BPLB2015-011278-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T4ht 4 a dfv Q"
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number:
BPLB2015-0112
Property Address:
51605 AVENIDA CARRANZA
APN:
773124018
Application Description:
LEE / REPLACE 50 GALLON
Property Zoning:
Application Valuation:
$850.00
Applicant:
JORGE A ALVAREZ
PO BOX 984
THERMAL, CA 92274
E
'T092015
CITY OF LA QUINTA
COMMUNITY DEVELOPMENT DEPARTMENT
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 License No.: 880103
Date: /10 �/—/ 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.).
(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 perjurythat.there is a construction lending agency for
the performance of the work for which this permit is issued•(Sec. 3097, Civ. Q.
Lender's Name:
Lender's Address:
VOICE (760) 777-7125
SCANNED FAX (760) 777-7011
1 SPECTIONS (760) 777-7153
Date: 10/9/2015
Owner:
FREDERIC LEE
P O BOX 50
LAKE ARROWHEAD, CA 92253
Contractor:
JORGE A ALVAREZ
PO BOX 984
THERMAL, CA 92274
(760)698-8975
LIC. No.: 880103
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.
( 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'Labor Code, I shall forthwith
comply with those provisions.
Date: %-�1-/S' Applicant:
WARNING: FAILURE TO SECURE WORKERS' COM ENSATION 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: 10—C(-15- Signature (Applicant or Agent):
I IIIIII
VIII IIII IIII
22
VOICE (760) 777-7125
SCANNED FAX (760) 777-7011
1 SPECTIONS (760) 777-7153
Date: 10/9/2015
Owner:
FREDERIC LEE
P O BOX 50
LAKE ARROWHEAD, CA 92253
Contractor:
JORGE A ALVAREZ
PO BOX 984
THERMAL, CA 92274
(760)698-8975
LIC. No.: 880103
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.
( 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'Labor Code, I shall forthwith
comply with those provisions.
Date: %-�1-/S' Applicant:
WARNING: FAILURE TO SECURE WORKERS' COM ENSATION 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: 10—C(-15- Signature (Applicant or Agent):
: DESCRIPTION
FINANCIAL •• •
;' ACCOUNT .; QTY; :,+x 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
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
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: LEE-/ REPLACE 50 GALLON
Type: PLUMBING Subtype:
Status: UNDER REVIEW
Applied: 10/9/2015 SGU
Approved: 10/9/2015 SGU
Parcel No: 773124018 Site Address: 51605 AVENIDA CARRANZA LA QUINTA,CA 92253
Subdivision: SANTA CARMELITA VALE LA QUINTA Block: 56
Lot: 6
Issued:
UNIT 5
ZIP PHONE - FAX EMAIL
APPLICANT
Lot Sq Ft: 0 Building Sq Ft: 0
Zoning:
Finaled:
Valuation: $850.00 Occupancy Type:
Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0
No. Unites: 0
CONTRACTOR
Details: WATER HEATER CHANGE OUT - 50GALLON/GAS [2013 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL
INSPECTION. 2013 CALIFORNIA BUILDING CODES
THERMAL
CA
ADDITIONAL SITES
Printed: Friday, October 09, 2015 8:45:36 AM 1 of 2- Or
SYS7ElviS
CHRONOLOGY
NAME TYPE
NAME
ADDRESSI
CONDITIONS
CONTACTS
CITY
STATE
ZIP PHONE - FAX EMAIL
APPLICANT
JORGE A ALVAREZ
PO BOX 984
THERMAL
CA
92274
CONTRACTOR
JORGE A ALVAREZ
PO BOX 984
THERMAL
CA
92274
OWNER
FREDERIC LEE
P 0 BOX 50
LAKE
ARROWHEAD
CA
92253
Printed: Friday, October 09, 2015 8:45:36 AM 1 of 2- Or
SYS7ElviS
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID BY
CLTD
.BY
PERMIT ISSUANCE
101-0000-42404
0
$91.85
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 for PLUMBING FEES: $19.34 $0.00
TOTALS:0•
INSPECTIONS
ATTACHMENTS
Printed: Friday, October 09, 2015 8:45:36 AM 2 of 2
SYSTEMS
Bin # .
City of La Quints
Bln7ding 8r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La (Mnta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
PmjectAftess: 5 160!g P.ve.[��c10. c r
Owner's Name: Z�Nvi d Lee
A. P. Number:
Address: S 1s0� �lei1�G- Tet
Legal Description
City. , Zip: �ST}� , Q
Contractor: '
Telephone
Description:
Address: C1 WL4Project
ST, Zip: r (A2 -1e-
�0
1City,
Telephone:
SteftLic.#: ggo do 3
city Lie. #; 0533 5
Arch., Engr., Designer:
Address:
City, ST. Zip:
Telephone:
State Lic. #:
=BIN
Name of Contact Person:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Pelson:
Estimated Value of:PMject: d
APPLICANT: DO NOT WRITE BELOW THIS UNE
N
Sabuiltial
Wd
Rec'd
TRACKING
PERM T FEES
Plea Seta
Plan Cheek sabinitted
item Amount
Structural Cala.
Reviewed, ready for corrections
Ran Cheek Deposit
Truss Cates.
Called contact Perm
Ran Check Balance.
11de 24 Codes.
Plans ptekod up
Coastruetioa
Flood plata plan
Plans resubmitted
Mechanical
Grading plan
21! Review, ready for eorrecGons/Issue
Elecd•leal
Sabcontactor List
Called Contact Person
Ptambing
Grant Dad
Plans picked up
S.M.L
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
r'` Review, ready for cormcdonstle me
Developer Impact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
STATE OF CALIFORNIA
RESIDENTIAL ALTERATIONS — WATER HEATER
CEC-CFiR-Ari-0!-E (Revisea 015114) CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CF1R-ALT-01-E WATER HEATER
Prescriptive Residential Alterations for Water Heater (Page 1 of 2)
A. GENERAL INFORMATION
Site address:
15 \OS V G
Building Type: )<Single Family Dwelling
❑ Multi Family Dwellings
City, Zip Code: G_ QA% Z 3
Climate Zone: 10
G. WATER HEATING SYSTEMS (Section 150.2(b)1G
01
02
1 03
04
05
1 06
07
08
09
10
11
12
13
14
15
Water
Heating
System
Identification
or
Name
Water
Heating
System
Type
Water
Heater
Type
# of
Water
Heaters
in
system
Water
Heater
Storage
Volume
(gal)
Fuel
Type
Rated
Input
Type
Rated
Input
Value
Heating
Efficiency
Type
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 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.
CERTIFICATE OF COMPLIANCE CF1R-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 (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 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: ❑Owner ❑ Authorized agent >Ia ontractor
Signature:
Company: twb� n
Contractor license #:O io3
Address:
CIL &q
Phone:
City/State/Zip: C� Z�
Date: vs,
For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300.