BPLB2016-012778-495 CALLE TAMPICO, ^ C& 0 U Zfv Q"
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BPLB2016-0127 PTWATEftfE PropertyAddress: 47620 CALEO BAYAPN: 643230002
Application Description: RICHARDS01 RESIDENCE$
Property Zoning: 1 4 2016
Application Valuation: $6,100.00 .
Applicant: DFS/GNgN�D�FP1q QU/Njq
965 R DGERLAKE BLVD SUITE 201 RVICES OF C OPMSNjUFPgRTMFN
r
MEMPHIS, TN 38120
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: C36. C10, C20 License No.: 765074
Date: /" Contractor:
OWNER -BUILDER DECLARATION ` V
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.).
( ) 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
Lender's
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/14/2016
Owner:
KATHRYN RICHARDSON
Contractor:
A R S AMERICAN RESIDENTIAL SERVICES OF C
965 RIDGE LAKE BLVD SUITE 201
MEMPHIS, TN 38120
(951)276-9744
Llc. No.: 765074
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: LIBERTY INSURANCE CORPORATION Polity Number: WC7631508631
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. J
Date: / 7Applicant
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 laws relating to building
construction, and hereby authorize representatives of this city to enter. on the
above-mentioned
/property for inspection purposes.
iDate: Y " Signature (Applicant or Agent):
Application Number:
BPLB2016-0127
Property Address:
47620 CALEO BAY
APN:
643230002
Application Description:
RICHARDSON RESIDENCE / HOT WATER HEATER
Property Zoning
Application Valuation:
$6,100.00 `.
Date: 11/14/2016
Owner:
KATHRYN RICHARDSON
Applicant: Contractor:
A R.5 AMERICAN RESIDENTIAL SERVICES OF C A R S AMERICAN RESIDENTIAL SERVICES OF C
965 RIDGE LAKE BLVD SUITE 201 965 RIDGE LAKE BLVD SUITE 201
MEMPHIS, TN 38120 MEMPHIS, TN 38120
(951)276-9744
Llc. No.: 765074
----------------------------------------------------------- ----------------------------------
Detail: WATER HEATER CHANGE OUT - 75 GALLON / GAS [2013 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION.
2013 CALIFORNIA BUILDING CODES.
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
Bin ##
Permit #i
Project Address: 4176,616 C%2a0U/yr,*
City of La Quin to
Building & Safety Division
78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Owner's Name:ubad
A. P. Number:/�e?ei53
Address: J-1Z"��
C�Q
Legal Description: 75C�AL k1AVZe_ IlL��79Z_
City, ST, Zip= b,w7W z- pia �3
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Contractor: '-
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Tele hone:
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Address: 22'',, ••��
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Project Description: Z
City, ST, Zip:p Qr t�j9 ��cSt
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Tele h 0
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State Lie. # : (0
City Lie- #-..t9/,q5373
Arch., Engr., Designer:
Address:
City, ST, Zip:
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Telephone:
one:
s
on traction T e•Occupancy:
C s Y P
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State a
Project typeone): Add'n Alter Repair- r
Demo circle N w
Name of Contact Person: o
Sq. Ft.: -3) 39 7
1 # Stories:
# Units:
Telephone # of Contact Perso sr(z
-Q( Z'
Estimated Value of Project: �Q
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 Cates.
Called Contact Person
Plan Check Balance.
Title 24 Cates.
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
RESIDENTIAL ALTERATIONS — WATER HEATER
CEC-CFI R,ALT-01-E (Revised 06114)
CERTIFICATE OF COMPLIANCE CALIFORNIA ENERGY CommISSION
Prescriptive Residential Alterations for Water Heater CF1R-ALT-01-E WATER HEATER
(Page 1 of 2}
A. GENERAL INFORMATION
Site address: �0 Building Type: Single Family Dwelling I p o Multi Family Dwellings
City, Zip Code:
Climate Zone: 10
S. WATER HEATING
SYSTEMS Section 150.2 b 1 G
01
Water
Heating
System
Identification
or
Name
02
Water
Heating
System
Type
03
Water
Heater
Type
04
# of
Water
Heaters
in
system
05
Water
Heater
Storage
Volume
(gal)
1 06 '
Fuel
Type
07
Rated
Input
Type
08
Rated
Input
Value
09
Heating
Efficiency
Type
10
li
12
13
1-4
Heating
Efficiency
Value
Standby
Loss (%)
Exterior
Insul.
R -Value
Back -Up
Solar
Savings
Fraction
Central
DHW System
Distribution
Type
Dwelling
Unit DHW
. System
Distribution
Type
WATER HEATING -SYSTEMS
Water heating compliance for an alteration is described in Section 150Z(b)1G. For single dwelling a gas or propane water heater, with a storage tank of60 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 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 CFMALT-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.
S. 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 appliesto 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: i oOwner o Authorized agent ontractor
Signature:
Company : 1 `mContractor
Address: a0 O M
license #: ")
Phone: _
EEI
City/State/Zip: �d P
Date: I
For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300.