BPLB2017-004978-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
c% D
ZVARTMENT
11DESIGN & DEVELOPM
BUILDING RMIT MAR 2 9 2017
Application Number:
BPLB2017-0049
Property Address:
78865 GRAND TRAVERSE AVE
APN:
770070013
Application Description:
SULLY RESIDENCE/ HOT WATER HEATER
Property Zoning:
Application Valuation:
$900.00
Applicant:
STATEWIDE SERVICES INC
DBA STATEWIDE CON
73-700 DINAH SHORE DR
STE 405
PALM DESERT, CA 92211
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 ClassGB License No.: 951607
^Day
` Contra r:— G'
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 ) 1, 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 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
VOICE (760) 777-7125
FAX (760) 777-7011
1 SPECTIONS (760) 777-7153
Date: 3/29/2017
CITY DESIGN AND DEVE OPhq� A
�II1 LLY
7886 'UUiRVERSE
LA QUINTA, CA 92253
Contractor:
STATEWIDE SERVEZES INC DBA STATEWIDE CON
73-700 DINAH SHORE DR STE 405
PALM DESERT, CA92211
(760)699-5434
Llc. No.: 951607
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one ofthe following declarations:
I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 370C of the Labor Code, for the performance
of the work for which this permit is issued.
I have and will maintain workers' cc npensation 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: BENCHMARK INSURANCE COMPANY Polity Number: CST5009630
I certify that in the performance of -.he work for which this permit is issued, I
shall not employ any person in any manner so 3s to become subject to the workers'
compensation laws of California, and agree thct, if I should become subject to the
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with those provisions.
ate: Appli4 ca
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 ($100,0OD). 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 thi: 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 r, 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 tie 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 ofissuance of such permit, or cessation of
work for 180 days will subject permit to cancelation.
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 i to enter upon the
above-mentioned property for inspection purposes.
Application Number:
BPLB2017-0049
Property Address:
78865 GRAND TRAVERSE AVE
APN:
770070013
Application Description:
SULLY RESIDENCE / HOT WATER HEATER
Property Zoning:
Application Valuation:
$900.00
Applicant:
STATEWIDE SERVICES INC DBA STATEWIDE CON
73-700 DINAH SHORE DR STE 405
PALM DESERT, CA 92211
Date: 3/29/2017
Owner:
BETTY LOU SULLY
78865 GRAND TRAVERSE
LA QUINTA, CA 92253
Contractor:
STATEWIDE SERVICES.INC DBA STATEWIDE CON
73-700 DINAH SHORE DR STE 405
PALM DESERT, CA 92211
(760)699-5434
Llc. No.: 951607
--------------------------------------------------------------------------------------------,-
Detail: 50 GALLON WATER HEATER CHANGE OUT [GAS] CARBON MONOXIDE 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 10 $1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION 3SA: $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 L -EES:, $20.27
DESCRIPTION
ACCOUNT
QTY
1
AMOUNT
1
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT. FEE:. $5.00
STATE OF CALIFORNIA
RESIDENTIAL ALTERATIONS
CEC-CFIR-ALT-01-E Revised 06/16 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CFIR-ALT-01-E
Prescriptive Residential Alterations (Page 1 of 6)
Project Name: / - - Date Prepared:
A. General Information
01
02
01
Project Name:
02
Date Prepared:
03
Project Location:
04
Building Front Orientati rOdeg or cardinal):
05
07
CA City: _ i,
Zip Code:
.� 06
08
Number of Altered Dwelling Units:
Fuel Type:'
09
Climate Zone:
10
Total Coniiiti�ned Floor Area,(ft2)s
11
Building Type
12
5`1101A(r6-.(02)
13
Project Scope:
x�ceptions to Minimu,ged Solar
14� ( Reflectance and IVMinimum Thermal or SRI
� 150.2(b)1Hi_
B. Building Insulation Details (Section 150.2(b)1)
01
02
03
04
05
06 07 .08 ' 09
10
11
Tag/ID
Assembly Type
Frame
Type
Frame
Depth
(inches)
FrameContinuous
Spacing
(inches)
Proposed #
Required
Comments
Cay�tty Insulation AR
,wR-valuetR-value
.
U factor,
Appendix JA4
Reference
U -Factor
0j ble Cell
4 (
Product
R -value
Deck
�.
Initial Solar
Aged Solar
Thermal SRI
Aged Solar Aged Solar
Reflectance Reflectance
-Thermal SRI
101
a
*W
r
ID
Tr 'fie " %f -,%L wr R. . �
C. Roof Replacement (Section 150.2(b)iH) "'a. —
'V06 808 09
01 02 03 04 05 �0,77 10 it 12 13 14
CR'RC
11 Proposed
Minimum Required
Tag/
Method of
Roof
'�&
L Product
ID
4 (
Product
R -value
Deck
�.
Initial Solar
Aged Solar
Thermal SRI
Aged Solar Aged Solar
Reflectance Reflectance
-Thermal SRI
101
ID
Compliance
Pitch
,Exception
NumberggTgpe
Insulation,,Reflectance
Reflectance
Emittance (Optional).
(Max) (Min)
Emittance (Optional)
'
.�
,
mow►,
�`
NOTES
• Roof area covered by b lu Id ng=inYegrated photovoltaic panels and solar thermal panels are exempt from the above Cool Roof requirements.
• Liquid field applied coatinn stimu t comply with installation criteria from section 110.8(1)4.
Registration Number:
CA Building Energy Efficiency Standards - 2013 Residential Compliance
Registration Date/Time: HERS Provider:
June 2016
STATE OF CALIFORNIA "
RESIDENTIAL ALTERATIONS
CEC-CFIR-ALT-01-E Revised 06/16 CALIFORNIA.ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE ; . CF1R-ALT701-E
Prescriptive Residential Alterations (Page 5 of 6)
Project Name: - Date Prepared:
G. Space Conditioning (SC) Systems - Heating/Cooling (Section 150.2(b))
.01 02 03
Dwelling Unit Name Dwelling Unit Total CFA {ftZ) Comme)ts,
H. Water Heating Systems (Section 150.2(b)l.G) 1.0
01
02
03
04
05
06
07
08
09
10
11
<12
13
14
15
Waterof
Alteration to the Space
ti
Water
Name,,
Identifl Name
Conditioning System(s)?
Comments
AKAd�
^�
-Up
F
Heating
System
Water
Heating
Water
Water
Heaters
Heater
Storage
Rated
Rated
Hqi� a ing
keating
Exterior
Back
Solar
Central DHW.
System
-Dwelling Unit
DHW System
Identification
System
Heater
in
Volume .
Fuel.
Input
Input
Effe
Efficiency
ndby
lnsul.
Savings
Distribution
Distribution
or Name
Type
Type
system
(gal)
Type
Type
Value
Type
Value �`
Loss (%)
R -Value
Fraction
Type.
Type .
I. Space Conditioning Systems and Water Heating Systems _in�Nluultifamily Dwelling Unit
01
02
v 03
' 04
OS
06
�Cerit al Water Heating
br.
Dwellingunifi '0
Dwelling Unit-.
Dwelling Unit Total CFA
Sysstteln Identification
Water HHeati gSystem
ati for
Alteration to the Space
Dwelling Unit Name
(ft)
Name,,
Identifl Name
Conditioning System(s)?
Comments
AKAd�
'
°
STATE OF CALIFORNIA
RESIDENTIAL ALTERATIONS - .
CEC-CFIR-ALT-01-E Revised 06/16 CALIFORNIA ENERGY COMMISSION ` WV
CERTIFICATE OF COMPLIANCE - CF1R-ALT-0I-E
Prescriptive.Assid n ial Iterations (Page 6 of 6)
Project Name: Date Prepared:
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT
1. 1 certify that this Certificate of Compliance documentation is accurate and complete.
Document io • uthorName:
K7 If, ASG; (,
Docume atio Auth rSignature: V
Comp
e: 'T ''. 1111110.1
Addres (/�/�Jo
CEA/ HERS Certification Identiflcallbn'jlffaapplicable): L
City/S t /Zip:
Phone:
OL
RESPONSIBLE PERSON'S DECLARATION STATEMENT
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 fo,�the buildinggdesign�ooRs2m design identified on this Certificate of Compliance (responsible
designer).
3. That the energy features and performance specifications, materials, components; a"'mahdufactured dev-11eesJor the building design or system design identified on this Certificate of
Title Part Part form Reeg�Gl�"atlon'
Compliance conform to the requirements of 24, 1 and 6 of th .Cal Code of
4. The building design features or system design. features identified on this Certificate of Compliance are�cfonsistent with4he information provided on other applicable compliance documents,
oval
worksheets, calculations- plans and specifications submitted to the enfo semen agency -for app with this btilding permit application.
5. 1 will ensure that a registered copy of this Certificate of Compliiance,shall be made availlaab e�with the buildirig.pemit(s) issued for the building, and made available to the enforcement agency
for all applicable inspections. I understand that a registered}, �o.,f this Certificate of Compliance is required tb be included with the documentation the builder provides to the building
�op
owner at occupancy. 1,, t,—
Responsible Designer Name:
RespdnSlbllee designer Signature:
Company:
`�4
'iDe Signed:
A
Address: ""' 'S:ik`` "'
WillkX _
License:
City/State/Zip:y' , V
Phone:
For�assistance or questions regarding the Energy Standards, contact the Energy'Hotline at: 1-800-772-3300
Registration Number: Registration Date/Time: HERS Provider:
CA Building Energy Efficiency Standards - 2013 Residential Compliance June 2016
Bin #
pity of >a Quin to
Building 81- Safety Division
78-495 Calle .Tampico
La Quinta, CA 92253 - (760) 777-701,2
Building PP Permit Application and Tracking Sheet
Owner's Name.IOU l.Q
Pert
�j U
Project Address:
A. P. Number:
Address V�V1�V aL
Legal Description:
City, ST, Zip:
ontract
C r o
� n� G
1
Phnc: S
Tele o
Address:
Project Description: C�.....
City, ST, Zi :
iIA /Z
Telephone:
a
State Lie. # .V4
City Lie. #;
Arch.,'Engr., Designer:
Address:
City, ST, Zip:
Telephone: one•
:
occupancy:
e: cY
Con iructioh TYP
State Lie. #
ProJ`ect bP circle one): New Add' n After Repair Demo.
Name of Contact Person:
!/�
1
Sq. Ft.:
# Stories:
#Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rcc'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
: Called Contact Person
Plan Check Balasce.
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:-
Jrd Review, ready for correctionsrssuc
Developer Impart Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. 1V1,s. Appr
Date of permit issue
School Fees,
Total Permit Fees