BPLB2017-0105• (i �
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78-495 CALLE TAMPICO
O.�i
D
VOICE (760) 777-7125
LA QUINTA, CALIFORNIA 92253
FAX (760) 777-7011
DESIGN &DEVELOPMENT DEPARTMENT
NS ECTIONS (760) 777-7153
BUILDING PERMIT
Lz
Dates 7/31/2017
Application Number: BPLB2017-0105
Owner: a
Property Address: 78016 CALLE NORTE
LLJ
MONICA BO L, EYER r` FQ— o
APN: 770012001
78016 CALLE NORTE oN z
Application Description: BOLLMEYER RESIDENCE
/WATER HEATER CHANGE OUT
LA QUINTA, CA72 3 ,.y M_
Property Zoning:
® MLL_ n
91
Application Valuation: . $3,485.00
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w
Applicant:
0
Contractor: U
A R S AMERICAN RESIDENTIAL SERVICES OF C
A R S AMERI 'N-MI9ENTIAL SERVICLEES OF C
965 RIDGE LAKE BLVD #201
965 RIDGE K BLV #201 GD
MEMPHIS, TN 38120
MEMPHIS,1!38h2 w
(951)276-9744
Llc. No.: 765074
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. C10. C20 License No.: 76SO74
Dat` e: . Contractor: /'r,4
^ vyc E
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).:
(_) 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, 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 Ad
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 tT)3
rk for which this permit is issued. .
Ihave and will maintain workers' compensation insurance, as required by
Sec00 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: WC7631SO8631
_ 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. //
DJit( ( i 7 Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS U WFUL,
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 enter u on the
above-mentioned property for inspection purposes.
Dat" "e: — r/l ' Signature (Applicant or Agent):
Date: 7/31/2017
Application Number:
SPLB2017-0105
Owner:
Property Address:
78016 CALLE NORTE
MONICA BOLLMEYER
APN:
770012001
78016 CALLE NORTE
Application Description:
BOLLMEYER RESIDENCE / WATER HEATER CHANGE OUT
LA QUINTA, CA 92253
Property Zoning:
Application Valuation:
$3,485.00
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: 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 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
CITY
AMOUNT
WATER HEATER/VENT PC
101-0000-42600
0
$7.60
Total Paid for PLUMBING FEES: $20.27 .
DESCRIPTION
ACCOUNT
CITY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
.0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: . $5.00
Bin #
City Of ick Quince
Building 8t Safety Division
� 78-495 Calle Tampico
La Quinta, CA 92253.- (760) 777-7012
Building Perinit Application and Tracking Sheet
Permit #
Project Address:UE Ah eLc
Owner's Name:ACA
A. P. Number:
Address,78N(v CAUCy`bjerS
Legal Description:
City, ST, Zip: &
R
Contractor: ^ � '
S E a S
Tele h one: p
P
Address: In e -4e S>
Project Description:
City, ST, Zip
TeleP h0 n
9
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State Lic. # :
City Lic. #; S137.3
Arch., Engr., Designer.
Address:
City, ST, Zip:
Teieh ne
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Construction n TY e: Occupancy:
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State Lic. #:
Project type (circle one) New Add'n Alter
r R ep air Demo
Name of Contact Person: QCs—
Sq. Ft:#
Stories:
#Units:
Telephone # of Contact Perso : ,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 Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2wd Review, ready for correctionsfissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant -Deed
Plans picked up
S.M.I.
H.O.A: Approval
Plans resubmitted
Grading
IN HOUSE:-
'"' 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
STATE OF CALIFORNIA
RESIDENTIAL ALTERATIONS — WATER HEATER
GEC-CFIR-ALT-01-E (Revised 06114) CALIFORNIA EXERGY COk NSSION
CERTIFICATE OF COMPLIANCE CRR -ALT -01-E WATER HEATER
Prescriptive Residential Alterations for Water Heater (Page 1 of 2)
A. GENERAL INFORMATION
Site address: 7001fo C.Ck\\e" _0c3c--k,
Building Type: ,Single Family Dwelling
o Multi Family Dwellings
City, Zip Code:
Climate Zone: 10 .
G. WATER
HEATING SYSTEMS Section 150.2 b 1 G
01
02 03
04
OS
1 06 '
07
08
09
10
, it
12
13
14
15
Water
Water Water
# of
Water
Fuel
Rated
Rated
Heating
Heating
Standby
Exterior
Back -Up
Central
Dwelling
Heating
Heating Heater
Water
Heater
Type
Input
Input
Efficiency
Efficiency
Loss (%)
Insul.
Solar
DHW 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
&
PKI A
5000
N
' N
r(Standar
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. .
NOTE: If the proposed installation does not meet the requirements allowed specifically for alterations, use form CFIR-NCB-01 to document the water heater alteration.
Instructions for sections with column numbers are given below:
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 MR -ALT -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. =` -
•5. 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.
S. Rated Input Value: Enter the numeric value of rated input.. a = -
9. Heating Efficiency Type: Energy,Factor, AFUE, or Thermal: Efficiency.- From product literature ora'California Energy Commission directory.
L 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 applies to any building with eight or more units. If the system is non -central or project is individual units enter n/a
- 25. 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
• I certify that this Certificate of Compliance documentation is accurate and complete.
Name: oOwner oAuthorized agent -gContractor Signature:
}
Company: C
Contractor licegg" 6c5
Address: �O O n/�
"I
��S
Phone:
700--(Pb�OLQ1
City/State/Zip: ,. a�J ii
Date:
For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: i-800-772-3300.
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