BPLB2017-0089 A-678-495 CALLE TAMPICO` D• �itiNifCl/
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BPLB2017-0089
Property Address: 42800 WASHINGTON ST A6
APN: 609040007
Application Description: HOT WATER HEATER CHANGE OUT
Property Zoning:
Application Valuation: $500.00
Applicant:
DM DOBKIN INC DBA MR ROOTER PLUMBING
P 0 BOX 3385
PALM DESERT, CA 92261
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 {commencing with Section 70001 of Division 3 of the Business and Professions Code,
and my License is in full force and effect. n
License Class: C36 License No.: 928636
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 Address:
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECT Ot (760) 777-7153
Z
6kl-1/2017
43
Owner:
REDEVELOPMENTAQENCY OF
78945 CALLE1fAl�fTCO
LA QUINTA, CAS, 9,x}253 Q
lel�y j �Sw
Contractor
DM OOBK9
. AMR ROOTE`�LUMBING
P 0 BOX 3385
PALM DESERT, CA 92261 O
(760)779-0190
Llc. No.: 928636
WORKER'S COMPENSAMON DECLARATION
I hereby affirm under penalty of perjury one o? the following declarations:
I have and will maintain a certificat 2 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: WESCO INSURANCE COMPANY Policy Number: WWC3236697
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 :700 of the Labor Code, I shall forthwith
comply with those provisions.
Date:
Applicant. ► �1
WARNING: FAILURE TO SECURE WORKERS' CCMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMIAAL 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 ACKNCWLEDGEMENT
IMPORTANT: Application is hereby made to t ie Building Official for a permit subject to
the conditions and restrictions set forth on the application.
1. Each person upon whose behalf this app'ication 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 th 2 City of La Quinta, its officers, agents, and
employees for any act or omission related to :he work being performed under or
following issuance of this permit.
2. Any permit issued as a result of this applcation becomes null and void if work is
not commenced within 180 days from date a= 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 -tate that the above information is correct.
I agree to comply with all city and county orcinances and statep ws relating to building
construction, and hereby authorize represen-.atives of this ci o enter upon the
above-mentioned property for inspection pu-poses.
Date: Signature (Applicant or Agent)
Application Number:
BPLB2017-0089
Property Address:
42800 WASHINGTON ST A6
APN:
609040007
Application Description:
HOT WATER HEATER CHANGE OUT
Property Zoning:
Application Valuation:
$500.00
Applicant:
DM DOBKIN INC DBA MR
ROOTER PLUMBING
P O.BOX 3385
PALM DESERT, CA 92261
Detail: REPLACE 30 GALLON GAS WATER HEATER. PER 2016 CALIFORNIA BUILDING CODE
Date: 6/21/2017
Owner:
REDEVELOPMENT AGENCY CITY OF
78945 CALLE TAM ?ICO
LA QUINTA, CA 92253
Contractor:
DM DOBKIN INC CIBA MR ROOTER PLUMBING
P 0 BOX 3385
PALM DESERT,CA92261
(760)779-0190
Llc. No.: 928636
FINANCIAL •• •
DESCRIPTION
ACCOUNT 13TY 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
ZtTY
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
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
TOTALS:
Bin #
City of La Quinta
Building &r Safety Division
78-495 Calle Tampico
La Quinta, CA 92253.- (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: ir-jvy)S�rO_Q.
Owner's Name:
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
Contractor:Te i a
M r J Vl
le h one:
P
Address: 101Se Y'e SLA I l C
Project Description:S
City, ST, Zip: rn 0�10f k ��
Telephone: v
State Lic. # : (, 3 6
City Lie. #;
Arch., Engr., Designer
Address:
City, ST, Zip:
Telephone:
::•f.»::«::::<::<::
Con struction T e: Occupancy:
YP P cY�
tate
S Lia #:
Project type (circle one): New Add' n Alt er Repair Demo
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
�
Estimated Value of Project: 14
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACIONG
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
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 correctionsfissue
Electrical:
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
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
STATE OF CALIFORNIA
Prescriptive Residential Alterations That Do Not Require HERS Field Verification
4 -
CEC-CFIR-ALT-05-E (Revised 04/16) CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CFIR-ALT-057E
Prescriptive Residential Alterations That Do Not Require HERS Field Verification Page 1 of.3
Project Name: Date Prepared:
This compliance document is only applicable to
with a HERS Provider Data Registry.
t do not require HERS verification for compliance. When HERS verification is required, a CFIR-ALT- 01
Alterations to Space Conditioning Systems that are exempt from HERS. verification requirements may use the CF1R-ALT-0S and CF2R- ALT -OS Compliance Documents. Possible exemptions from duct
leakoge testing include: less than 40 ft of ducts. were added or replaced, or the existing duct system was insulated with asbestos, or the existing duct system was previously tested and passed by a
HERS Rater. If space conditioning systems are altered and are not exempt from HERS verification, then o CFIR-ALT-02 must be completed and registered with a HERS Provider Data Registry.
Alterations that utilize close Cell Spray Polyurethane Foam (ccSPF) with a density of 1.5 to less than 2.5 pounds per cubic foot having an R -value other than 5.8 per inch, or Open Cell Spray
Polyurethane Foam (ocSPF) with a density of 0.4 to less than 1.5 pounds per cubic foot having an R -value of 3.6 per Inch, shall complete and register a CF1R-ALT-01 with a HERS Provider Data
Registry.
If more than one person has responsibilityfor installation of the items on this certificate, each person shall prepare and sign a certificate applicable to the portion of construction for which they are
responsible. Alternatively, the person with chief responsibility for construction shall prepare and sign this certificate for the entire construction. All applicable Mandatory Measures shall be met.
Temporary labels shall not be removed before verification by the building inspector.
A. General Information
01
Project Name:�C
hln a„
' u
n;
02
Date Prepared:
03
Project Location:
a �jV� w�� i _ 1
i�—
04
Building Front Orientation (deg or cardinal):
05
CA City:
06 '
Number of Altered Dwelling Units:
07
Zip Code:
1� .
V
08
Fuel Type:
09
Climate Zone:
10
Total Conditioned Floor Area (W):
11
Building Type:7
12
Slab Area (W)
?�3
Prgiect Scope (Select all that apply):
❑ B. Insulation ❑ D. & E. Fenestration/Glazing - ADD ❑ G, Space Conditioning System (Heating, Cooling, Duct system) ❑ Lighting
❑ C. Roof Replacement ❑ D. & F. Fenestration/Glazing - REPLACE ✓❑ H. Water Heating System ❑ Include Mandatory Measures?
CA Building Energy Efficiency Standards - 2016 Residential Compliance April 2016
STATE OF CALIFORNIA
Prescriptive. Residential Alterations That Do Not Require HERS Field Verification
EC-CF1 R -ALT -05-E (Revised 04/16) CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CF1R-ALT-05-E
Prescriptive Residential Alterations That Do Not Require HERS Field Verification Page 2 of 3
Project Name: - .Date Prepared:
H. Water Heating Systems (Section 150.2(b)1G)
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
# of
Water
Water
Water
Water
Back -Up
Heating
Heating System
Heaters
'Heater
Rated
Heating
Heating
Exterior
Solar
Dwelling
System
Location or
Water Heating
Water
In
Storage
Fuel
Rated
Input
Efficiency
Efficiency.
Standby
Insulation
Savings
Unit Name
ID or Name
Area Served
System Type
Heater Type
System
Volume (gal)l
Type
Input Type
Value
Type
Value
Loss (%)'
R -Value
Fractlon
D0J .6J6
AdRolei'eRbW�
CA Building Energy Efficiency Standards - 2016 Residential Compliance April 2016
STATE OF CALIFORNIA
Prescriptive Residential Alterations That Do Not Require HERS Field Verification
n-
CEC-CF1 R -ALT -05-E (Revised 04/16) GALR UKNIA LNLKUY GUMMlbb.—.
CERTIFICATE OF COMPLIANCE CF1R-ALT-05-E
Prescriptive Residential Alterations That Do Not Require HERS Field Verification Page 3 of 3
Project Name: Date Prepared:
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT
1. 1 certify that this Certificate of Compliance documentation is accurate and complete.
nnyAuthor Name:
Documentation
� 1 f
"`.
lotion thor Signature:
Company: D
51 ate:
Address:CEA/
HERS Certification Identification If applicable):
101 ..
City/State/Zip: (1
Phone:
RESPONSIBLE PERSON'S DECLARATION STATEMENT
I certify the following under penalty of perjury, under the laws of the State of California:
1.. The information provided on this Certificate of Compliance Is true and correct.
2.. I am eligible under Division 3 of the Business and Professions Code to accept responsibility for the building design or system design identified on this Certificate of Compliance (responsible
designer).
3. That the energy features and performance specifications, materials, components, and manufactured devices 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 of Regulations.
4. The building design features or system design features identified on this Certificate of Compliance are consistent with the Information provided on otherapplicable compliance documents,
worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application.
5. 1 will ensure that a registered copy of this Certificate of Compliance shall be made available 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 Certificate of Compliance is require to be included with the documentation the builder provides to the building
owner at occupancy.
Responsible Desi&ner Name:
Res Des er Signature:
Date Signed:
Company:
Address:
License: '
City/State/Zip:.
Phone:
For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772=3300.
CA Building Energy Efficiency Standards - 2016 Residential Compliance April 2016