BPLB2016-009478-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Twq� 4 4� QuiRro
COMMUNITY DEVELOPMENT DE
BUILDING PERMIT
Application Number:
BPLB2016-0094
Property Address:
48615 VISTA TIERRA
APN:
646081008
Application Description:
SHARON CALUSSIO % WATER HEATER CHANGE OUT
Property Zoning:
Application Valuation:
$2,231.30
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 70001 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
Dater 071344 - Contractor:
OWNER -BUILDER DECLARATION l�
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
applyto 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
ame:
Lender's Add
�OVA 2 3 W,
wner:
46
WA 92253
VOICE (760) 777-7125
FAX (760) 777-7011
TIONS (760) 777-7153,
Date: 6/23/2016
Contractor:
A R S AMERICAN RESIDENTIAL SERVICES OF C
965 RIDGE LAKE ELVD SUITE 201
MEMPHISJN 38-,20
(951)276-9744
Llc. No.: 765074
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' cc•mpensation. insurance, as required by
Section 3700 of the Labor Code, for the perfornance of the work for which this permit
is issued.. My wor rs' compensation insurance carrier and policy number are:
Carrier: alcy Number: N JCC �2/a �
_ I certify that in the performance of the wor for w ich 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. J
Date: a . Applicant:
WARNING: FAILURE TO SECURE WORKERS' CCLMPENSATION C E GE IS UNLAWF ,
AND SHALL SUBJECT AN EMPLOYER TO CRIMMAL 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 appl"cation is made, each personat 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 appli.ation 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 s -.ate that the above information incorrect.
I agree to.comply with all city and county ord nances and state laws relating to building
construction, and hereby authorize representatives of this city enter upon the
above-mentioned property for inspection puraoses.
Date: ts4'��y�sg
nature (ApplicamorAge
FINANCIAL INFORMATION.
ru € DESCRIPTION ' »AN F ' ACCOUNT QTY z'AM UNT + x PAID �� PAID'DATE%
�... :.._. ,.,._.. _..
__ s h. ._ _ ._._.».. _, ter. • ,�� �_ � _ .. � �. _.._ _. _xr
BSAS SB1473 FEE
101-0000-20306 0 $1.00
$1.00'
6/23/16
METHOD RECEIPTS# rq..�
CHECKCLTDBY
*23
_ u<.
:.
A R S AMERICAN RESIDENTIAL SER
CHECK R16532
005505
RSE
Total Paid for BUILDING. STANDARDS ADMINISTRATION BSA: $1.00 $1.001
"DESCRIPTION ; '
>W
'.ACCOUNT',
�. Y
r! ail, 53�
_'»`AMOUNT;
t i r'C"Y
PAID,;
PAID DATE`
43t
;QTY
4
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$91.85
6/23/16
PAIDBY xz
V '
"Ill"
ET
HOD
"
K#CLTD
BY Lr
, Y
K"
. a ' «
tr , FHCx S
A R S AMERICAN RESIDENTIAL SER
CHECK
R16532
005505
RSE
Total Paid for PERMIT ISSUANCE: $91.85 $91.85
g
- b6CRIPTION
ACCOUNT x <
QTY,
AMOUNT
F
x
`PAID DATE;
w�
�4
-PAID F
WATER HEATER/VENT'
101-0000-42401
0
$12.09
$12.09
6/23/16
i
+PAID<BYMETHOD
f ,.* X Y• � t ' ' 9r �
Et� &
RECEIPT # �
; y
�.
€ g CHECK #
CLTD BY
A R S AMERICAN RESIDENTIAL SER
CHECK
R16532
005505
RSE
;DESCRIPTION ' t,
f
ACCO.UNT�s
rQTYr
� 5 AMOUNT
q z F �c£
'PAID DATE -i
p y*3';
s K$
aPAID
WATER HEATER/VENT PC
101-0000-42600
0
$7.25
$7.25
6/23/16
METHOD *�
r
San
'.RECEIPT #aCHECK
# `CLTD
BY
+sSH A.x� '4.
A R S AMERICAN RESIDENTIAL SER
CHECK
R16532
005505
RSE
Total Paid for PLUMBING FEES: $19.34 $19.34
TOTALS:
+
e
e
Description: SHARON CALUSSIO / WATER HEATER CHANGE OUT
Type: PLUMBING Subtype: Status: APPROVED
Applied: 6/23/2016 RSE
Approved: 6/23/2016 6SE
Parcel No: 646081008 Site Address: 48615 VISTA TIERRA LA QUINTA,CA 92253
Subdivision: TR 20052-6 Block: Lot: 8
Issued:
Lot Scl Ft: 0 Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $2,231.30 Occupancy Type: Consfruction Type:
Expired:
No. Buildings: 0 No. Stories: 0 No. Unites: 0
Details: WATER HEATER CHANGE OUT - 50GALLON/GAS [2013 ENERGY) CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL
INSPECTION. 2013 CALIFORNIA BUILDING CODES.
Applied to Approved
"F
INANCIAI:INFOR MATION
Printed: Thursday, June 23, 2016 2:42:39 PM 1 of 2 &mMYSTEMS
.. ... . ... ... .. ..... . .. .. .. .. . . .. ..... .... . ....... ......
INSPECTIONS
PARENT PROJECTS
......... . .
-7
ADESCRIPTION '.
:. ACCOUNT,.
U
RECE 107
44
B
A R S AMERICANRSE
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$1.00
6/23/16
R16532
005505
CHECK
RESIDENTIAL SER
Total Paid for BUILDING STANDARDS ADMINISTRATION
$1.00 $1.00
BSA:
,
S AMERICAN
PERMIT ISSUANCE404
101-0000-42.
-.0
$91.85
$ 91.85
6/23/16
-1116532
005505
CHECK
17�IDENTIAL
RSE
SER
Total Paid for PERMIT ISSUANCE: $91.85 $91.85
A R S AMERICAN
WATER HEATER/VENT
'101-0000-42401
0
$12.09
$12.09
6/23/16
R16S32
.005505
CHECK
RSE
RESIDENTIAL SER
WATER HEATER/VENT
A R S AMERICAN
101-0000-42600
0.
$7.25
$7.25
6/23/16
R16532
005505
CHECK
RSE
PC
RESIDENTIAL SER
Total Paid for PLUMBING FEES: .$19.34 $19.34
TOTALS: $112.19 $112.19
.. ... . ... ... .. ..... . .. .. .. .. . . .. ..... .... . ....... ......
INSPECTIONS
PARENT PROJECTS
Pin #
City of La Quinta
Building 8t Safety Division RECEIVE
78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012 JUN 2 3 2016
Building Permit Application and- Tracking Sheet
Permit #
Project Address-Y$�f6"�� �� a
Owner's Name:
A. P. Number:
Address: X15 E
Legal Description:
City, ST, Zip: Tip 5.3
Contra
T le
- O.
hone:3o7
Address:3a �5 57
Project Description:
City, ST, Zip:, 4,51 tl ,q?;54 S
TeleP h0 n 8 UD
]OEM
State Lica# : 65o 7
Arch., Engr., Designer:
Address:
City., ST, Zip: .
Telephone:hone:
Cans tructi on Type: Occupancy:
:
State Lic. #:
-- dd'n Alter Repair- Demoject tYPe cir le ne)
Name of Contact Person: C
Sq. Ft.: 6
# Stories:
# Units:
Telephone # of Contact Person:(-Q<0 7S
Estimated Value of Project: .,
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan C Deposit
ru s.
Called Contact Person
Ian Check Balance
Title 24 Cales.
Plans picked up
Construction'
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2°' ready for co ctions/issue
Electrical
Subcontactor List
Called Contact rso
Plumbing
Grant Deed
Plansed up
S.M.I.
H.O.A. Approval
laps resubmitted
Grading '
IN HOUSE:-
'"! Review, ready for corrections/issue
Dcvelo mpact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fces
Total Permit Fees
dT
I V E D
STATE OF CALIFORNIA
RESIDENTIAL ALTERATIONS -- WATER HEATER II iKi 2.3 9n1h
CEC-CF1 R -ALT -01-E (Revised 06114)
CALIFORNIAENERGY COMMISSION
CERTIFICATE OF COMPLIANCE UINTA CF111-ALT-81-E WATER HEATER
prescriptive Residential Alterations for Water Heater COMMUNITY DEVELOPMENT (Page 1 of 2)
A. GENERAL INFORMATION .
Site address: �Q' n �� .�/ Building Type: � Single Family Dwelling
U lX U I ,S I w I e� d�� o Multi Family Dwellings
City, Zip Code: Climate Zone: 10-
71
G. WATER
HEATING SYSTEMS Section 160.2 b 1 G
01
02 03
04
05
06
07
1 08
09
10
11
12
13
14
IS
Water
Water Water
'Heating
# of
Water
Fuel
Rated
Rated
Heating
Heating
Standby
Exterior
Back -Up .
Central
Dwelling
Heating
Heater
Water
Heater
Type
Input _
Input
Efficiency
Efficiency
Loss (96)
Insul.
Solar
OHW 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
5
&
M
E
C_2
11N
r
fi f,U
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. F
NOTE: If the proposed installation does not meet the requirements allowed specifically for alterations, use form CF1R-NC8-01 to document the water heater alteration.
Instructions for sections with column numbers are given below::. N
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
c CFMALT-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.
S. 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.. -
t 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 appliesto 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
• 1 certify that this Certificate of Compliance documentation is accurate and complete.
Name:I oOwner o Authorized agent IdContractor • -
Signature:
Company: ..Rome `C
Contractor license (DC5 o J4
Address:bO O �rS
City/State/Zip: 1 vi r* 3 0-e C A q5 o
Phone:
gU0-(;� -DLo�
Date:.. / n om __ I