BPLB2017-009978-49S CALLE TAMPICO U �N�I{Aiil/
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: 13PL132017-0099
Property Address:
57218 MEDINAH
APN:
762110025
Application Description:
CONWAY / CHANGE OUT (1)SO GALLON (GAS) WATER HEATER
Property Zoning:
compensation laws of California, and agree that, if I should become subject to the
Application Valuation:
$900.00
Applicant:
STATEWIDE SERVICES INC DBA STATE WIDE PL
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 Class: C36, C33, CSO License No6147
9
ate Contra �r-1: `
VOICE (760) 777-7125
FAX _(760) 777-7011
INSPECTIONS (760) 777-7153
(760)699-5434
Llc. No.: 936147
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 3700 of the Labor Lode, for the performance
of Mork for which this permit is issued.
0 �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:
OWNER -BUILDER DECLARATION
Date: 7/26/2017
Owner:
o
GREGORY CONWAY
CZ
3147 FAIRVIEW AVE E #300.
compensation laws of California, and agree that, if I should become subject to the
SEATTLE, WA 92253
C77 -:3 C
signed statement that he or she is licensed pursuant to the provisions of the
.q
Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division
Contractor: y o
STATEWIDE SERVICES INC DBA STATE�WID-E`PL
73-700 DINAH SHORE DR STE
PALM DESERT, CA. 92211
40�__f
(760)699-5434
Llc. No.: 936147
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 3700 of the Labor Lode, for the performance
of Mork for which this permit is issued.
0 �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:
OWNER -BUILDER DECLARATION
Carrier: BENCHMARK INSURANCE COMPANY Policy Number: CSTS009630
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State
I certify that in the performance of the work for which this permit is issued, I
License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
shall not employ any person in any manner so as to become subject to the workers'
city or county that requires a permit to construct, alter, improve, demolish, or repair
compensation laws of California, and agree that, if I should become subject to the
any structure, prior to its issuance, also requires the applicant for the permit to file a
workers' compensation provisions of Section 37 of the Labor Code, I shall forthwith
signed statement that he or she is licensed pursuant to the provisions of the
comply with those provisions. `
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
Date: V � �� Applicant'
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
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
($500).:
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
(_) 1, as owner of the property, or my employees with wages as their sole
ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
compensation, will do the work, and the structure is not intended or offered for sale.
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
(Sec. 7044, Business and Professions Code: The Contractors' State License Law does not
INTEREST, AND ATTORNEY'S FEES.
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
APPLICANT ACKNOWLEDGEMENT '
are not intended or offered for sale. -if, however, the building or improvement is sold
IMPORTANT: Application is hereby made to the Building Official for a permit subject to
within one year of completion, the owner -builder will have the burden of proving that
the conditions and restrictions set forth on this application.
he or she did not build or improve for the purpose of sale.).
1. Each person upon whose behalf this application is made, each person at whose
(_) I, as owner of the property; am exclusively contracting with licensed contractors
request and for whose benefit work is performed under or pursuant to any permit
to construct the project. (Sec. 7044, Business and Professions Code: The Contractors'
issued as a result of this application , the owner, and the applicant, each agrees to, and
State License Law does not apply to an owner of property who builds or improves
shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and
thereon, and, who contracts for the projects with a contractor(s) licensed pursuant to
employees for any act or omission related to the work being performed under or
the Contractors' State License Law.).•
following issuance of this permit. '
(_) I am exempt under Sec. , B.&P.C. for this reason
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.
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
Lenders
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 representat'ves of this city t ter upon the
above-mentioned property for inspection purposes.
c.
Dt90ir Signature (Applicant or Ageft�;
Date: 7/26/2017
Application Number: ZPLB2017-0099
Owner:
Property Address: 57218 MEDINAH
GREGORY CONWAY
APN: 762110025
3147 FAIRVIEW AVE E #300
Application Description: CONWAY / CHANGE OUT (1)50 GALLON (GAS) WATER HEATER
SEATTLE, WA 92253
Property Zoning:
Application Valuation: $900.00
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
Detail: CHANGE OUT (1)50 GALLON (GAS) WATER HEATER. CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2016
CALIFORNIA BUILDING CODES.
FINANCIAL
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
0
Total Paid for TECHNOLOGY ENHANCEMENIT FEE: $5.00
j
, , 0
>3it, #
Permit 7'1178-495
Project Address:
21
arty of L Quinta
Building 8t Safety Division
Cal(e.Tanipico
La Quinta, CA 92253 - (760) 777-701,2
Building Permit Application and Tracking Sheet
Owner's Naine:00'a U3
A. P. Number:
Address: %` l "td U.
Legal Description:
City, ST, Zip: Y j
ra
Cont ctr.
0
0'U L
Te1eP hon e: 3(0 o
Address: 39 foq
k U Lo I
Project Description:
City_ ST, Zip: ''" c_ YY-)
Das
Telephone:
(l 2
State Lic. #: a
City Lie. #•:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone- e:
ean :
Co n traction Type:O cF cY
Lic.#
Re air
Demo.
PrJectnP cit le one :Ne d'n Iter
Name of Contact Person:
--d-
VCA -0
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project: t✓ o ,
APPLICANT: DO NOT WRITE 13ELOW THIS LINE
#
Submittal
Req'd
Rcc'd
TRACKMIG
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cnlcs.
Called Contact Person
Plan Check Balsnce.
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 Dced
Plans picked up
S.M.I. .
14.0.A. Approval
Plans resubmitted
Grading
IN HOUSE:-.
'"' Revicw, ready for corrcctions/;ssue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. 1Vks. Appr
Date of permit issue
Scl ool Pecs,
Total Permit Fees
STATE &',PALIFORNIA
RESIDENTIAL ALTERATIONS — WATER HEATER
'EC
-CF1R-ALT-01-E (Revised D3/2017 -AUR)„ CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE C41 -ALT -01-E WATER HEATER
Prescriptive Residential Alterations for Water Heater Page 1 of 2)
A. GENERAL INFORMAMOR
Site ad -dress:
Bulldinj Type:
n Sin& Family rAnIPliinB
❑ Multi Family Dwellings
City, Zl,p Code: LA QUIN,TA, CA
Climate Zone:
15
G. WATER HEATING SYSTEMS Section 16,i.2(b)1G)
01._
02
03.,,.
04
05
Q6
07
08_
09
10.`
11
12
13
14 :`
15
Water
Water
Water
# of
Water
Fuel
Rated
Rat6d
Heating
Hea'
tlii
Standby
Exterior
Back -Up
Central '
Dwelling
Heating
Heating
Heater
Water
Heater
type
Input
Input
Efficiency
Efflclegt.y
Loss (%)
Insul.
Solar
DHW System
Unit DHW
SystpT
System
Type .
Heaters
Storage
Type
Value
Type
Value,
R -Value
Savings
Distributia t
System
Identification
Type
In
Volume
Fraction
Type
Distribution
or
system
(gal)
Type
Name
/
Q
o
WATER HEATING SYSTEMS
Water heating compliance for an alteration ls'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 bd'used. Dwelling Unit dlstrlbution systems are Ilmited to Standard trunk.and branch or demand recirculation for gas or propane water
heater.' Demand recirculation is'iibt allowed for electric water heater. If there is do natural gas connected to the building, an electric water heater may be.replaced with
another electric water heater. 1-16wever, changing fromps to electric is not allowed. Multl-family central systems must use certlfied equipment as defiried under Section
110.1 apd• 110.3.
NOTE: If the proposed installation does not meet the requirements allowed speFlkally 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 Nat nq: enter a unique name for the Water Heating SysEem.
2;. Water heating system type: Domestic Hot Water (DHW), Hydronic, Combined Hydronlc, 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 provlde both space conditioning and domestic hot water.
Water heater type: For non -central systems pnly Small Storage or Small Instantaneous are alloyyed. For central systems pick from Large Storage, Small Storage,
Heat Pump, Boiler, Large Instantaneous, Srmrr.11 Instantaneous or Indlrect. .
CERTIFICATE OF COMPLIANCE MR -ALT -01-E WATER HEATER
Prescriptive Residential Alt6rations for Water Heater y (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-familv centra1 systems enter the total storage volume.
�. 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 areB.tuh, for electric fired system the units are kW.
B. 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 Insulatioh R -Value: Enter the R -value if exterior Insulation on the storage tank is installed
113. 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 mgIti•famlly 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.
S. Dwelling Unit DHW Distribution Type: Fora Central DHW this field: shall be Standard. If nQn-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":camplete.
o0wner 4 A'uthoriied agent ..ontractor
NarrieTV (^�G
Signature: �� g
�
Companlly : -�`
contractor license #: �p
Address: �"c�—�
Piio,ne:
CityState/Zip:
Date:
For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800.7t2-3300.
Bin # 1• �/
I IK`
City of La QUlnta
Building 8T Safety Division
o l? P.O. Box 1504, 78-495 Calle Tampico
boLa Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Perm # r
ProjeetAddmss: 57-141 Medinah
owner's Name: Larry & Nancu Justis
A.P.Number: 762-110-035
Address: 57-141 Medinah
Legal Description:
Contractor: Bob Edwards Construction
City, ST, zip: La Quinta, CA 92253
Telephone: XXX XXX-XXXXsr.`;£2:;
( ) 4
Address: 51-455 Desert Club Drive
Project Description:
City, sT, ziP: La Quinta, CA 92236
- Proposed Patio Addition 152 ' .ft. .
Tel hone: 760-777-8202
eP
=>`: k`>z !
-Proposed added electrical.
State Lic. # :
City Lic. #•:
Arch., Engr.,Designer: Gabriel Rios
Address: 49901 Cinnabar Ln.
city, ST, zip: Coachella, CA 92236
Telephone: 760-485-7431
State Lic.ProJect
f`-<'�5z'
Construction Type: V -B occupancy: R-3 .
type circle one) New Repair ir Demo
Name of Contact Person: Gabriel Rios
Sq. Pt.: 152 s.f.
# Stories: 1
# Units:
Telephone # of Contact Person: 760-485-7431
Estimated Value of Project: $10,000.00
APPLICANT: DO NOT WRITE BELOW THIS LINE
tI
Submittal
Req'd
Reed
TRACKING
PZRMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Coles.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Cheek Balance.
Title 24 Coles.
Plans pickid up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading phn
2" Review, ready for corrections/issue
Electrical
Subcontector List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE—
7id Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit Issue
,
Wood] Fees
Total Permit Fees