BPLB2017-000578-495 CALLE TAMPICO V �14tII�Cl/
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BPLB2017-0005
Property Address:
60518 WHITE SAGE DR
APN:
764330062
Application Description:
POPICH / CHANGE OUT (1) 50GALLON GAS WATER HEATER
Property Zoning:
Application Valuation:
$2,997.00
Applicant:
A R S AMERICAN RESIDENTIAL SERVICES OF C
965 RIDGE LAKE BLVD SUITE 201
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
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.).
(_) 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) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
GREGORY POPICH
10129 CHERRY LN NW
GIG HARBOR, WA 92253
Contractor:
A R S AMERICAN RESIDENTIAL S
965 RIDGE LAKE BLVD SUITE 201
MEMPHIS, TN 38120
(951)276-9744
Llc. No.: 765074
Date: 1/11/2017
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 rk for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by
Secti , n 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 Policy 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.
Date: ��- / 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, 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 upon the
above-mentioned property for inspection purposes.
Date: �- /r Signature (Applicant or Agent):
Application Number: BPLB2017-0005
Property Address: 60518 WHITE SAGE DR
APN: 764330062
Application Description: POPICH / CHANGE OUT (1) 50GALLON GAS WATER HEATER
Property Zoning:
Application Valuation: $2,997.00
Applicant:
A R S AMERICAN RESIDENTIAL SERVICES OF C
965 RIDGE LAKE BLVD SUITE 201
MEMPHIS, TN 38120
Date: 1/11/2017
Owner:
GREGORY POPICH,
10_29 CHERRY LN NW
GIG HARBOR, WA 92253
Contractor:
A R'S AMERICAN RESIDENTIAL SERVICES OF C
965 RIDGE LAKE BLVD SUITE 201
MEMPHIS, TN 38120
(95°)276-9744
Llc. No.: 765074
---------------------------------------------------------------------------------------------
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'
FINANCIAL INFORMATION
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
CF111-ALT-01-E WATER MEATER
CERTIFICATE OF COMPLIANCE
n—'.A.-+ia1 Alterations for Water Heater
i
4. 'Number of water heaters In system: In single-family and multi -family YAth water heaters In each dwb1lin JnIts<.thewa1ae4s4.:Fdr•,�'tm'IfihfanSNycertralsystems
serving multiple dwelling units enter the total . number of water heaters.,,
unit this will b on -.essf�.if.'InstantameouApep.tter..n/a. For
5. Water heater volume (gal): tank capacity In gallons. For Individual water . . heaters for i dwelling
multi -family centra Isyste;ms �entert the to.talistoragemolume.
6. Fuel .Typ#:r.Gas,! Pr6pan e; Vectric (Only If natural gas is not available)
fqr ear . 5 or Dropane .. fired olts are ptuh, for electric fired system the units are kW...
7. Rated Input Tvae. Enter the djgUjjDment Ino
8. Rated Input Value: Enter the numeric value of rated input.
.. -ffi
9. Kiating'EffictinoType' Erj&&Pact6r, AFUE,6f Thermal tfftlin6y. FrbOffdiff
,Ehergy CommisMbdifedory
10. Heating EfficiencyVaI6e:'Eht4r- the value from 1product literature ora .'.'Calft' rn15;ori nstantaneous-wati r. heaters.
11. Standby Loss!(petcent): Applies:oniyA*-Iarge,storagL-waterheaters, Enterm/a for small storage
12.'E)(tetidr'lnsulatldhr R-Valuel. Ehteeth-R=VbIu#,jf,,&t&dr Irisufmidivion thVstorage-tank. is installed required.
13. Back-up solar savings fr9dtioh: if. compliance: recliu-ires a back-up solar-systeM, Indicate the solar'contfIb6tion (6*.'9..-,'0.30).`Ekt#rnaI calculations are a cl.,rgcIrculation system with at least.two, distribution
14. Central DHW Distribution System- For multi -fa mily buildingswith usingia central distribution system,a,.Oem n ,..enter n1a.
lies to anybuilding with eight or more units, If the systemisnon-central or project Is individual units
loops must be Installed. This requirement app Central . DHW this field shall I 1 9 be Stamdard. If non -cent . ral then pick from Standard, Demand Recirculation — Manual
15. Dwelling Unit DHW Distribution Type: Fora Ce electric . *ater heater this must be Standard, no recirculation system shall be. installed.
Control, Demand Recirculation —Sensor Control. if non -central
Prescri
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT
efiCompliance+decur��n€a'tidfl�iS�aectifiren8�eoglYete
Name:
Company::
Address: ,
City/State/Zip:
oOwner o Authorized agent
Signature:
..contractor,liicense•,#:. 7
Phone:
For assistance,or qu.estionsregarding.the.-Ener..gy<St-andards,.contaLl.,the -Energy H9tII.nqj!t; 1-800-7.72-3300.
.3
1
STATE OF CALIFORNIA
RESIDENTIAL ALTERATIONS - WATER HEATER
CEC-CFIR-ALT-01-E (Reviled 061141
CERTIFICATE OF COMPLIANCE CALIFORNIA ENERGY COMMISSION
Prescriptive Residential Alterations for water Heater MR -ALT -01-E WATER HEATER
(Page 1 of 21
A. GENERAL INFORMATION'
Site address: ' l ^
%tWl`//TE
Bulldln T
BYPe:
Ingle Family Dwelling
City, Zip Code:
o Multi Family Dwellings
U 1,10 7-7f
Climate Zone:
10
G. WATER HEATING SYSTEMS Section 150.2 b 1G
01 02 03 04 05' 06
Water Water Water q of Water fuel
Heating Heating Heater Water Heater
07 08
Rated - Rated
09
Heating
10 11
Heating Standby
12 13 14
.Exterior Back -Up Central
-15
Dwelling
Type
System System Type Heaters Storage
Input Input
Type Value
Efficiency
Type
Efficiency loss (%)
Value
Insul. Solar DHW System
Unit DHW
.
Identification Type In Volume
R•Value Savings Distribution
System
or system (gal)
Fraction Type
Distribution
Name
Type
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 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.
l3in.tt
Permit #
ProjectOwer
Address: � (�Jh�'7 S
..Cl ty of La Q (. in t3
Building 8i: Safety Division
78-495 Caffe Tampico
La Quinta, CA 92253 - (760) 777-701,2
Building Permit Application and Tracking Sheet
n's Name•
's
,Q�L� as '� Nam! . -!I E
A. P. Number:
Address: 60 5 %
Legal Description:
City, ST, Zip: z'( 74
Contractor: //
Tele hon . -'r (/D
Address: 3v,?b
S?
Project Description: S
City, ST, Zip l/?,,gS�,dX
TeleP h0n
S
C
State Lic. #: r (rQs0
City Lie. #;
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
Construction type: ancY:
u hQ i Occupancy:
t ic. #
State a L
Add'n Alter Repairair
Demo type circle one): New
Name of Contact Person: VP
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: �(�(�, �D_O ('p %S
Estimated Value of Project: ,
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 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for corrections/issue
Electrcal
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'"! Review, ready for corrections/issue
Dcvclo�cr Impact Fee
Planning Approval
Called Contact Person
A.I.P.P
Pub. Wks. Appr
Date or permit issue
School Fees,
Total Parmit Fees