BPLB2015-0016•
440 "moi
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.; :LIC -0111366
Date: (i 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 Division3 \
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 df
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 agericy for
the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
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: Policy Number: _
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 La,Code, I shall forthwith
comply wit]ap r
th se provisions.
DAe:"' 7 1 '� 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 abo
mentioned property for inspection purposes.
Date: T- <_ Signature (Applicant or Agen
Ta�
/ "i- � �
VOICE (760) 777-7125
78-495 CALLE TAMPICO
D
FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253
COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS
(760) 777-7153
BUILDING PERMIT
Date: 2/3/2015
Application Number:
BPLB2015-0016
Owner:
Property Address:
51425 CALLE GUATEMALA
EDWARD SIEGEL .
APN:
770162009
51425 CALLE GUATEMALA
Application Description:
WATER HEATER REPLACEMENT
40 GALLON
LA QUINTA, CA 92253
Property Zoning:
Application Valuation:
$1,700.00
Applicant:
Contractor:
V -=v
D
RESCUE ROOTER
RESCUE ROOTER
0 OUTSIDE CITY LIMITS
OUTSIDE
LA QUINTA, CA 92253
FEBLA
EO 3 2015
CIT 9225135
CITY OF LA QUINTA
(951)341-9370
COMMUNITY DEVELOPMENT DEPARTMENT
Llc. No.: :LIC -0111366
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.; :LIC -0111366
Date: (i 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 Division3 \
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 df
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 agericy for
the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
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: Policy Number: _
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 La,Code, I shall forthwith
comply wit]ap r
th se provisions.
DAe:"' 7 1 '� 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 abo
mentioned property for inspection purposes.
Date: T- <_ Signature (Applicant or Agen
STATE. OF CALIFORNIA
RESIDENTIAL ALTERATIONS -WATER HEATER
CFC-MR-ALT-01-E+Revised 06/14) CALIFORNIA FNFRr;Y COMMISSION
CERTIFICATE OF COMPLIANCE CF111-ALT-01-E WATER HEATER
Prescriptive Residential Alterations for Water Heater (Page 1 of 2)
A. GENERAL INFORMATION
Site address: L E_ (:5,04 7C 4y 14-L Building Type: ❑Single Family Dwelling
❑ M Iti Family Dwellings
City, Zip Code: L Q u N!)/A- Z 7 573 Climate Zone: js
G. WATER HEATING SYSTEMS Section 150.2 b 1G
01
02
03
04
05
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
w�h
51011 d1I
Vo
134,)1
E
��
N%
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 CFIR-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.
w 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.
to
CERTIFICATE OF COMPLIANCE CFiR-ALT-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.
5. Water heater volume (gat): 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 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: NO �)(('J "Owner `^�dAuthorized agent ❑Contractor
Signature:
Company: v r�
Contractor license #: S 1 S
Address: *1eD W tilN 6
Phone: 7 /
City/State/Zip: 2 1 v ti f
Date: / S/
For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300.
FINANCIAL INFORMATION
DESCRIPTION ACCOUNT QTY
AMOUNT PAID PAID DATE
BSAS SB1473 FEE 101-0000-20306 0
$1.00 $0.00
PAID BY METHOD RECEIPT # CHECK # CLTD BY
Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $1.00 $0.00
DESCRIPTION
ACCOUNT
QTY.
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
QTY
AMOUNT
PAID
PAID DATE
WATER HEATER/VENT
101-0000-42401
0
$12.09
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
QTY
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 forPLUMBING FEES: $19.34 $0.00
TOTALS:00
Description: WATER HEATER REPLACEMENT 40 GALLON
Type: PLUMBING Subtype: Status: UNDER REVIEW
Applied: 2/3/2015 PJU
Approved:
Parcel No: 770162009 Site Address: 51425 CALLE GUATEMALA LA QUINTA,CA 92253
Subdivision: PM 31772 Block: Lot: 2
Issued:
Lot Sq Ft: 0 Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $1,700.00 Occupancy Type: Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0 No. Unites: 0
PAID
Details: WATER HEATER REPLACEMENT 40 GALLON GAS 2013 PLUMBING CODES.CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO
FINAL INSPECTION. 2013 CALIFORNIA BUILDING CODES
CHRONOLOGY
CONDITIONS
INFORMATION
CONTACTS
CLTD
DESCRIPTION ACCOUNT QTY
AMOUNT
PAID
NAME TYPE
NAME
ADDRESSI
CITY
STATE
ZIP
PHONE
FAX
EMAIL
APPLICANT
RESCUE ROOTER
0 OUTSIDE CITY LIMITS
LA QUINTA
CA
92253
(
Printed: Tuesday, February 03, 2015 11:01:18 AM 1 of 2
CRWSYS TEMS
FINANCIAL
INFORMATION
CLTD
DESCRIPTION ACCOUNT QTY
AMOUNT
PAID
PAID DATE
RECEIPT # CHECK # METHOD PAID BY
BY
BSAS 561473 FEE 101-0000-20306 0
$1.00
$0.00
Total Paid for BUILDING STANDARDS ADMINISTRATION
$1.00
$0.00
BSA:
Printed: Tuesday, February 03, 2015 11:01:18 AM 1 of 2
CRWSYS TEMS
PARENT PROJECTS
Printed: Tuesday, February 03, 2015 11:01:18 AM 2 of 2 cg?
uw
SYSTEMS
INSPECTIONS
SEQID INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED
DATE DATE
RESULT REMARKS NOTES
PLUMBING FINAL"
CLTD
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID BY
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
101-0000-42600
0
$7.25
$0.00
PC
Total Paid forPLUMBING FEES: $19.34 $0.00
TOTALS:• 00
PARENT PROJECTS
Printed: Tuesday, February 03, 2015 11:01:18 AM 2 of 2 cg?
uw
SYSTEMS
INSPECTIONS
SEQID INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED
DATE DATE
RESULT REMARKS NOTES
PLUMBING FINAL"
PARENT PROJECTS
Printed: Tuesday, February 03, 2015 11:01:18 AM 2 of 2 cg?
uw
SYSTEMS
Bin t/ >'
.. –
City of La Q rain to .
Building 81: Safety Division
P.O. Box 1504; 78-495 Calle Tampico .
La Quinta, CA 92253 - (760) 777 -7012.
Building Permit Application and Tracking -Sheet
Permit #
Project Address: �� 2 rj L 14 L t- C (pvAI-604r�
Owner's Namc: 60 S1 — (9 L L
A. P. Number:
Address: slift C— 64-1-
4'<Legal
LegalDescription: q
City, ST, Zip: L. A– 0. TJ T� (✓� � Z Z
Contractor: Z �, D�
a t�j � 1 EYL
Telephone: %
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Address: azo L 1 N p `� T
Project.Description: lv-"Gvx� k"'
City, ST, Zip:.' .V " i'L5 I c_ CA 9jtSrD% .
Q at / It7 ar
Telephone: -11-:'
Sl SII 95
,
State Lic. #
City Lie. #;
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
>? `:; ;;:-: <;:;„s:::,- ::::>
:
Construction Type: Occupancy:'
yP
State Lic. #:
' to . e i
Project type (circle one): New Add'n Al r R pa r Demo
Name of Contact Person:Sq.
Ft.:
#Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project: 7 d e)
APPLICANT: DO NOT WRITE BELOW THIS LINE
# Submittal Rcq'd RCC'd TRACMIG PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Cheek Deposit
Truss Calcs.
Called Contact Person,
Plan Check Balance.
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mcchanieal
Grading plan
2°' Review, ready for eorrcctionsrissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Decd
Plans picked up
S.M.T.
Ii.O.A. Approval
Plans resubmitted
Grading
IN ROUSE:-
'`0 Rcviav, ready for eorrcclions/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School FCC$
Total Permit Fees