BPLB2017-009078-495 CALLE TAMPICO
r LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application Description
Property Zoning:
Application Valuation:
Applicant:
MICHAEL ANTHONY ELLIS
7085 BARBERRY AVE
YUCCA VALLEY, CA 92284
Td4f 04 4 QUM&
DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PER
BPLB2017-0090
51295 CALLE QUITO
770173009
VILLA / CHANGE OUT (1)50GALLON GAS WATERHEATER
$475.00
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: _ License No.: 901491
Date: ZX11 7 Contractor:
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 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.).
(1 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 ) 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
INSPECTIONS (760) 777-7153
Date: 6/28/2017
(530)251-6258
Llc. No.: 901491
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 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 insurance carrier and policy number are:
Carrier- EXEMPT Policy Number: _
i�rcertify 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.
`U
Date: zQ I Applicant:
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 ($100,000). 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 upo4e above-
mentioned property for inspection purposes. c /'
Dater Z� �% Signature (Applicant or Agent):
Owner:
RONALD VILLA
( r
5215 ORCA DR NE
TACOMA, WA 92253~
L
Cz
wu,
Contractor:
t�
MICHAEL ANTHONY ELLIS.aN
7085 BARBERRY AVE
YUCCA VALLEY, CA 92284
(530)251-6258
Llc. No.: 901491
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 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 insurance carrier and policy number are:
Carrier- EXEMPT Policy Number: _
i�rcertify 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.
`U
Date: zQ I Applicant:
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 ($100,000). 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 upo4e above-
mentioned property for inspection purposes. c /'
Dater Z� �% Signature (Applicant or Agent):
r
Date: 6/28/2017
Application Number: BPLB2017-0090
Owner:
Property Address: 51295 CALLE QUITO
RONALD VILLA
APN: 770173009
5215 ORCA DR NE
Application Description: VILLA / CHANGE OUT (1)50GALLON GAS WATERHEATER
TACOMA, WA 92253
Property Zoning:
Application Valuation: $475.00
Applicant:
Contractor:
MICHAEL ANTHONY ELLIS
MICHAEL ANTHONY ELLIS
7085 BARBERRY AVE
7085 BARBERRY AVE
YUCCA VALLEY, CA 92284
YUCCA VALLEY, CA 92284
(530)251-6258
------------------------------------- -------------------------------------------------------
Llc. No.: 901491
Petail: 50GALLON WATER HEATER CHANGE OUT [GAS] CARBON MONOXIDE-ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2016 CALIFORNIA
BUILDING CODES.
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
INFORMATIONFINANCIAL
DESCRIPTION ACCOUNT QTY AMOUNT
BSAS SB1473 FEE 101-0000-20306 0 $1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION
ACCOUNTQTY
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 #
City of La Quinta
Building &• Safety Division
78-495 Calle Tampico
La Quinta, CA 92253 - (760)777-7012
Building Permit Application and Tracking Sheet
Pen -nit #
Project Address: ��
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Owner's Name: fu L
A. P. Number:
Address: 70,5r_5,-
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LegalDescription:
City, ST, Zip:. U « V C/.9
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Contractor:Tel
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Address: %g'�/�
Project Description:
City, ST, Zip: e V
Telephone:
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State Lic. # :
City Lic. #:
Arch., Engr., Designer.
Address:
City, ST, Zip:
Telephone: e.
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Construction T Occu
YPe: an Occupancy:
type (circle one): New Add'n Alter Repair Demo
StateLt •c. #:
:.Project
Name of Contact Person:
'� e
L%,�'
Sq. Ft.:
# Stories:
#'Units:
Telephone # of Contact Person: 5-30 2Sr
Estimated Value of Project -,21
APPLICANT: DO NOT WRITE BELOW THIS LINE '
#
Submittal
Req'd
Recd
'TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural talcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss talcs.
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.
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
Prescriptive Residential Alterations That Do Not Require HERS Field Verification
CEC-CFIR-ALT-05-E Revised 04/16 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CF1R-ALT-057E
Prescriptive sidential Alterations That Do Not Require HERS Field Verification Page 1 of 3
Protect Name:DtP
Date repare
d:.
.se
17
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-A.LT-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 CFI1?-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-01'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:_
J L
02.
Date Prepared:
Lz,7117.03
Project Location:
[ �jsS '
04
Building Front Orientation (deg or cardinal):
05
CA City:7
C ,42v S—�� '
06
Number -of Altered Dwelling Units:
j
07
Zip Code:
vL S 3
08
Fuel Type:
09
Climate Zone:
5�
10
Total Conditioned Floor Area (ft):
2'_(1
11
Building Type:'
7.
12
Slab Area (ft 2)
?j
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
.STATE OF CALIFORNIA'
CEC-CF1 R -AT -05-E (Revised 04/16) CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CFIR-ALT-05-E
Prescriptive Residential Alteratiops That Do Not Require HERS Field Verification- Page 2 of 3 —
Project Name: tj Vt. / �/L--' Date Prepared: -L-1 -7
.H. Water Heating Systems (Section 150.2(b) IG)
01
02.
03
04.
05
06
07
08
09
10
11
12
13
14
15
# 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
eater Type
System
Volume (gal)
Type
Input Type
Value
Type
Value
Loss (%)
R -Value
Fraction
ie__
ol h/,L
HOA
I t 60,
CA Building Energy Efficiency Standards - 2016 Residential Compliance
April 2016
STATE OF CALIFORNIA
Prescriptive Residential Alterations That Do Not Require HERS Field Verification
CEC-CFIR-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 3 of 3
Project Name: 1 /r // G Date Prepared:
I/,,, Z� �T
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT
1. 1 certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name:
ryio
Documentation Author -SI nature
Com any:
Signature'Date:
Address:
70 $'� v- 4 erl A/
CE HERS Certification Identification (it applicable):
City/State/Zip:
lone: 210) 2
ESPONSIBLE 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 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 Desitner Name:
Responsible Designer Signature:
Company:
% t %
Date Signed:
Address:
License:
City/State/Zip:
Phone:
C - e -4/-11-C. C �229-L
r
J
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