BPLB2018-015578-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Permit Type/Subtype:
Application Number:
Property Address:
APN:
Application Description
Property Zoning:
Application Valuation:
Applicant:
CAMPESINOS UNIDOS INC
P0BOX 39
BRAWLEY, CA 92227
PLUMBING/
BPLB2018-0155
T-iht 4 4� Qum&
DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
78955 BAYBERRY LN
604304003
SCHRAGER / 50GALLON WATER HEATER CHANGE OUT
$1,000.00
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
JOVIE SCHRAGER
78955 BAYBERRY LANE
LA QUINTA, CA 92253
Contractor:
D CAMPESINOS UNIDOS INC
DEC 11 2018 P 0 BOX 39 DBRAWLEY, CA 92227
CITY OF LA QUINTA (760)344-4500
DESIGN & DEVELOPMENT DEPARTMENT Llc. No.: 618140
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: B. C36 License No.: M 4
Date: „/rl �tContractor: ~
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.).
(_) 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 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 Na
Lender's
Date: 12/11/2018
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 - a work for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by
Se on 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: Policy
Number: MIC201800012896 _
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.
Dat Aoplicant:
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
MPORTANT: Application is hereby made to the Building Official for a permit subject to
;he conditions and restrictions set forth on this application.
1. Each person upon whose behalfthis application is made, each person at whose
-equest and for whose benefit work is performed under or pursuant to any permit issued
is a result of this application, the owner, and the applicant, each agrees to, and shall
Jefend, indemnify and hold harmless the City of La Quinta, its officers, agents, and
amployees for any act or omission related to the work being performed under or
ollowing issuance of this permit.
2. Any permit issued as a result of this application becomes null and void if work is not
:ommenced within 180 days from date of issuance of such permit, or cessation of work
or 180 days will subject permit to cancellation.
certify that I have read this application and state that the above information is correct.
agree to comply with all city and county ordinances and state laws relating to building
:onstruction, and hereby authorize representatives of this city to enter upon the above-
nentioned property for inspection purposes.
z
)r�� a e' Signature(Applicantor-
Date: 12/11/2018
Application Number:
Property Address:
APN:
Application Description
Property Zoning:
Application Valuation:
Applicant:
CAMPESINOS UNIDOS INC
P 0 BOX 39
BRAWLEY, CA 92227
BPLB2018-0155
78955 BAYBERRY LN
604304003
SCHRAGER / 50GALLON WATER HEATER CHANGE OUT
$1,000.00
Owner:
JOVIE SCHRAGER
78955 BAYBERRY LANE
LA QUINTA, CA 92253
Contractor:
CAMPESINOS UNIDOS INC
P0BOX 39
BRAWLEY, CA 92227
(760)344-4500
Llc. No.: 618140
Detail: 50GALLON 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 0 $1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PERMIT ISSUANCE
101-0000-42404
0
$101.40
Total Paid for PERMIT ISSUANCE: $101.40
DESCRIPTION
ACCOUNT
QTY
AMOUNT
WATER HEATER/VENT
101-0000-42401
0
$13.34
DESCRIPTION
ACCOUNT
QTY
AMOUNT
WATER HEATER/VENT PC
101-0000-42600
0
$8.00
Total Paid for PLUMBING FEES: $21.34
DESCRIPTION
ACCOUNT
QTY
AMOUNT
RECORDS MANAGEMENT FEE
101-0000-42416
0
$10.00
Total Paid for RECORDS MANAGEMENT FEE: $10.00
DESCRIPTION ACCOUNT QTY AMOUNT
TECHNOLOGY ENHANCEMENT FEE 502-0000-43611 0 $5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
=Ca W
PERMIT# OL ZC�($ CIS
Project Address: -70C S -9AY73E" Y Lt,)
APN #:
rf
Applicant Name: v ��
Address: ? t t' S
City, ST, Zip:/— A Q C K> q 22 _S'3
Telepho
Email:
Property Owner's Name:
Address: 7t QIS S �jq �r.r L1,J
City, ST, Zip L J1 v"�aN 2-3
Telephoned _��•�
Email:
PLAN LOCATION:
Project Description: Pool, Remodel, Add't, Elect, Plumb, Mech
C aihc 0CJ�� �C�0jr
Valuation of Project $ / 0 Do a'
New Commercial / Tenant Improvements:
Total Building SF
Construction Type: Occupancy:
78495 CALLE TAMPICO
LA QUINTA, CA 92253
760-777-7000
STATE OF CALIFORNIA
Prescriptive Residential Alterations That Do Not Require HERS Field Verification
CEC-CF1 R-ALT-05-E {Revised 04/16
CERTIFICATE OF COMPLIANCE
Prescriptive Residential Alterations That Do Not Require HERS Field Verification
Praj"T"ame: -
D V
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT
I. I certify that this Certificate of Compliance do umentation is accurate and complete.
Documentation Authot Name: SZ Documentation Author Signature:
Company: Signature Date:
12
Address: --3I CEAJ HERS Certiflsatlon Identification (If applicable):
IA ENERGY CO
iS1ON
R-ALT-05-E
Page 3 of 3
RESPONSIBLE PERSON'S DECLARATION STATEMENT y
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 Designer Name: — 1 Responsipte Designer Sign t
Wmpany
Corn �S' rl o �V1' C� oS
V- 0,
trp
(ai'b ` z z-�7
Date Signed
License: 4 C � — l O
�9Q-
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
STATE OF CALIFORNIA ,
Prescriptive Residential Alterations That Do Not Require HERS Field Verification
CEC-CFIR-ALT-05-E Renisea 04/16)
CERTIFICATE OF COMPLIANCE -
Prescriptive Re idential Alterations That Do Not Require HERS Field Verification
Project Name: V
NIA ENERGY
CFIR-ALT-05-E
This compliance document is only applicable to simple alterations that do not require HERS verif catian for compliance. When HERS verification is required, a CFIR-ALT- 01 shall first be
with a HERS Provider Data Registry.
Page 1 of 3
Alterations to Space Conditioning Systems that are exempt from HERS verification requirements may use the CF1R-ALT-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 CFIR-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 CF1R-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:
- V c' "N- r��
�Y
02
Date Prepared:
T
03
Project Location:
�, SS %!� Q�
04 Building Front Orientation (deg or cardinal):
05
CA City:✓�
C�
06 Number of Altered Dwelling Units:
/
07
Zip Code:
�
08 Fuel Type:
A�
09
Climate Zone:
10 Total Conditioned Floor Area
11
Building Type:
S'�, l�
I 12 Slab Area (ft)
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
Prescriptive Residential Alterations That Do Not Require HERS Field Verification
:EC-CF1 R-ALT-05-E (Revised 04/16) _
CERTIFICATE OF COMPLIANCE
Prescriptive Residential Alterations That Do Not Require HERS Field Verification
H. Water Heating Systems (Section 150.2(b)1G)
01 02 1 03 1 04 05
Water
Water
Heating
Heating System
Dwelling System
Location or
Water Heating
Water
Unit Name
Por Name
Area Served
System Type
Heater Type
,e I I,(n
�r 1
Gh.S/A)G�
Add Row I DFlete Row
MMISSIONO
CF 1 R-ALT-05-E
Page 2 of 3
- 1 4 -/
06 07
08
09
10
11
12
13
14
15
# of
Water
Water
Back -Up
Heaters
Heater
Rated
Heating
Heating
Exterior
Solar
in
Storage
Fuel
Rated
Input
Efficiency
Efficiency
Standby
Insulation
Savings
System
Volume (gal)
Type
Input Type
Value
Type
Value
Loss (%)
R-Value
Fraction
i
°% )
(�) As
P � ,-) a Z>
—1) . 6.7
—I,G
CA Building Energy Efficiency Standards - 2016 Residential Compliance April 2016