BPLB2015-0041 D-478-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 253
Twit 4 4 Qums
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number:
BPLB2015-0041
Property Address:
42800 WASHINGTON ST D-4
APN:
609040023
Application Description:
WASHINGTON APARTMENTS WATER HEATER CHANGE OUT
Property Zoning:
Application Valuation:
$600.00
Applicant:
REDEVELOPMENT AGENCY CITY OF
P 0 BOX 1504
Contractor:REDEVELOPMENT
LA QUINTA, CA 92203
AGENCY CITY OP
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.::AZA:1503101025520 8113
ye `.205 Contractor \�
TOWNER -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).:
(_) 1, 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, 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 Seca . 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 Address:
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date:
5/1/2015
Owner:
REDEVELOPMENT A 33ENCY CITY OF
P 0 BOX 1504
LA QUINTA, CA 922[03
Contractor:REDEVELOPMENT
EC)
AGENCY CITY OP
0 BOX 1504
LA QUINTA, CA 92203
LIc. No.::AZA:1503_01025520813
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificate ct consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the performance
of the ork 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 performz nce 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 th? work for which this permit is issued, I
shall not employ any person in any manner so asto 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: ftm 1� Applicant: ` b
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINA_ PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,000)i IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR IA SECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOW .EDGEMENT
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 Gty 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,,�ereby authorize representatives of this city to ent upon the above-
mentioned property for inspection purposes.
Date: Signature (Applicant or Agent) k!
FINANCIAL INFORMATION
DESCRIPTION ACCOUNT CITY AMOUNT PAID PAID DATE
BSAS SB1473 FEE 101-0000-20306
0
$1.00 $0.00
PAID BY METHOD
RECEIPT # CHECK # CLTD BY
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA $1.00 $0.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
PAID
PAID DATE
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid for PERMIT ISSUANCE: $91.85 $0.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
PAID
PAID DATE
WATER HEATER/VENT
101-0000-42401
0
$12.09
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
CITY
AMOUNT
PAID
PAID DATE
WATER HEATER/VENT PC
101-0000-42600
0
$7.25
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid for PLUMBING FEES: $19.34 $0.00
TOTALS:00
Description: WASHINGTON APARTMENTS WATER HEATER CHANGE OUT
Type: PLUMBING
Subtype: Status: UNDER REVIEW
Applied: 3/10/2015 PJU
Approved:
Parcel No: 609040023 Site Address: 42800 WASHINGTON ST D-4 LA QUINTA,CA 92253
Subdivision: PM 12323
Block: Lot: 2
Issued:
Lot Sq Ft: 0
Building Scl Ft: 0 Zoning:
Finaled:
Valuation: $600.00.
Occupancy Type: Construction Type:
Expired:
No. Buildings: 0
No. Stories: 0 No. Unites: 0
Details: REPLACE ONE NATURAL GAS WATER HEATER 40 GALLON PER 2013 CALIFORNIA PLUMBING CODES.
ADDITIONAL SITES
CHRONOLOGY
CONDITIONS
DESCRIPTIONI ACCOUNT I QTY I AMOUNT ( PAID I PAID DATE I RECEIPT # I CHECK # I METHOD I PAID BY I CLL YD
BSAS SB1473 FEE 1 101-0000-20306 1 0 $1.00 $0.00
Total Paid forBUILDING STANDARDS ADMINISTRATION $1.00 $0.00
BSA:
Printed: Friday, May 01, 2015 10:29:24 AM 1 of 2
CRW Y57EMS
DESCRIPTION
ACCOUNT r
QTY
AMOUNT
PAID
-PAID DATE
RECEIPT #
CHECK #�
METHOD
PAID BY
CLTD
BY
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
Total Paid for PERMIT ISSUANCE: $91.85 $0.00
WATER HEATER/VENT
101-0000-42401
0
$12.09
$0.00
WATER HEATER/VENT
PC
101-0000-42600
0
$7.25
$0.00
Total Paid for PLUMBING FEES: $19.34 $0.00
TOTALS; $112.19 $0.00
INSPECTIONS
SEQID INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED RESULT REMARKS NOTES
DATE DATE
PLUMBING FINAL**
PARENT PROJECTS
REVIEWS
REVIEW TYPE REVIEWER SENT DATE DUE DATE RETURNED STATUS REMARKSDATE NOTES
Printed: Friday, May 01, 2015 10:29:24 AM 2 of 2
c8?w1YS7EMS
BOND
INFORMATION
ATTACHMENTS
Printed: Friday, May 01, 2015 10:29:24 AM 2 of 2
c8?w1YS7EMS
r
P.O. Box 1504
LA' QUINTA, CALIFORNIA 92247-1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
(760) 777-7012
FAX (760) 777-7011
Considering Becoming an Owner -Builder?
Important information you need to know BEFORE pulling your permit!
The term "Owner -Builder" can mean three different things:
"Owner as Worker", "Owner as Contractor" or "Owner as EmpAoyer"
Understand each has Benefits or Risk, and it is possible to combine: them!
Hiring a California Licensed Contractor means you do not personally perform any of the constructior: work, the permit is not taken
out in your name, you are not personally responsible for the construction and you are not an Owner -Builder. Instead, you become a
"Customer" and California law provides you the benefit of protection from poor workmanship, failure to finish the job and financial
risk due to worker injury.
Benefit/Risk: Highest Benefits and the Least amount of Risk
Owner -as -Worker is a type of Owner -Builder where you personally perform the construction work, the permit is taken out in your
name and you are personally responsible for the construction management, knowledge, workmanship, and completion of the job. You
benefit by not paying others to perform this work for you and your risk depends on your own ability to complete the job successfully.
Benefit/Risk: Possible Benefit with Low Financial Risk
Owner -as -Contractor is a type of Owner -Builder where you personally act as your own General Contractor, the permit is taken out in
your name and you hire California licensed sub -contractors to perform portions of the construction work. WARNING: The benefit of
protection provided by law when you hire only California licensed sub -contractors can turn to serious financial risk if you hire
unlicensed contractors to perform any of the work.
Benefit/Risk: Possible. Benefit and Significant Financial Risk
Owner -as -Employer is a type of Owner: -Builder where you pay any unlicensed individual to perform any construction work valued at
more than $500.00, the permit is taken out in your name and you are personally responsible for. their employment requirements,
supervision, performance, safety and welfare while on your property. WARNING: Cost savings benefit can turn to serious financial
risk if you fail to deduct payroll taxes or provide workers compensation insurance for each worker.
Benefit/Risk: Possible Benefit with Significant Financial Risk
(Health and Safety Code Section 19827) The California Legislature declares an "urgent and statewide
public interest in assuring" that contractors comply with Contractors' License Law,* Business and
Professions Code and Workers' Compensation Insurance requirements to ensure property owners are
informed about, and protected from the following when improving their property as Owner -Builders:
Fraudulent representations • Liability for worker's injuries • Liability for material and labor costs unpaid by
contractors • Licensing requirements • Employers tax liabilities
Over 20,000 consumer complaints are filed each year. Many complaints relate to owner/builder projects
and include workmanship and workers' compensation issues Homeowners suffer financial harm due to
defective workmanship and injured employees.
Following are alarming examples of what has occurred with Owner -Builder permits:
Example 1: Homeowner received insurance money to rebuild burhed-down home.
■ Owner/Builder permit pulled to rebuild structure.
■ Unlicensed contractor built substandard structure — must be torn down and replaced.
■ Estimated financial injury is $225,000.
• Additional financial injury - IRS threatened to tax insurance -payout if house not completed by the end of
the year.
Example 2: Brother-in-law had active license but filed an exemption from Workers Comp.
• Owner -Builder hires brother-in-law to install a new roof.
■ Employee falls and sustains multiple spinal and extremity fractures as well as a head injury and
remains in a coma to this day.
■ The Owner -Builder, who has sold the home, is now a defendant in a lawsuit for reimbursement for
benefits paid to the injured worker.
Example 3: Employee of contractor without Workers Comp is hired by Owner -Builder to install septic
system and suffers injury that results in permanent disability.
■ The Owner -Builder did not have a homeowner's insurance policy on the house against which to submit
a claim.
■ The Owner -Builder is now a defendant in a lawsuit for reimbursement for benefits paid to the injured .
worker.
Did you know — unlicensed persons frequently have the property owner obtain an "Owner -Builder". building
permit which erroneously implies that the property owner is providing his or her own labor and material
personally?
Did you know — your homeowner's insurance may not provide coverage for injuries sustained on your
property by an unlicensed contractor and his/her employees?
Did you know — if you are considered an "employer" under state and federal law, you must register with
the state and federal government, withhold payroll taxes, provide workers compensation and disability
insurance and contribute to unemployment compensation for each "employee"?
Did you know — that if you fail to abide by these laws you may be subjected to serious financial risk?
OWNERS BEWARE AND CONSIDER THE RISK BEFORE ACCEPTING FULL RESPONSIBILITY FOR
YOUR CONSTRUCTION PERMIT
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 build' ermit as en sub 'tted in your �me,li$tin yourself as the builder of the property
improvements specified at
We are providing you with an Owner-iluifde Ackno 1 dgment and Information Verifi tion orm9 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 each provision,
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 signify you understand or verify this informaaon.
k LL
-MI I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder"
b ding permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, 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 pr -)vide 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.
`,42. I understand building permits are not required to be signed by property owners unless they are responsible for the
construction and are not hiring a licensed Contractor to assume this responsibility.
I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect
myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his c•r her name instead of my
own.. .
/ 4. I understand Contractors are required by law to be licensed and bonded in California and to lis;. their license numbers on
Is and contracts.
AD. I understand if I employ, or otherwise engage any persons, other than California licensed Contractors, and the total value
of my construction is at least five hundred dollars ($500), including labor and materials, I may be oonsidered an "employer"
under state and federal law.
6� I understand if I am considered an "employer" under state and federal law, I must register -with the state and federal
g emment, 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.
s
I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential
V1.
ecannot 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 3f the work is performed
under contract with a licensed general building Contractor.
8. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any
inaricial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the
workmanship or materials.
M9. I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue
r�'ervi9ce, 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.
410. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the
-,Jega and fin racially resp ible for .pro ejed �onstru�tion �ctivip+.) at the following address:
J
11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all
applicable laws and requirements that govern Owner -Builders as well as employers.
12. I agree to note the issuer of this form immediately tely of any additions, deletions, or changes to any of the information I
have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with
someone 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 the permit. Note. A copy of the property 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
owner's signature. `
is
Signature of property owne d �: 3
Note: The following Authorization Form is required to be completed by theproperty 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: \ Tel No' b0 Sa-
Address of Authorized Agent:
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 re uired to be presented when the permit is issued to verb th roperty owner's signature.
Property Owner's Signature: Date:
STATE OF CALIFORNIA
RESIDENTIAL ALTERATIONS o
'CEC-CF1R-ALT-01-E Revised 06/14 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CF1R-ALT-01-E v
Prescriptive Residential Alterations (Page 1 of 4)
Project Name: IJ AS N 1 >J t,1' o /- tD T- Date Prepared:
A. GENERAL INFORMATION
01
-
01
Project Name:
VJ ASHl rl to Toa
97, A P % •
02
Date Prepared: 9. 'N `+
03
Project Location:
lerA -? eOO
wA$i4 jr►( T QUI C,7.
04
Building Front Orieritation`(deg or cardinal):
05
07
CA CILy:
Zip Code:
/Os Q 0
O 3
06
08
Numher of Alterpd Dwelling Units:
Fuel Type: 4,
09
Climate Zone:
� .,• APpendixJA4
',,Continuous
Minimum Required
10
To6I,C66ditiOned Floor:Area FT
11
Building Type
P, PAet- 1w EiV
%' S
12
1 Sfab)i'rea'(ft2)
3
Project Scope:
Frame
Depth i
Spacing
Cavitytlnsulation
B. BUILDING INSULATION DETAILS (Section 150.2(b)1);;
01
02
03
04
05
06 ,, _ . ' _.dam 07 08 c; 09
10
it
03
04
OS:. -
r''' 06
"' `07�
eroposed : Cff,
Required
R -value `?
%s
� .,• APpendixJA4
',,Continuous
Minimum Required
Method of
Roof
Frame
Frame
Reference
Initial Solar
Aged Solar Thermal SRI
Aged Solar Thermal SRI
Compliance
Frame
Depth i
Spacing
Cavitytlnsulation
.,insufatioh
,,Reflectance
Ta /ID
Assembly Type
Type
(inches)
(inches)
R -value_ R -value „'` =f. "ctor Table Cell
1 U -Factor
Comments
NOTES '
C. ROOF REPLACEMENT (Prescriptive Alteration, Sect oK-150.2(b)1H)
~
01
02
03
04
OS:. -
r''' 06
"' `07�
08 09 10
11 12 13
R -value `?
%s
Proposed
Minimum Required
Method of
Roof
CR_R_C`Product ID
Deck..
Initial Solar
Aged Solar Thermal SRI
Aged Solar Thermal SRI
Compliance
Pitch
Exception
+ • ;• Number
Product Type .
.,insufatioh
,,Reflectance
Reflectance Emittance (Optional)
Reflectance Emittance (Optional)
NOTES '
• Roof area covered by.builtl Yng integrated photo`vbltaic panels and solar thermal panels are exempt from the above Cool Roof requirements.
• Liquid field applied;cpatings'must comply with: irSstallation criteria from section 110.8(i)4.
,n
Registration Number: Registration Date/Time: HERS Provider:
CA Building Energy Efficiency Standards - 2013 Residential Compliance June 2014
STATE OF CALIFORNIA ,sem
RESIDENTIAL ALTERATIONS o
CEG-CFIR-ALT-01-E Revised 06/14 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CF1R-ALT-01-E
Prescriptive Residential Alterations (Page 2 of 4)
Project Name: Date Prepared:
D. FENESTRATION/GLAZING AREAS ALLOWED (Section 150.2(b)1)
ate+,
01
Oc.
01 02 03
:'��.
Alteration Type Orientation Maximum Allowed ft2
COmrtlenCs ;
07
O8 �.�
•a �c
. 'u;,�'09
JV
— 554. 10 - �?
E. FENESTRATION/GLAZING PROPOSED AREAS AND EFFICIENCIES (Section 150.2(b)1) `���
e
ate+,
01
02
03
04
05
06
07
O8 �.�
•a �c
. 'u;,�'09
i�
10'
1 h-'�'
541 11
12
13
14
15
''°•
Combined
Orientation
Area
Area '
, Net°
Maximum �..
Exterior
SHGC
Tag/
Fenestration
Frame
Dynamic
N, S, W, E, or
Removed
Added i�
-��Added
S
Allowed,
Shading
from
ID
Type
Type
Glazing
Roof
ft2
ft2
`"Area ft2
U fac[ r
U -factor
Source
SHGC
Source
Device
CF1R-ENV-03
=N a f r
r'
71
•
^v"
a
Net Added West fa&hj Fenestration Area
�
y Aill
b
Existing +Add d West;f cing Fenestratidn,3Area
c
Maximum Allow d West-facing:Fenestration Area
d
Is West -facing Fenestration Amp,< Maximum Allowed West fac ng FenestratioTn
`
,`i '.xa _l±-1 u • ST S� 41 �.;"r+'GI
i
e
�, n• -Net Added Fenestration Aiea (all orientations)
f
` Ezistin + Added Fe e'
g stration Area all orientations)
(
Kr ., {
g*'
Maximum'Allol;4Fenestration Area all orientations
.% VA
h
Is Existing + Aed'Fenestration Area <"Maximum Allowed Fenestration Area (all
orientations)
Registration Number: Registration Date/Time: HERS Provider:
CA Building Energy Efficiency Standards - 2013 Residential Compliance June 2014
STATE OF CALIFORNIA ,
RESIDENTIAL ALTERATIONS o
CEC-CFIR-ALT-01-E Revised 06/14 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CF1R-ALT-01-E
Prescriptive Residential Alterations (Page 3 of 4)
Project Name: Sl,. P! Date Prepared:
F. SPACE CONDITIONING(SC) SYSTEMS — HEATING/COOLING (Prescriptive section 150.2(b)),,'�
01 02 03 01N.
Dwelling Unit Name Dwelling Unit CFA (Ft2) Comm nts Y''
G. WATER HEATING SYSTEMS (Section 150.2(b)1G).a.
01
02
03
04
05
06
07
08
09, `�.
10
-1 � ,,,
' ~ 12
13
14
15
System Identification or '
� Water;Heating System
Alteration to the Space
N of
Water
}(ft'2]y) `� 4
„4 x �)iName ,. % fi�
Identification or Name
Conditioning System(s)?
Comments
Back -Up
Water Heating
System
Water
Water
Water
Heater
Rated
Rated
Heating
.'."Heating',,'
`.�.
'
Exterior
Solar
Dwelling Unit DHW
Identification or
Heating
Heater
Heaters
in
Storage
Volume
Fuel
Inputs
tag --
,4lnpuf"
EfficiencyfficMency
& *, -'-
Standby
. Insul..
Sayings .,
c* ti System
System
Name
System Type
Type
system
(gal)
Type
Type• °
a. Value
Typed ,
;'Value
Loss (%)
R -Value
Fraction
Distribution Type
Distribution Type
H. SPACE CONDITIONING SYSTEMS AND WATER HEATING SYSTEMS IN"MULTIFAMILYMWELLING UNITS
'
�'`L.
01
02
034i i
�i 04 �`
05
06
f
Central Water.Heating
" D`w"elling Unit
Dwelling Unit:
Dwelling UnittTot6l CFA
System Identification or '
� Water;Heating System
Alteration to the Space
Dwelling Unit Name
}(ft'2]y) `� 4
„4 x �)iName ,. % fi�
Identification or Name
Conditioning System(s)?
Comments
y
W
Registration Number: Registration Date/Time: HERS Provider:
CA Building Energy Efficiency Standards - 2013 Residential Compliance June 2014
PEC'CF1
E OF CALIFORNIA -s°`�
SIDENTIAL ALTERATIONS o
R -ALT -01-E Revised 06/14 CALIFORNIA ENERGY COMMISSION "
CERTIFICATE OF COMPLIANCE CF1R-ALT-01-E
Prescriptive Residential Alterations (Page 4 of 4)
Project Name: PO 4 /i ,/71, T D /J 7. aP 7- • Date Prepared:
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT -.
1. 1 certify that this Certificate of Compliance documentation is accurate and complete.
Documentation uthor fyame:
Documentation Autho nature:;x `� '' '"t4•
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Company:
Signature Date:
Address: t I
CEA/ HERS Certification Identification (jiif applicable): `r
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Gty/State/Zip: I6C,0 ffl�aoop 2
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RESPONSIBLE PERSON'S DECLARATION STATEMENT
I certify the following under penalty of perjury, under the laws of the State of California: ; ' i� 4
`
1. The information provided on this Certificate of Compliance is true and correct.,, )
2. 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility_ for the building de§Ikn.or system design identified on this Certificate of Compliance (responsible
designer).
`and
3. That the energy features and performance specifications, materials, components; manufactured- evi a -.for the building design or system design identified on this Certificate of
Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the California Code ofRegulations.,
4. The building design features or system design features identified on this -Certificate of Compliance -are consistennt wlth�:the information provided on other applicable compliance documents,
worksheets, calculations, plans and specifications submitted to the enforcement agency fobapproval with this building permit application.
5. 1 will ensure that a registered copy of this Certificate of Compliance>shall be made.avail.able with the building permit(s) issued for the building, and made available to the enforcement agency
for all applicable inspections. I understand that a registered copy of this Certifi atelof Compliance is requ edto be included with the documentation the builder provides to the building
�=
owner at occupancy.
Responsi(`r"" j
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r.Rspnsible Design Sl gnat e:
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Company:
Date Signed:
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Address:
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For assistance o 'questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300.
Registration Number: Registration Date/Time: HERS Provider:
CA Building Energy Efficiency Standards - 2013 Residential Compliance June 2014
_ Washington. Street A_ partments
Profs» Tonally Mencged By
ro Verty .
Hyder fYi ee e B e ma at
Proleselooele
42-800 Washington Street
Bermuda Dunes, CA 92203
Phone:)760) 345-5573
Fax: )760)360.4885
Email: woshingtonstreet@hyderco.com .a.
Bin # '
City Of La Q uin to .
Building &-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:
Owner's Name: %ii n i� TDA A RT.
A. P. Number:
Address: $p
Legal Description:
City, ST, Zip: 6 �Jolq n2 g 0 3
Contractor: /�-JT �d? Dyl l e / .
Telephone: 7teo-. 3 3
Address:
Project Description:
City, ST, Zip:
Telephone:
4i��,.�:rr3.<�s;;�.sf�'trr,''."�%„�v�.'�s�
:::: S.'•�ii.^•;Yin /.;%x%1 :%i1%+'i ill i}JiFf �'i::f
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State Lic. # :
City Lie. #;
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
:a; .:: :k�%.sn ` �N<> .c: ;.fir
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a{''+f'E'M1� F %��'i''v'f srai+',�,k•�f�;:'Rv',$'.�:5f4iy"oA3:;£ �',''i',,: �
f>{'�z•r:r.`>'.:a:%k.v.:3>'°.F<">%^':. :>^
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Construction Type: Ocau ane
'
State Lic.#:
Project type (circle one): Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone #,of Contact Person: 7&o -- 3 S - SSS -3
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd.
TRACMG
PERMIT FEES
Plan Sets
PIan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cales.
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
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Decd
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN IIOUSE:-
'"' Revinv, ready for corrcctions/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
Schodl Fccs
Total Permit Fees