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BPLB2017-0085LICENSED 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- C366, C10. C20 License No.: 765074 a�"'� l/Contractors 'l 4 A 12, 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).: (� 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.). (_) 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 Lender's Address: (951)276-9744 Llc. No.: 765074 WORKER'S COMPENSATION DECLARATION 1 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 t ork 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: LIBERTY INSURANCE CORPORATION Policy Number: WC7631508631 _ 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. atif/ nt_ir_k4U,_// A�"v� - WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVE GEIS 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 en er upon above- �men�tion d pro rty for inspection purposes. W_ZD'a1 e:gnature (Applicant or Agent).. �.. — 4� VOICE (760) 777-7125 78-495 CALLE TAMPICO D FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT G� y D te:—" 6 P/2017 Application Number: BPLB2017-0085 Property Address: 81183 CASPIAN CT Owner: DEREK WONG _ C_— m Z APN: 764800029 81183 CASPIAN CT r-+ Application Description: WONG / 50GALLON GAS WATER HEATER LA QUINTA, CA 92253 Property Zoning: 0 Application Valuation: $2,345.15 U0 y n Applicant: Contractor: A R S AMERICAN RESIDENTIAL SERVICES OF C A R S AMERICAN RESIDENTIA "SER ICES OF C 965 RIDGE LAKE BLVD #201 965 RIDGE LAKE BLVD #201 MEMPHIS, TN 38120 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 7000) of Division 3 of the Business and Professions Code, and my License is in full force and effect. License Class- C366, C10. C20 License No.: 765074 a�"'� l/Contractors 'l 4 A 12, 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).: (� 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.). (_) 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 Lender's Address: (951)276-9744 Llc. No.: 765074 WORKER'S COMPENSATION DECLARATION 1 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 t ork 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: LIBERTY INSURANCE CORPORATION Policy Number: WC7631508631 _ 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. atif/ nt_ir_k4U,_// A�"v� - WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVE GEIS 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 en er upon above- �men�tion d pro rty for inspection purposes. W_ZD'a1 e:gnature (Applicant or Agent).. �.. — Date: 6/14/2017 Application Number: BPLB2017-0085 Owner: Property Address: 81183 CASPIAN CT DEREK WONG APN: 764800029 81183 CASPIAN CT Application Description: WONG / 50GALLON GAS WATER HEATER LA QUINTA, CA 92253 Property Zoning: Application Valuation: $2,345.15 Applicant: Contractor: A R S AMERICAN RESIDENTIAL SERVICES OF C A R S AMERICAN RESIDENTIAL SERVICES OF C 965 RIDGE LAKE BLVD #201. 965 RIDGE LAKE BLVD #201 MEMPHIS, TN 38120 MEMPHIS, TN 38120 (951)276-9744 ------------------------------------------------------------- LIc. No.: 765074 Detail: 50GALLON WATER HEATER CHANGE OUT [GAS] CARBONMONOXIDE ALARM(S) -----=------------------------- TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2016 CALIFORNIA BUILDING CODES. FINANCIAL INFORMATION DESCRIPTION ACCOUNT QTY 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 QTY 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 Bin # Permit 9f Project Address //83 �_ City of La Quinta Building 8F Safety Division 78-495 Ca/1e Tampico La Quinta, CA 92253 -.(760) 777-701,2 Building Permit Application and Tracking Sheet CT Owncr's Name: A. P. Number: Address: ?! ee5g,014," Legal Description: City, ST, Zip: lA/ r -f CW Contractor: n' � D � CPr� Tele '— h n o c P � 333 9 � Address: 3o3U !'J'1 ��S S' Project Description: City, ST, Zip. ) TeleP on h (O / Q—N- t G State Lic. # :7(oSo 7el City:7(o Arch., Engr., Designer: C Address: City, ST, Zip: Telephone- 0 ne: :' Constructi n TYPe• ianeY Occupancy: i% • State Lre.#. • 0ProJect type (circle ne New . Add'n Alter Repair Demo Name of Contact Person: Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: Estimated Value of Project: c';i S45 APPLICANT: DO NOT WRITE BELOW THIS LINE N Submittal Req'd Rcc'd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Cafes. Called Contact Person Plan Clieck Balance Title 24 Cales. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2"" Review, ready for corrcctions/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Dced Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:-. 'rd. 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 t STATE OF CALIFORNIA r. Prescriptive Residential Alterations That Do Not Require HERS Field Verification -i 'EC-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: ob 1--/` �+� �n A /� Date Prepared: _ /4 1 This compliance document is only applicable to simple alterations that do not require HERS verification for compliance. When HERS verification is required, a CFIR-ALT- 01 shall first be registered with a HERS Provider Data Registry. Alterations to Space Conditioning Systems that are exempt from HERS verification requirements may use the CFIR-ALT-05 and CF2R- ALT -05 Compliance Documents. Possible exemptions from duct leakage 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 a C17IR-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 CFIR-ALT-OS with a HERS Provider Data Registry. If more than one person has responsibility for 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: ��� jn %D p / !�' v��' v�� 02 Date Prepared: / 03 Project Location: 2//82 s 04 Building Front Orientation (deg or cardinal): 05 ' CA City: /� �� 06 Number Altered Dwelling Units: 07 Zip Code: 018 Fuel Type: 09' Climate Zone: 10 Total Conditioned Floor Area (ft): 11 Building Type: 12 Slab Area (ft) 13 Project 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 r STATE OF CALIFORNIA Prescriptive Residential Alterations That Do Not Require HERS Field Verification CEC-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) 0 1 02 03' 04 05 06 07 08 09 10 11 12 13 14 15 t# 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) Type Input Value Type Value Loss (%) RR . Fraction S c /V /TyApe CJG `''� / --Value ,`/AdZA l � �AddR��o'w 0»e�leteRow�� . CA Building Energy Efficiency Standards - 2016 Residential Compliance April 2016 STATE OF CALIFORNIA Prescriptive Residential Alterations That Do Not Require HERS Field Verification n " EC-CFIR-ALT-05-E (Revised 04116) l,AUFVRIVIM CIVCRM CGIVIIVIIJJIVIV-9� CERTIFICATE OF COMPLIANCE CF111-ALT-05-E Prescriptive Residential Alterations That Do Not Require HERS Field Verification Page 3 of 3 Project Name:./3 �� / C ` � Date Prepared: .a7- P � N T `4 C�-lrt iiVT ��9,J_3 / DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: '� L( Documentation Author Signatur � Company: ' �`/ �A �1 -�7 Signature Date: Address: 30 CEA HERS Certification Identification If applicable): City/State/Zip: ^ Phone: RESPONSIBLE PERSON'S DECLARATION STATEMENT i 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. 1 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 other applicable 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 required to be included.with the documentation the builder provides to the building owner at occupancy. Responsible Designer Name: Responsible Designer Signatur Company: Date Signed: Address: � O � � 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