BPLB2019-000878-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Permit Type/Subtype:
Application Number:
Property Address:
APN:
Application Description:
Property Zoning:
Application Valuation:
PLUMBING/
BPLB2019-0008
c&ty/ 4lwQa4t*)
DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
51940 AVENIDA VELASCO
773174010
MILLER / 50GALLON WATER HEATER CHANGE OUT
$900.00
Applicant:
STATEWIDE SERVICES INC DBA STATE WIDE PL
73-700 DINAH SHORE DRIVE
SUITE 405
PALM DESERT, CA 92211
I R
� 7
JEAN 4 9 2019
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.
License ClassQC336 C33, C10, A License No. 6147
Date:'� I �1 Contractor: _ `—' 9
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 Name:
Lender's
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/9/2019
Owner:
SUMMER MILLER
51940 AVENIDA VELASCO
LA QUINTA, CA 92253
Contractor:
STATEWIDE SERVICES INC DBA STATE WIDE PL
73-700 DINAH SHORE DRIVE
SUITE 405
PALM DESERT, CA 92211
(760)699-5434
Llc. No.: 936147
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
oft or which this permit is issued.
I ave and wlll maintain workers' compensation insurance, as required by
Sec on "MOO 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: EN MARK INS RAN E COMPANY Policy Number: CST5012063
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 hould become subject to the
workers' compensation provisions of Section 37 o the Labor Code, I shall forthwith
comply with those provisions.
Date: L :7 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 upon the
above -mentioned property for inspection purposes.
Date: r Signature (Applicant or Agent): L
Date: 1/9/2019
Application Number:
BPLB2019-0008
Property Address:
51940 AVENIDA VELASCO
APN:
773174010
Application Description:
MILLER / 50GALLON WATER HEATER CHANGE OUT
Property Zoning:
Application Valuation:
$900.00
Applicant:
STATEWIDE SERVICES INC DBA STATE WIDE PL
73-700 DINAH SHORE DRIVE
SUITE 405
PALM DESERT, CA 92211
Owner:
SUMMER MILLER
51940 AVENIDA VELASCO
LA QUINTA, CA 92253
Contractor:
STATEWIDE SERVICES INC DBA STATE WIDE PL
73-700 DINAH SHORE DRIVE
SUITE 405
PALM DESERT, CA 92211
(760)699-5434
Llc. No.: 936147
Detail: 50GALLON WATER HEATER CHANGE OUT [GAS] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2016 CALIFORNIA
BUILDING CODES.
DESCRIPTION I ACCOUNT I QTY I 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
I 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
CITY
AMOUNT
RECORDS MANAGEMENT FEE
101-0000-42416
0
$10.00
I Total Paid for RECORDS MANAGEMENT FEE: $10.00
I DESCRIPTION I ACCOUNT I QTY I AMOUNT I
TECHNOLOGY ENHANCEMENT FEE I 502-0000-43611 I 0 I $5.00 I
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
Bin
Permit u
P�32D1� ✓
Project Addr=cAcAU6L
arty of La Qu«ita
Building 8t Safety Division
. - 78-495 Calle Tampico
j(]i La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
9 Owner's Name: u yr vy a V 1 Yq t {J
A. P. Number:
Address P4'L
Legal Description:
City, ST, Zip:
Contractor: S
+
Telephone
Address: —13-7b L)
•Fl
Project Description:
I
City` ST, Zip
Telephone: ii �
� i ° ` .....e
State Lic. # . Cilbiq7lCity Lic. #.:
Arch., ) ngr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Naive of Contact Person:
�4 i ,
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: r I
Estimated Value of Project: 94)
APPLICANT: DO NOT WRITE BELOW THIS LINE
dl Submittal
Req'd Rcc'd
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 Clieck Balance,
Tit!e 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2"a Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Gran( Deed
Plans picked up
S.M.I.
I-I.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'rd 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
CEC-CF1 -ALT-01-E (Revised 03/2017-AOR)
CERTIFICATE OF COMPLIANCE
Prescriptive Residential Alterations for Water Heater
A. GENERAL INFORMATION
Site address:
City, Zip Code: LA QUINTA, CA
La at..,,m4
CALIFORNIA ENERGY COMMISSION
CFIR-ALT-01-E WATER HEATER
(Page 1 of 2)
Building Type: ❑ Single Family Dwelling
❑ Multi Family Dwellings
Clirna% Zone: 15
G. WATER HEATING SYSTEMS Section 450,2 b 1
01
Water
02
Water
03
Water
04
# of
OS - - 06
Water Fuel
07
08
09
10
11 12 13
g4
is
Heating
System
Heating
System
Heater
Water
Heater type
Rated
Input
Rated
Input
Heating
Efficiency
Heath
Efficlen'py
Standby Exterior
Loss
Back -Up
Central
Dwelling
Identifigation
Type
T ype
Heaters
Storage
Type
Value
Type
Value
(%) Insul.
Solar
Solar
DHW System
Unit DHW
in
Volume
Savings
Distributign
System
or
Name
system
(gal)
Fraction
Type
Distribution
-
Type
yy 66
WATER HEATING SYSTEMS -
Water heating compliance for a'n alteration Is described In Section 150,2(b)1G. For single dwelling a gas of propane Water heater, with a storage tank of r.Q gallons maximum
or instaptaneous (tankless) can be'used. Dwelling Unit dlstrlbution systems are limited to Standard trunk and branch or demand recirculation for gas or propane water
heater. pemand 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. Multl-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 CF1R-NCB-01 to document the water heater alteration.
instructfo s far sections with c lumn numbers are ive below:
I. 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 S'Mall Instantaneous are allowed. For central systems pick from Large Storage, Small Storage,
Heat Pump, Boiler, Large Instantaneous, Small Instantaneous or Indhrect.
MR-ALT-01-E
CERTIFICATE OF COMPLIANCE
prPscriotive Residential Alterations for Water Heater
\NArER HEATER
page 2of2
' le-famil and multi -family with water heaters in each dwelling units the value is 1. For multi-famlly central systems
q, Number of water heaters in system: In sing. Y ailons or less. If instantaneous, enter n/a. For
serving multiple dwelling units enter the total number of water heaters. unit this will be 60 g
5, Water he
ater volume (gal): tank capacity In gallons. For individual water heaters for a dwelling
multi -family central systems enter the total storage volume.
5, Fuel Type: Gas, Propane, Electric (Only if natural gas Is not availdle)
ui ment input rating type, for gas or propane fired units W.
are i3#uh, for electric fired system the units are k
7. Rated Input Type: Enterthe eq p
From product literature or a California Energy Commission directory.
g, Rated Input Value: Enter the numeric value of rated input,
g, Heating Efficiency Type: Energy Factor, AFUE, or Thermal Efficiency.
Value: Enter the value from product literature or a California Energy Corflmisslon directory
1p. Heating Efficiency Enter n/a for small storage or instantaneous water heaters.
1l. Standby Loss (percent): Applies only to large storage water heaters,
agetanki 0,30). External calculations are required.
12. Exterior Insulation It -Value: Enter the R•value If exteriorbinsulationcku solar system, On the l Indicate the SOlarecontributlon (e'gec'irculation system with at least two distribution
13. Back-up solar savings fraction: If compllattce requires a pstem is non central or project is individual units enter n/a.
al
on
tem
1A. Central DHW Distribution System: For multl-famlly buildings with uslnelaht orrmorre urnits.lif the ssy t a demand re errand Recirculation —Manual
loops must be installed. This requirement applies to any building with g this must be Standard, no recirculation system shall be installed.
15, Dwelling Unit DHW
Distribution Type: For a Central DHW this field shall be Standaerd. If non -central then pick from Standard,
Control, Demand Raclrculation —Sensor Control. Ifnon-central electric water heater
pD =T;-_NTATiDN AUTHOR DECLARATION STATEMENT
that this Certificate of Compliance docurnar�tation is accurate and tam lets. G
I certify ontraCtar Signature: [yam
wner 9 Authorized agent r
Name: j Contractor license #:
Phone: ��
ConmdnY : i
Address: C;1 U �' i c�G� �� Date'
City/statel2ip: ,.. L 1'YV
'tions regarding the Energy Starndards, contact the Energy Hotline at:1-g00-77_2-3300.
For assistance or clues