BPLB2019-005578-495 CALLE TAMPICO C� 0 U 4�L1iA.)
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Permit Type/Subtype:
PLUMBING/
Application Number:
BPLB2019-0055
Property Address:
78540 VIA SONATA
APN:
646290013
Application Description:
PALMISANO /WATER HEATER CHANGEOUT
Property Zoning:
Application Valuation:
$900.00
Applicant: n
STATEWIDE SERVICES INC DBA STATE WIDE PL D
73700 DINAH SHORE STE 405
SUITE 405 APIA 0 9 2019
PALM DESERT, CA 92211
CITY OF LA QUINTA
DESIGN & DEVELOPMENT DEPARTMENT
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 Class: C36, C33, C10, A, B _ License Np ; 936147
Ll-- 0 i-1 cont
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 DlvisjD
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: 4/9/2019
Owner:
RICHARD PALMISANO
92253
Contractor:
STATEWIDE SERVICES INC DBA STATE WIDE PL
73700 DINAH SHORE STE 405
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
of the ork for which this permit is issued.
v 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: BENCHMARK INSURANCE COMPANY Policy Number: CST5015156
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 gf the Labor Code, I shall forthwith
comply with those provisions. !I
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-
Sigpplicant or Age 117'
Application Number:
BPLB2019-0055
Property Address:
78540 VIA SONATA
APN:
646290013
Application Description.
PALMISANO / WATER HEATER CHANGEOUT
Property Zoning:
Application Valuation:
$900.00
Applicant:
STATEWIDE SERVICES INC
DBA STATE WIDE PL
73700 DINAH SHORE STE 405
SUITE 405
PALM DESERT, CA 92211
Data? 4/9/,2019
Owner:
RICHARD PALMISANO
92253
Contractor:
STATEWIDE SERVICES INC DBA STATE WIDE PL
73700 DINAH SHORE STE 405
SUITE 405
PALM DESERT, CA 92211
(760)699-5434
Llc. No.: 936147
Detail: 50 GALLON 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
Bin #
Perr * #
A fizp%5- GtoSS
Project Address:
A. P. Number.
City. ST, Zip:
Telephone: Q i
Arch., Eng., Designer:
Address:
City, ST, Zip:
Telephone:
Statc Lie. it:
Name ofContnct Person: F
Telephone # of Contact Personr-It'd
# Submittal
Plan Sets
Structural C61cs.
Truss Cales.
Title.24 Calc.
Flood plain plan
Grading plan
SubcodNctor Lith
Grant Decd
iLO.A.Approval
IN HOUSE: -
Planning Approval
Pub. Wks. Appr
sebaall'eea
PC
City Of La QUlnia
Building ez Safety Division
P.O. Box 1504, 78-4.95 Cage i'amplco,
La Quinta; CA 92253.(760) 777-7012
Building permit Application and Tracking
MAddrownws'ld me:
City, ST, Zip:
mess-.
Talephmo!�Project Description:
Lie. M
t
Construction Type:
Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
R Sq. Ft: # Stories: # Units:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
Reed 'TRACIMG
PERMIT REFS
Item Amondt
Revicwtd=rcady for corrcctlons
Plan.CGeelcDepasit
Called Contact Person
Plan Check Balance.
Plaus picked up
Cons -traction
Plans resubmitted
Mechanical
21. Review, ready for correciionslissue
Electrical
CQk4 Contact Person
Plumbing
Plans picked up
S.M:I.
Plans resubmitted
Grading,
Review, ready for correctionslissue
Developer impact Fee
Called Contact Person
A.LP.P.
Date of permit issue
Total Permit Fees
STATE OF CALIFORNIA
RESIDENTIAL ALTERATIONS — WATER HEATER
CEC-CF1 R-Al,T-01-E (Revised 03/2017- AOR)
CERTIFICATE OF COMPLIANCE
Prescriptive Residential Alterations for Water H
A. GENERAL INFORMATION
Site address:
City, zip Code: LA QUINTA, CA
G. WATER HEATING SYSTEMS (Section 1
01 0203
07
04
05
Water Water
Water
# of
Water
Heating Heating
Heater
Water
Heater
System System
Type
Heaters
Storage
Identifigotion Type
I ValLve Type
in
Volume
or
system
(gal)
Nance
Building Type:
Climate Zone:
06
07
08 09
10
Dwelling
Unit DHW
Fuel
f Rated
Rated HeatingI
HeatlFrg
51
Type
l Input
Input Efficiency
Efflclericy
I
Li
Type
I ValLve Type
Value
La at,,, m4
RAI IF()A1111e or.ican_v n
CFIR-ALT-01-E
❑ Single Family Dwelling
13Multi Family Dwellings
3.5
WATER HEATER
(Page 1 of 2)
11 12 13 14 15
andby
Iss K
Exterior 1 Back -Up
Insul. Solar
Central
DHW System
Dwelling
Unit DHW
R -Value Savings
Distributipn
System
Fraction
Type
Distribution
Type
f
WATER HEATING SYSTEMS
Water heating compliance for an alteration is described In Sectlon 150.2(b)1G. For single dwelling a gas or propane water heater, with a storage tank of 6.0 gallons maximum
or instantaneous (tankless) can be'used. Dwelling Unit distribution systems are ilimited to Standard trunk and branch or demand recirculation for gas or propane water
heater. Demand recirculation isnot 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 spedflcally for alterations, use form CF1R-NCB-01 to document the water heater alteration.
Instructions for sections with column numbers are iven 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 tate water heater will provide both space conditioning and domestic hot water,
3. Water heater type: For non -central systems only Small Storage or SImall Instantaneous are allowed. For central systems pick from Large Storage, Small Storage,
Heat Pump, Boiler, Large Instantaneous, Small Instantaneous or Indlrrect,
CERTIFICATE OF COMPLIANCE CF1R-ALT-41-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.
8, Rated Input Value: Enter the numeric value of rated input.
9. Heating Efficiency Type: Energy Factor, AFLIE, or Thermal Efficiency. From product literature or a California Energy Commission directory.
10. Heating Efficiency Value: Enter the value from product literature or a California Energy CoMmisslon directory
11. Standby Loss (percent): Applies only to large storage water heaters, Enter n/a for small stofage 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., 030). External calculations are required.
14. Central DHW Distribution System: For mWItl-famlly 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.
1.5. 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 most be Standard, no recirculation system shall be installed.
DOCMENTATION AUTHOR'S DECLARATION STATEf,IIENT
• I certify that this Certificate of Compliance documentation is accurate and, complete.
Nam loaOL ❑Owner r uthoriiecl agent z<ontractor
1111
Slpt tune:
Company )tCJ
Cgptractor license #: to PY
Address:
Phone: L �Le
city/state/zipo`
Dote:
For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-77,2.3300.