFORNIA BUILDING CODES.
DESCRIPTION
�-BSAS
7!
- ACCOUNT QTY
77
AMOUNT
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 PLUMBINGTEES:
PTI
$20.27
Bit) #
�a L��l(v'Ort City of La Quintd
Buifding 81; Safety Division
Permit # 78-495 Caffe Tampico
La Quinta, CA 92253 -'(760) 777-701,2
Buildin Permit Application and Tracking Sheet
Project Address: — Owner's Name: 1
A. P. Number:
Address:
JIM
Legal Description:
City, ST, Zip:
Contractor:
h ne:
Tele o w) ZoZ
P Z
.................
Address:Z.24- 40
Project Description:
City_ ST, Zip:
_
*'o
Iik 4AL
(U��
Teleh0ne /�., - 0` Z
l G �i
State Lie. # :
City Lie.
Arch., Engr., Designer:
Address:
City, ST, Zip:
Tel e hone:
P
:»
n trocti n T O ecu aneY:
Cos o Type: P
State Lie. #
Pro'ect type circle one • New Add'n Alter Repair. r Demo.
0
Name of Contact Person:
Sq. Ft.: ?�
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project: 6D
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rcc'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Check Deposit '
Truss Cafes..
Called Contact Person
Plan Check Balance.
Title 24 Cafes.
Plans picked up
Construction
Floodplain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
M.O.A. Approval
Plans resubmitted
Grading
IN HOUSE.:-
''d Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Dale of permit issue
School Fees,
Total Permit Fees
STATE OF CALIFORNIA
RES IDENTIAL'ALTERATIONS —WATER HEATER
CEC-CFIR-ALT-01-E (Revised 06/14) CALIFORNIA ENERGY COMMISSION'
'
CERTIFICATE OF COMPLIANCE CF1R-ALT-01-E WATER HEATER
Prescriptive Residential Alterations for Water Heater (Page 1 of 2)
A. GENERAL INFORMATION
Site address: 44Building Type; ingle Family Dwelling .
Via, ❑ Multi Family Dwellings.
City, Zip Code: 22-5Climate Zone: 10
G. WATER HEATING SYSTEMS Section 150.2 b 1G
01
02
1 03
04
05
1 06
.07
08
09
10
11
12
13
14
15
Water
Water
Water
# of
Water
Fuel
Rated
Rated
Heating
Heating
Standby
Exterior
Back -Up
Central
Dwelling
Heating
Heating
Heater
Water
Heater
Type
Input
Input
Efficiency
Efficiency
Loss (%)
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
lmk
I2FJ
WATER HEATING SYSTEMS
Water heating compliance for an alteration is described in Section 150.2(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 CF1R-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 willprovide 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 CF111-ALT-014 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 isnot 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 -central electric 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: f oOwner o Authorized agent oContractor
✓'"
Signature:
Company:
Contract icen #:
Address:
Phone:
/ C�
(iJ
City/State/Zip: 0 /� 1�- (1,�7 /i► (
Date:
For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300.