09-1263 (PLBG)P.O. BOX 1504.
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: ��09—O'00! 6.3
Property Address: 0154-229 OAK HILL
APN: 775 -0,61 -014 -
Application description: PLUMBING
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 895
Tiilf 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Applicant: Architect or Engineer:
cam-
------------------
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 Professionals Code, and my License is in full force and effect.
License Class:.ii C3,6 : License No.: 935651
Date-J,24I-o ontractor:-
D 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 Coder Any city or county that requires,apermit to
.construct, alter, improve, demolish, or. repair'any,struaur :Orior 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),pf Division 3 of`the Business and Professions Code) or
I
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 structurelis not intended or. -offered for sale (Sec. 7044] Business and Professions Code: The .
Contractors' State License Law does not appl'y�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'riot 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 dill not build or
improvefor 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 cbntracts-for the projects with a contractors) licensed -
pursuant to the Contractors' State License Law:).
(_ 1 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 Address:
LQPERMIT
Owner:
ROY MARVYN
54-229 OAK HILL
LA QUINTA, CA 92253
Contractor:
A+ MECHANICAL PLUMBING
8.1-370 PALUDOSA DRIVE
INDIO, -CA 92201
(760)42,3-7237
LiC. No.:'935651
WORKER'S COMPENSAT10. uc�wnH uun
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 performanc6of the work for which this permit is
issued.
_ I have and willmaintain 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 EXEMPTPolicy Number EXEMPT
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,workeirs' compensation provisions of Section
3700 of the Labor
/Code, I shall forthwithccomply,with those provisions.
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 15100;0001. IN -ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 12/11/09
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is. hereby made to the Director of Building and Safety 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 thiscounty to enter upon the above-mentioned property for inspection purposes.
Dat- Signature -77 genu:
Application Number . . . . 09-00001263
Permit . . . . . . PLUMBING
Additional desc .
Permit Fee . . . . 22.50 Plan Check Fee 5.63
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 6/09/10
Qty Unit Charge Per Extension
BASE FEE 15.00
1.00 7.5000 EA PLB WATER HEATER/VENT 7.50
----------------------------------------------------------------=-----------
Special Notes and Comments
WATER HEATER CHANGE OUT 50 GALLON TANK
-----------------------------------------------------------------------------
Other Fees . . . . . . . .. . BLDG STDS ADMIN (SB1473) 1.00
Fee summary Charged
Permit Fee Total 22.50
Plan Check Total 5.63
Other Fee Total 1.00
Grand Total. 29.13
LQPERMIT
Paid Credited Due
.00 .00 22.50
.00 '.00 5.63
.00 .00 1.00
.00 .00 29.13
CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page'4 of 4) CF -1R
Project Title Date
Indicate which special features are part of this project. The'lisf below only represents special features relevant to the
nrescrintive methM
�!
Feature
Re uired-Forms(if applicable)
Descri tion
❑
Metal Framed Walls
CF -1R
Refrigerant Charge'
❑
Radiant Barriers
CF -.1R
CF=611'0ait 6of 12
❑
Exterior Shades
WS -4R.
❑
Cool Roof
N/A; Attach CRRC Label to
Forms.
❑
Dedicated Hydronic Heating
Performance Calculation
System
R uired•:Attach Run to Forms.
❑
Combined Hydronic System
Performance Calculation
R uired;.Attach Run to Forms.
❑
Gas Cooling
Performance Calculation
Rwired.
O
Buried Ducts
N/A-Jndieate _on buildiniz plans.
❑
Kitchen Pipe Insulation
See on,5;6.2 Distribution
'stems'
in Residential Manual.
❑
Multiple Water Heaters Per
. See Table 5-13' or use
Dwelling Unit
Performance Calculation and
attach, Rum to.Forms.
❑
Central Water Heating System
Performance Calculation and
Serving Multiple Dwellin s
attach Run to Forms.
❑
Non-NAECA Large Water
Heater
CF -1 R
See Table 5-13 or use
❑
Indirect Water Heater
Performance Calculation and
attach Run -to Forms
See Table 5-13 or use
❑
Instantaneous Gas Water Heater
Performance Calculation and
attach Run•to'Forms
See Table 5-13 of use
❑
Solar Water Heating System
Performance Calculation and
attach Run to Forms
❑
Wood Stove Boiler
PerformanceCalculation and
attach Run to Forms
(add extra sheets if necessary) Indicate to the•HERS Rater which credits are part of this project and need
verification.
✓
Feature
Forms if a licable • Descri tion
❑
--.Required
Duct Sealing
CF -6R art 4'of. 12
❑
Refrigerant Charge'
CF=611': "art 5 of112
❑
Thermostatic Expansion Valve
CF=611'0ait 6of 12
Residential Compliance Forms March 2005
0
Up,
CERTIFICATE OF COMPI
SEALED -DUCTS and TXVs (or Alterna
A signed CF -4R Form must be'provided'to the built
reauirert-
�: RESIDENTIAL (Page 3 of 4) CF -1R
Date
for each home for which the following. are
Alternative to Sealed Ducts and Refrigerant Charge lTXVs: See Package ❑ Project Climate Zone in the RM Appendix B Table 151 C, Footnoel4.
D Alternative Package Features for
OR
For additions and alterations, dud systems that are not documented to have been previously
❑ sealed as confirmed through field verification and diagnostic testing,in accordance with procedures in the
Residential ACM Manual and dud systems with:more than 40 linear feet in unconditioned
shall meet the,r uirements of,Sedion '15 m and"dud insulation requirements of Package D.
WATER `AF ATiTT(, Cvc7�i�rc .
Distribution
❑
Sealed Ducts all climate. roses Installer testis and certification and HERS rater field verification wired.
Energy
'Tank Factor or
Capacity Thermal
Ions Efficiency
TXVs, readily accessible"(climate zones 2 and 8-4
Tank
External
Insulation
R -Value
(Installer testis and.certification and HERS Rater;;field verificationrequired.)
0
Refrigerant Charge (climate zones 2 and 8-15.only) (Installer testing and certification and HERS Rater field
tI0 00�
verification uired.
AD
Alternative to Sealed Ducts and Refrigerant Charge lTXVs: See Package ❑ Project Climate Zone in the RM Appendix B Table 151 C, Footnoel4.
D Alternative Package Features for
OR
For additions and alterations, dud systems that are not documented to have been previously
❑ sealed as confirmed through field verification and diagnostic testing,in accordance with procedures in the
Residential ACM Manual and dud systems with:more than 40 linear feet in unconditioned
shall meet the,r uirements of,Sedion '15 m and"dud insulation requirements of Package D.
WATER `AF ATiTT(, Cvc7�i�rc .
Water Heater
Type/Fuel
Distribution
Rated Ener&y Tank
mputl Tank Factor or External
Number (kw ortyty aci Thermal Standby Insulation
in S stem snifir Ion I . Efficien Loss % R -Value
Check box if system meets criteria of a "Standard"'system: Standard system is one_gas=fired water heater per
Energy
'Tank Factor or
Capacity Thermal
Ions Efficiency
dwelling unit. If the water heater is a storage type, 50 gallons is the maximum capacity and recirculation system is
Tank
External
Insulation
R -Value
not allowed.
❑
Check box when using Preapproved Alternative Wafer Heating table, Table"5-4 in Chapter 5 in the Residential
tI0 00�
Manual. No water:heatin calculationsare requirecLand the system co lies automati
tem
Check box if sysdoes noY`meet criteria of "Standard" system, and does not comply with the Preapproved
❑
Alternative Water Heating table. In this case, the'Performance Metbod must be used and must be included in the
submittal.
0
Check box to verify that a time control is required for a recirculating system.pump for a system serving multiple
units
Water Heater
Type/Fuel
Distribution
Rated Ener&y Tank
mputl Tank Factor or External
Number (kw ortyty aci Thermal Standby Insulation
in S stem snifir Ion I . Efficien Loss % R -Value
Rat
(kwTXpe
BvAi
Energy
'Tank Factor or
Capacity Thermal
Ions Efficiency
Standby'
Loss % :
Tank
External
Insulation
R -Value
tI0 00�
�7. l
Water Heater
Distribution
Number.or
in stem '
Rat
(kwTXpe
BvAi
Energy
'Tank Factor or
Capacity Thermal
Ions Efficiency
Standby'
Loss % :
Tank
External
Insulation
R -Value
tI0 00�
�7. l
-. - �•.• - • b -........g.. ...+.,., raw 1a t. u-1.1Nuu ul less ulan.or equal to /J,uvv tstwnr), electi7c resistance, and heat
pump water heaters;, list' Energy Factor., For large gas storage water.heaters (rated input of greater than 75,000
Bughr), list Rated Input,. Recovery Efficiency,. Thermal Efficiency. and Standby Loss. For instantaneous gas water
heaters, list Rated Input and Thermal Efficiencies.
P1pC IIISulation(kitchen`lines 2:3/4 inches) All hot water pipes from the heating source to the kitchen fixtures that are'/a
inches or greater in diameter shall be thermally insulated as specified by Section 150 (j) 2 A or 150 (j) 2 B.
Residential Compliance Forms March 2005
Bin #
City of .La Quinta
Building &I 'Safety Division
P.O. Box 1504, 78-495 Calle Tamplco
La Quinta, CA 92253 - (760) 777=7012
Building Permit ,Applitation and Tracking Sheet
Pe it # `
`O
Project Address:
Owner'ss.Name'
A. P. Number:
Address: S 2 f
Legal Description:
Contractor:v6 °
City, ST, Zip:Qq,�,,4s4G ► Z 2
Telephone:? T%(1—
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Address: g
Address:
Project Description: Ctl►Q9;1�oma+
City, ST, Zip:: � 22� .
[zcrt •2
�� ' '?` f;• YY%.,`G`3aicr' �:L•`{ ?till:
Telephone: ..,;,� t {v: :r;4l,Pf:<�iJi.Y:l:<}}rF�t
.Yfti:,'vrY�::�j.`;^:i:$::frff•�q:;ff: 'at",
J
State Lie. # : City' Lic. #;
Arch., Engr., Designer.
Address:
City,, ST, Zip:
Telehone:
P
sfw' hof ' r
r6 •.< rte, Y: s,
J FN l.: i.: j•.r. i::i:;:;....
nn,. ,,;•r.Y Y
;:s.:;�$'f ''y„F : `
Construction Type: Occupancy:
State Lie. #:�ryrf
t
`Project type (circle one): New Add'n Alter jepair Demo
Name of Contact Person:
Sq. FL:
#Stories:
# Units:
Telephone # of Contact Person:
Estimate&Vgue=of,Project: Cr —��
APPLICANT: DO. NO,T WRITE BELOW THIS, -LINE
#
Submittal
Req'd;
Recd
TRACKING r
PERMIT, FEES
Plan Sets
Plan Chick submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cates.
Called Contact Person
Plan Check Balance
Tide 14 Calcs.
Plans.pieked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan.
1°” Review, ready for corrcctionsrissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.1.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE::
'W Reyiew, ready, for correetions/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
v
Total. P.ermit Fees