BPLB2019-000578-495 CALLE TAMPICO 4 4v
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Permit Type/Subtype: PLUMBING/
Application Number: BPLB2019-0005
Property Address: 50120 INDIAN CAMP RD RD
APN: 776011028
Application Description: MCKENDRICK / 50GAL WATER HEATER
Property Zoning:
Application Valuation: $1,500.00 i
/A Applicant: -�- I
NANCE MCKENDRICK �]
50120 INDIAN CAMP RD JAB! D 7 2019
LA QUINTA, CA 92253 I j
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
MARTIN MCKENDRICK
50120 INDIAN CAMP RD
LA QUINTA, CA 92253
Contractor:
OWNER BUILDER
�►�+ 1011YORAv[{ifP,.
Llc. No.:
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9
{commencing with Section 70001 of Division 3 of the Business and Professions Code, and
my License is in full force and effect.
LicenseClass:_ LicenseNo.:_
Date
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 signe
state
men hat he or she is licensed pursuant to the provisions of the Contractor's $ta e
License w (Chapter 9 (commencing with Section 7000) of Division 3 of the Business
itSc.
essions Code) or that he or she is exempt therefrom and the basis for the
xemption. Any violation of Section 7031.5 by any applicant for a permit'the applicant to a civil penalty of not more than five hundred dollars ($500�s owner of the property, or my employees with wages as their sole 40
dtion, will do the work, and the structure is not intended or offered for sale.
4, 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
lhimselfop.Wself through his or her own employees, provided that the improvements
are not i hded or offered for sale. If, however, the building or improvement is sold
withi year of completion, the owner -builder will have the burden of proving that he
or not build or improve for the purpose of sale.).
( s owner of the property, am exclusively contracting with licensed contractors to
uct the project. (Sec. 7044, Business a '�rafessions Code: The Contractors' State
License Law does not apply to an owner d roperty who builds or improves thereon,
and who contracts for the projectZIB
contractor(s) licensed pursuant to the
Contractors' State Li� nse Law.). ,
(_) I amAempt v(ider Sec.P.C. for thig re?son
Lender's Na
Date: 1/7/2019
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
have and will maintain a certificate of consent to self -insure for workers'
compensation, Kncd
vided for by Section 3700 of the Labor Code, for the performance
of the work for this permit is issued.
_ I will maintain workers' compensationn to an[e, as required by
Section 37 f e Labor Code, for the performance -tl5e work for which this permit is
issued, ers' compensation insurance card and policy number are:
Carrie Policy Number:_
1] ertify that in the performZI
ork for which thi permit is issued, I
s ploy any person in any mecvm 'suhje o the w rkersam a tion laws of California, andshou cv subje to thek��ompensayion provisions off tF ode, I i _(1 fort) th
WARN
AND 9HAGL UBJRCT AN EMUPLOYER TOECRIMIONA�T)IALTO SAND CIVIL FINES UE IS �P O
ONE HUNDRED THOUSAND DOLLARS ($100,000). IN AD TiON TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR IN SE. ON 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 behalfthis 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 inta, its officers, agents, and
employees for any act or omission related to work being performed under or
folidwing issuance of this permit.
2. Any permit issued as a result of this pIication becomes null and void if work is not
commenced within 180 days from dot f issuance of such permit, or cessation of work
for 180 days will subject permit to go Ilation.
CON5TRUCTION� G AGENCY l I certify that I hav read this a tlon and state that e a inform n is
rm and p alty of perjury th is a construction lending agency for I agreZto nn'd
with all eit countydrdinances n sta laws re ingonce the work for which thispe It is issued (Sec. 3097, Civ. C.), Consthereby a t rizg representat", tyto. upo�mandrty for i t' our
1
Lender's Address:
Application Number:
Property Address:
APN:
Application Description
Property Zoning:
Application Valuation:
Applicant:
NANCE MCKENDRICK
50120 INDIAN CAMP RD
LA QUINTA, CA 92253
BPLB2019-0005
50120 INDIAN CAMP RD RD
776011028
MCKENDRICK / 50GAL WATER HEATER
$1,500.00
Owner:
MARTIN MCKENDRICK
50120 INDIAN CAMP RD
LA QUINTA, CA 92253
Contractor:
OWNER BUILDER
Llc. No.:
Date: 1/7/2019
Detail: 50GALLON WATER HEATER CHANGE OUT [GAS] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2016 CALIFORNIA
BUILDING CODES.
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
•
Ar
PLAN LOCATION:
Project Address:
FA
14 M-A
Projec scription;/Po/ol,/Remodel, Add't Elect, Plumb, Mech
APN
�-�
7wag Er"r I FA
.��
� AIINAM
oo..
Contractor Name: /I�I
(wSFD Construction:
Address:
Camd`itio Space SF
City, St, Zip
Garage SF
Telephone:
Patio/Porch SF
Email:
Fire Sprinklers SF
State Lie: City Bus Lie:
Arch/Eng Name: Construction Type: Occupancy:
Address: Grading:
City, St, Zip I
Telephone: Bedrooms: I Stories: �Un :
Email:
State Lie: City Bus Lie:
Property Owner's Nam iNew Commercial / Tenant Improvements:
Address: 1 Building SF
City, ST, Zip Construction Type: Occupancy:
Telephone:
Email:
78495 CALLE TAMPICO
LA QUINTA, CA 92253
760-777-7000
P.O. Box 1504
LA QUINTA, CALIFORNIA 92247-1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
PROPERTY OWNER'S PACKAGE
(760) 777-7012
FAX (760) 777-7011
Disclosures & Forms for Owner -Builders Applying for Construction Permits
IMPORTANT! NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application for a build 't has b submitted ' y r name H nng o self as the +r of O rop j
improvements specified at / YWr erWe are providing you with caner- wild r ❑wledg e t and nfo lion a o to
responsibilities and poi ' e risk you may i by having ' pe t is in your name th
Owner -Builder. W ill not issue a b 'ding permit unti you v read, initialed your understanding of each provision,
signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice
unless you, the property owner, obtain the prior approval of the permitting authority.
'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
NS: Read and initial each statement below to signify you understand or verify this information.
KOunderstand a tzequ"' practice of unlicensed persons is to have the property owner obtain an "Owner -Builder"
er-B
ermitthat erraneousiyimplies that the property owner is providing his or her own labor and material personally. 1, as
uilder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person
and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those
injures am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers
on n(,{wberty.
understand building permits are not required to be signed by property owners unless they are responsible for the
n and are not hiring a licensed Contractor to assume this responsibility.
erstand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect
potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my
lerstand Contractors are required by law to be licensed and bonded in California and to list their license numbers on
contracts.
derstand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value
truction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer"
and federal law.
ZI understand if I am considered an "employer" under state and federal law, I must register with the state and federal
e , withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment
compen lion for each "employee." I also understand my failure to abide by these laws may subject me to serious financial
risk. /►
understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential
IbcoftPractors.
s cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed
and the number of structures does not exceed four within any calendar year, or all of the work is performed
under contract with a licensed general building Contractor.
0
understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any
,or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the
shin or materials.
I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue
the United States Small Business Administration, the California Department of Benefit Payments, and the California
yoy Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-
SLB (2752) or www.cslb.ca.gov for more information about licensed contractors.
I am aware of and consent to an Owner -Builder building permit
egally and Anclalylyn" resFpn93A ForCOE
I agree that, the party tegX -and tmarfiany r onstuie i4ruus propu.,
( laws an requirements that govern Owner rlders as well as employers.
in m me, and understan hat I am the
ac • ty at the foI w'
,d donstructYin actir+ity, I will a ide by all
A agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I
vided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with
s�omjcne who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss
you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also
important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working
on your property, you may be held liable for dVmgs. If you obtain a permit as Owner -Builder and wish to hire Contractors,
you will be responsible for verifying whethe or not those Contractors are properly licensed and the status of their workers'
compensation insurance coverage.
Before a building permit can be iss , this form
the agency responsible for issuln a permit. No
other verification acceptable to a agency is rey
owner's signature. n ,
,Signature of property
and signed by the property owner and returned to
peip owner's driver's licen e. for notarization, or
'dvj
the permit is iss ed torify the property
Note: The following Authorization Form is required to be completed by the property owner only when designating
an agent of the property owner to apply for a construction permit for the Owner -Builder.
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize
the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner -Builder
Permit for my project.
Scope of Construction Project (or Description of Work):
Project Location or Address:
Name of Authorized Agent:
Address of Authorized Agent:
Tel No
I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above
information and certify its accuracy. Note: A copy of the owner's driver's license, form notarization, or other verification
acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature.
Property Owner's Signature: Date:
STATE OF CALIFORNIA
Prescriptive Residential Alterations That Do Not Require HERS Field Verification
{ r
C@C-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 Pagel of 3
Project Name: Date Prepared:
I his 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 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:
'
02
Date Prepared.
03
Project Location:
1
'1
04
Building Front Orientation (deg or cardinal):
ry
�
05
CA City:
v
/ �v
06
Number of Altered Dwelling Units:
07
Zip Code:
' -1, L1_ -
08
Fuel Type:
09
Climate Zone:
10
Total Conditioned Floor Area
11
Building Type:
/
12
Slab Area (ft)
13
Project Scope (S a all t a ply]:
❑ 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
IF, 771 -
CEC-CF1 R-ALT-05-E (Revised 04/18; GAL IFOR NIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CF1R-ALT-05-E
Prescriptive Residential Alterations That Do Not Require HERS Field Verification Page 2 of 3
Project Name: Date Prepared:
H. Water Heating Systems (Section 150.2(b)1G)
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 I System Type
Heater Type
System
Volume (gal)
Type
Input Type
Value
Type
Value
Loss (%)
R-Value
Fraction
I
� 15-kf
Ca�S
S 0
511)A
Or
Add Row
Delete Row
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)
CERTIFICATE OF COMPLIANCE
Prescriptive Res
s That Do Not Require HERS Field
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT
1. 1 gertify that this Certificate of Cgirrinlianep rinrumRnt.
is accurate and complete.
MMISSION
0
CF1R-ALT-05-E
Page 3 of 3
r
I certify the following und9rr penalty of perju er the laws of the State of California:
I. 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 f Fes and performance specifications, materials, components, and manufactured devices fort building design or system design identified on this Certificate of
Compliance c orm to the requirements of Title 24, Part 1 and Part 6 of the California Code of Regulations.
4. /Thebuildinesign features or system design features identified on this Certificate of Compliance are consist t with the information provided on other applicable compliance documents,
lculations, plans and spe ifications submitted to the enforcement agency for approval with t s building permit application.5. at a registered c y of is Certlfi to of Com nce shall be made available with the buii g permit(s) issued for e 1 ng, an made available to the enforcement agency
le inspections tand tha a register opyof this Certificate of Compliance is re rred to be included w omen tion t#��uifder provides to the budding
pancy.
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