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BPLB2017-002078-495 CALLE TAMPICO U �i4NNCl/ LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT BUILDING PERMIT Application Number: BPLB2017-0020 Property Address: 49780 ENTRADA CIR CIR ® APN: 646240003 Application Description: MONTGOMERY RESIDEN BINCCp 0 3 2017 Property Zoning: r CD Application Valuation: $900.00 Applicant: STATEWIDE SERVICES INC DBA STATE WIDE PL 73-700 DINAH SHORE DR STE 405 PALM DESERT, CA 92211 CITY OF LA QUINTA DESIGN AND 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: C136, A. C333,C--10-� License : 99336/147 Date:d� ' 1 -7( _(',nlralnr, 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 forla— 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 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.). (L�i 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 INSPECTIONS (760) 777-7153 Date: 2/3/2017 Owner: CHARLES MONTGOMERY 151 GOLF CLUB LN GROVE CITY, PA 92253 Contractor: STATEWIDE SERVICES INC DBA STATE WIDE PL 73-700 DINAH SFORE DR STE 405 PALM DESERT, CA 92211 (760)699-5434 Llc. No.: 936147 WORKER'S COMPENSAMON DECLARATION I hereby affirm under penalty of perjury one or the following declarations: I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 37011 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 insuranca carrier and policy number are: Carrier: STATE COMPENSATION INSURANCE FL ND Policy Number: 1948371 I certify that in the performance of :he work for which this permit is issued, l shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree thet, if I should become subject to the workers' compensation provisions of Section 34 of the Labor Code, I shall forthwith comply with those provisions. D"atef . • �pl ci ant:- /' •� WARNING: FAILURE TO SECURE WORKERS' CO"APENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,00)). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOF. IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT: Application is hereby made to th 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 owne_, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the Zity 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 stste that the above information is correct. I agree to comply with all city and county ordirances and state laws relating to building construction, and hereby authorize representa=:fives of s city to enter upon'the above-mentioned property for inspection purposes. bat . e —� Signature (Applicant ':,A — --- S Application Number: BPLB2017-0020 Property Address: 49780 ENTRADA CIR CIR APN: 646240003 Application Description: MONTGOMERY RESIDENCE / PLUMBING Property Zoning: Application Valuation: $900.00 Owner: CHARLES MONTGOMERY 151 GOLF CLUB LN GROVE CITY, PA 92253 Date: 2/3/2017 Applicant: Contractor: STATEWIDE SERVICES INC DBA STATE WIDE PL STATEWIDE SERVICES INC DBA STATE WIDE PL 73-700 DINAH SHORE DR STE 405 73-700 DINAH SHORE DR STE 405 PALM DESERT, CA 92211 PALM DESERT, CA 92211 (760)699-5434 Llc. No.: 936147 -----------------------------------------------------7--------------------------------------- Detail: WATER HEATER CHANGE OUT - 50 GALLON / GAS [2016 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2016 CALIFORNIA BUILDING CODES. FINANCIAL INFORMATION DESCRIPTION ACCOUNT CITY AMOUNT BSAS SB1473 FEE 101-0000-20306 0 $1.00 Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 DESCRIPTION ACCOUNT CITY AMOUNT PERMIT ISSUANCE 101-0000-42404 0 $96.27 Total Paid for PERMIT ISSUANCE: $96.27 DESCRIPTION ACCOUNT CITY 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: $20.27 Bin # Permit # Project Address: Qty V I La Q l,t i t to Building &r Safety Division 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-701,2 Building Permit Application and Tracking Sheet . , Q�v Owner's Name: A. P. Number: Address: U4 V Legal Description: Ir City, ST, Zip: La 4'�/ Eontracto . d .0 � S ele hone: TP 7 7 0' MMW Address: Project Description: City` ST, Zip: Telephone: 0 ne: 7 v i State tic. # : '� le 14 —7 City Lie.:#. Arch., Engr., Designer: Address: City, ST, Zip: Telephone: h one: Construction Type: Occupancy: cY• State S Lic. #• ' type n Project a circle d'n J one): : New Ad salter Repair. Demo Name of Contact Person: f .li`L ►t Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: — Estimated Value of Project: © e APPLICANT: DO NOT WRITE BELOW THIS LINE tJ Submittal Req'd Rcc'd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Dep *sit Truss Calcs. Called Contact person Plan Check Balance Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2°" Review, ready for corrections/issue Electrical . Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. II.O.A. Approval Plans resubmitted Grading IN HOUSE:- ''d Reyicw, ready for correctionstissue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. \Vks. Appr . Date of permit issue School Fees, Total Permit Fees STATE OF CALIFORNIA RESIDENTIAL ALTERATIONS CEC-CFIR-ALT-01-E Revised 06/14 CERTIFICATE OF COMPLIANCE ' Prescriptive Residential Alterations Project Name: Date Prepared: CF1R-ALT-01-E (Paee 1 of 41 A. GENERAL INFORMATION Ol 02 07 Project Name: Qn 02 Date Prepared: 03 Project Location: G G 04 Building Front. Qq mt. n (deg or cardinal): OG CA City:. u OG Number of Awelling Units: , 07 Zip Code: 08 Fuel Type:, . qk, 4 ,. 09 Climate Zone: 10 To,$LCoriFditioned FloorjA-Fe.a'(ftip 11 1 Building Type e 12 Slab Area l ft2 " `" ( ) ws 13 Project Scope: (Optional) B. BUILDING INSULATION DETAILS•(Section 150.2(b)1) Ol 02 03 04 05 0607 08Q9 10 it Tag/ID Assembly Type Frame Type Frame Depth (inches) Frame. Spacing (inches) "day" 0.""Rrop' 6'sed Required Comments Continuous Cavity � Insulation R -value R -value ,? o 4 �r y ll'',fC or Appendix1A4 Reference LI -Factor Table, Cell Compliance p Pitch Exce tion p Number ?Product Type . `Insulat Reflectance Reflectance Emittance (Optional) Reflectance Emittance (Optional) C. ROOF REPLACEMENT (Prescriptive Alteration, Sectl.`616150.2(b)1H) 01 02 03 ' 04 0%, ;, 06 '0;7 08 09 10 11 12 13 I&it. valuer W* Propos d Minimum Required . Initial Solar Aged Solar Thermal SRI Aged Solar Thermal SRI Method of Roof i CRRC P,�roduct ID I eck on Compliance p Pitch Exce tion p Number ?Product Type . `Insulat Reflectance Reflectance Emittance (Optional) Reflectance Emittance (Optional) NOTES - • Roof area covered by build) glintegrated photcvol aiC panels and solar thermal panels are exempt from the above Cool Roof requirements. 04 '4 Liquid field hdn tallation from 110.8(i)4. • applied must comply wi criteria section A•' N Registration Number: Registration Date/Time: CA Building Energy Efficiency Standards - 2013 Residential Compliance HERS Provider: June 2014 STATE OF. CALIFORNIA RESIDENTIAL ALTERATIONS CEC-CF1 R -ALT -01 -E Revised 06114 CERTIFICATE OF COMPLIANCE ` Prescriptive Residential Alterations Project Name: CALIFORNIA CF1R-ALT-01-E (Page'3 of 4) Date Prepared: F. SPACE CONDITIONING SC SYSTEMS— HEATING/COOLING (Prescriptive section.150.2(b)) 01 02 03 Dwelling Unit Name Dwelling Unit CFA (Ft2) Comrnentsx IN.101 G. WATER HEATING SYSTEMS (Section 150.2(b)1G) . *, 01 02 03 04 05 06. 07 08 0,9 ,10 t11 V5, """12 13 14 15 Water Heating Alteration to the Space k of Water Name entification or Name Conditioning System(s)7 bN ` k� ` ;,.1.110 �"°tib �'s ��, Back -Up Water Heater !, 'Heating d' lHeating : System Water Water Heaters Storage Rated Rated vq� I Exterior Solar Dwelling Unit DHW Identification or Heating Heater in Volume Fuel Input Input Efficiency 4'�Efficiency Standby Insul. Savings Central DHW System System Name System Type Type system (gal) Type TypeL• Value Typep� Value Loss. (°�) R -Value Fraction Distribution Type Distribution Type o ,, . `%z v � H. SPACE CONDITIONING SYSTEMS AND WATER HEAT IN"G SYSTEMS INRM" "IFAMILY,DU_'C LING UNITS . *, 01 02 03` 4 ,;,�,, , 0"40 05 06 . k �� Central WateW eating �' L', wt - . 01 EDwelling Unit Dwelling Unit: Dwelhn UnitTota4CFA g system or �, y ' ' '' .�. aterwHeatin System 'W g Y Alteration to the Space Dwelling Unit Name (f12)xe Name entification or Name Conditioning System(s)7 Comments '� . ; '`�u�` �:� �"°tib �'s ��, • ik'A Registration Number: Registration Date/tlme: HERS Provider: CA Building Energy Efficiency Standards - 2013 Residential Compliance June 2014 STATE OF CALIFORNIA RESIDENTIAL ALTERATIONS CEC-CFIR-ALT-011-E (Revised 06/14) CERTIFICATE OF COMPLIAN(E- Prescriptive Residential Alterations Project Name: Date Prepared: ENERGY COMMISSION MR -ALT -01-E (Page 4 of 4) DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate oftompliance documentation is accurate and complete. It' 0. V_ CocumentatiQp;gUthor Name: 4v-rurnqntition Author Signature; k e compa Signature Date: 14, M 7`7 CS1 A 16--kt rfm CEA/ HERS Certification ideritificifloril(if applicable)- City/State/zip: Lyn Phone: %7 RESPONSIBLE PERSON'S DECLARATION STATEMENT X%p I certify the following under penalty of perjury, under the laws of the State of California: 1 0 1. The information on this Certificate of Compliance is true and,correct. U. ) .provided I ". V of -and Professions 2. 1 am eligible under Division 3 the Business Code to accept respons*- t. for the building,qsi_P1Mn& system design identified on this Certificate of Compliance (responsible 1D. designer). ' 'performance 3. That the energy features and specifications, materials, components s 1� manufacture�d�'de` ldie§for the building design or system design identified on this Certificate of I - 0 Kf .0 W Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the �jlifornia Code of Regulations. 4. The building design features design features identified dertificate or system on this of Cftoliancetare consistent;,% V. With ,6 . We information provided on other applicable compliance documents, Vk 4. 'W, '! 47�, o th"06rif6rcement ager�-qy�foj�approval with this buildlin permit application. worksheets, calculations, plan,s and specifications submitted tot . - -. 0 W - i& P his 9 S. 1 will ensure that a registered' �opy of this Certificate of Complitincb,,§hall be madea.9killjable with the building pprmit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a registered -cop�y%f this Certifica`tAlof Compliance isjrOqJr-od,to be included documentation with the the builder provides to thebuilding owner at occupancy. %Uf. Responsible Designer Name: LFR 6 'eQsp- U sible Designer Signature: n Company: M Date Signed: Address: %V License: City/State/Zip: z-_ 'W Phone: N ofto For.assistarce aouestions regarding the Energy Standards, contact the Energy Hotline at: 1-800-172-3300. Registration Number: Registration Date/Time: CA Building Energy Efficiency Standards - 2013 Residential Compliance HERS Provider June 2014