11-0321 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: (:�11=00000321
Property Address: 54295 AVENIDA OBREGON
APN: 774-241-014-3 -000000-
Application description: PLUMBING
Property Zoning: COVE RESIDENTIAL
Application valuation: 150
Applicant: Architect or Engineer:
C A
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LICENSED CONTRACTOR'S DECLARATION
•
t!t 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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 usiness and Professionals Code, and my License is in full force and effect. .
License Class: C36 License No.: 731855
Da -Con raaor:
-- — — —
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 70001 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).:
(_ 1 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 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 I -am exempt under Sec. , B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
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:
.PTERSON CONNIE
54295 AVENIDA OBREGON
LA QUINTA, CA 92253
(760)564-3564
Contractor:
STATE WIDE PLUMBIP
70244 CATANIA COM
INDIO, CA 92203--(
(760)393-6115
Lic. No.: 731855
VOICE`,(760) 777-7012
FAX (760).7-7011
INSPECTIONS (760) 777-7153
Date: 3/31/11
WORKER'S COMPENSATION DECLARAITO�I
I hereby affirm under penalty of perjury one of the following declarations: .�\P
I have and will maintain a certificate of consent to self -insure for workers' com /ation, as provided
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
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 EXEMPT Policy 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 man er 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
3700 of the Lab e�, I�shallQfortQh�with comply with those provisions.
Date: - Ij r _--Appli.
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 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 a above information is correct. I agree to comply with all
city and county ordinances and state laws relating to ' ding construction, and hereby authorize representatives
oLilais county to enter upon the above-mentioned pr pe y for inspBCtion purposes .
Signature (Applicant -or an
r
LQPERMIT
Application Number 11-00000321
Permit . . . PLUMBING
Additional desc .
Permit Fee. 22.50 Plan Check Fee
5.63
Issue Date . . . . Valuation . . .
. 0
Expiration Date 9/27/11
Qty Unit Charge Per
Extension
BASE FEE
15.00
1,.00 7.5000 EA PLB.WATER HEATER/VENT
7.50
------------------------------------------------------------------------------
Special Notes and Comments
REMOVE AND REPLACE 40 GALLON WATER
ELECTRIC HEATER.
-----------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN.(SB1473)
-
1.00
Fee summary Charged Paid Credited
Due
Permit Fee Total 22.50 .00 .00
22.50
Plari Check Total 5.63 .00 .00
.5.63
Other Fee Total 1.00 .00 .00
1.00
Grand Total .29.13 .00 .00
29.13
LQPERMIT
Prescriptive Certificate of Compliance: Residential
ResidenlW-Aileralions- --------------__--
CF-YR-ALT
Climate Zorie•II kof Stories.
General Information
Site Address:
Enforcement Agency: Date:
Building Type , Single Family ❑ Multi Family
Circle the FrontOrienta_tion: K. Ifs)W, or degrees
Conditioned- Floor Area (CFA):
Project Type: O ❑ Envelope O FenestO Roof O HVAC
F
Re lacement O Duct Replacement Water Heater
o
NOTE: This form Is not to be used jor Newly Constructed
Buildings or Additions
Insulation Values For Opaque Surfaces (for Furring use the Mass and Furring Strips Construction table below)
Assembly Alteration.
O Opening of framed cavity alone - Alterations that involve the opening of the framed cavity of a wall, ceiling, or floor must install the
mandatory minimum insulation value per §l S0 for the altered assembly. Fill in Columns A -C and enter mandatory insulation value in Column H.
O Replacement of eatire assembly- Replacement of an entire wall, ceiling, or floor assembly requires the installation of Component
Package- D insulation values in Table 151-C Fill in Column:.1 - _1
Opaque Surface Details For the furred portiosed of Mass Walls see Furring Strips Construction Table below.
A B C D E F G H I J
Pro Standard Values From JA4 Table
Tap/
iD
Assembly Name
or T
Framing Thidatess, Framed Continuous JA4Proposed
Material Spacing, U- JA4 Table Cavity Insulation Assembly Assembl
and Size or Other' factor' Numbers R -value° R -Value Cell Valuer U-faaor
E
F
G I
H I 1 I J I
K I
L M
Proposed Properties of Masonry and Concrete
Added Interior or Exterior Insulation
Walls From Reference
Note: For furred assemblies, accounting jor Contimrous insulation R-walue, see Page JA4-1 and Equation 4-1. For cakvlating furred walls —the Mats and
Furring Construction table below.
I. For Tag.11D indicate the identification name that matches the building plans.
2. Indicate the Assembly Name or type: R6of7Ceiling, Walls, Floors. Slabs, Crawl Space. Doors and etc... indicate the Frame type and Site: For
Wood..Wetal. Metal Buildings. Mass, enter 2x4. 2x6. or etc... see JA4 for other possible frame type assemblies -
J. Enter the thic*ness for incus in inches or Spacing between framing members enter; 16 "or 24 "OC: or Other for all other assembly description
such as Concrete Sandwich Panel. Spandrel Panel. Logs. Straw Bale Panel and etc....
4. Based on the Climate Zone: enter the Standard U factor from Table I S 1-B. C or D jor tach different assembly Name or type.
S. Enter the Table number that closely resembles the proposed assembly.
6. Enter the R -value that is being installed in the wall cavity or between the framing; otherwise. enter
7. Enter the Continuous Insulation R -value for the proposed assembly: otherwise. enter "0 ".
8. Enter the row and column of the U factor value based on Column F Table :Number and enter the Assembly U factor in Column J
9. Ilse Proposed Assembly U factor, Column J, must be equal to or less than the Standard U -factor in Column E to Co"WY-
Furring Strips Construction Table for Mass Walls Onl
A IB C D J.
E
F
G I
H I 1 I J I
K I
L M
Proposed Properties of Masonry and Concrete
Added Interior or Exterior Insulation
Walls From Reference
in Furring Space from Reference
Joint A ndix Table 4-3.5.4-3.6.4.3.7
Joint
Appendix Table 4.3.1.
• �
`o a
Assembl)-
-S
U.
o c
' 2 _
- `o V -
-.,
Final
Mass
Thickness
Name or
JA4 Table a
=
`v, 8
E
a
6
b S '
Y, A
'
Assembly
6 7
T
Number' < >
e % 2
< >
L;J-'
�
U -factor Comment
Registration Number • Registration Date Time: HERS Provider:
2008 Residential Compliance Forms August 2009
HVAC SYSTEMS - HEATING
List water heaters and boilers for both domestic hot water (DHW) heaters and hvdronic space heating. individual dwelling DHfi° heaters must be
Heating Equipment
Type and Capacity'-:-'
Minimum
Efficiency
(AFUE or HSPF)
Distribution
Type and Location
Duct or Piping Configuration
Insulation Thermostat (Central. Split_
R -Value Type Space. Package or H •dronic)
Type' (Standard. Recirculating2 system Capacity (al) Thermal Efficiency R -Value'
fir1
a
I. Indicate Heating Tipe (Central Furnace. {fall Furnace. Heat pump, Boiler. Electric Resistance. etc.)
2. Electric resistance heating is allowed only in Component Package C. or except where electric heating is supplemental (i.e.. if total capacity
2 KlV or 7.000 Btu••hr electric heating is controlled by a (ime-limiting device not exceeding 30 minutes). See $151(b)3 exception_
3. Refer to the HERS Verification section on Page a of the CF- IR -ALT Form for additional requirements and check applicable bates.
4. Indicate Type or Location (Ducts. Hydronic in Floor. Radiators, etc.)
HVAC SYSTEMS - COOLING
Cooling Equipment
Type and Capacity"
Minimum
Efficiencv Duct or Piping Configuration
(SEER/EER or- Distribution Insulation Thermostat (Central. Split
COP) Type and Location' R -Value Type Spam Package or H •dronic
not allow the installation of a recirculating water heating system for single dwelling units.
3. The external water heating tank andpipes shall be insulated to meet the requirements of §150(j).
1. Indicate Cooling Type (A C. Heat pump. Evap. Cooling, etc)
2. Refer to the HERS Verification section on Page # of the CF -IR -ALT Form for additional requirements and check applicable bates.
3. Indicate Type or Location (Ducts. Hydronic in Floor. Radiators. etc.)
WATER HEATING ,
List water heaters and boilers for both domestic hot water (DHW) heaters and hvdronic space heating. individual dwelling DHfi° heaters must be
gas or propane fired. and may not exceed 50 gallons. Hot water pipe insulation from the DHW heater to the kitchen(s) and on all underground
hot water pipes is required in all omponent packages in all climate =ones.
External Tank
Water Heater Type/Fuel Distribution Type Number In Tank Energy Factor or Insulation
Type' (Standard. Recirculating2 system Capacity (al) Thermal Efficiency R -Value'
fir1
a
1. Indicate Type (Storage Gas. Heat Pump. Instantaneous. etc.)
2. Recirculating systems serving multiple dwelling units shall meet the recirculation requirements of 0150(n). The Prescriptive requirements do
not allow the installation of a recirculating water heating system for single dwelling units.
3. The external water heating tank andpipes shall be insulated to meet the requirements of §150(j).
SPECIAL FEATURES The enforcement agency should pay special attention to the Special Features specified in this checklist below.
These items ma • require written 'usti tcation and documentation and special verification-
NEW
era ication.NEW ROOF ASSEMBLY - Radiant Barrier
The radiant barrier requirement of § 151 2 does not apply to roof alterations.
Slab Edge (Perimeter) Insulation O YES O NO
YES: In Climate Zone 16 in Component Packages D. R-7 insulation is required.
Heated Slab Insulation O YES O NO
YES: Slab edge insulation required for all heated slabs in all Climate Zones. See details in Table i 18-A of the standards.
Raised Slab Insulation O YES O NO
YES: In Climate Zones 1. 2. H. 13. 14 & 16. R-8 insulation is required: in Climate Zones 12 & 15. R4 is required under component Package I
Thermal Mass
To obtain Compliance Credit for the installation of thermal mass. use the Performance Approach.
Registration Number: _ _ _ Registration Date Time. HERS Provider:
2008 Residential Compliance Forms August 2
HVAC SYSTEMS- HEATING
Heating Equipment
Type and C city ='
Minimum Duct or Piping Configuration
Efficiency Distribution Insulation Thermostat (Central. Split -
(AFUE or HSPF) Type and Location' R -Value Type Space. Package or H -dronic
Distribution Type
(Standard. Recirculatin 2
Number In
System
Tank
Capwity (gal)-
External Tank,
Energy Factor or Insulation
Thermal Efficiency -Value'
1. Indicate Heating Ttpe (Central Furnace. Wall Furnace. Heat pump, Boiler. Electric Resistance. etc.)
2. Electric resistance heating is allowed only in Component Package C. or except where electric heating is supplemental (i.e.. if total capacity"
2 K 11"or 7.00 0 Btu"ltr electric heating is controlled by a time -limiting device nor exceeding 30 minutes). See 051(b)3 exception.
3. Refer to the HERS Verification section on Page 4 of the CF -1 R -ALT Form for additional requirements and check applicable boxes.
4. Indicate Type or Location (Ducts. Hydropic in Floor. Radiators. etc.)
HVAC SYSTEMS - COOLING
—R
o
Minimum
Cooling Equipment
Type and CapacitV1.2
Efficiency
(SEER/EER or
COP)
Duct or Piping Configuration
Distribution Insulation Thermostat (Central. Split -
Type and Location] R -Value Type Space. Package or H •dronic'
I. Indicate Cooling Type (A -C. Heat pump. Evap. Cooling. etc)
2. Refer to the HERS Verification section on Page 4 of the CF- IR -.4 LT Form for additional requirements and check applicable boxes.
3. Indicate TAy or Location (Ducts, H _ onic in Floor. Radiators, etc.)
W-�►-ER.HEAMNG,
List water heaters and boilers for both domestic hot water (DHW) heaters and hvdronic space heating. Individual dwelling DHII`heaters must t
gas or propane fired and may not exceed 50 gallons. Hot water pipe insulation from the DHW" heater to the kitchens) and on all underground
hot water pipes is required in all omponeni packages in all climate =ones.
Water Heater Type/Fuel
T ' i
Distribution Type
(Standard. Recirculatin 2
Number In
System
Tank
Capwity (gal)-
External Tank,
Energy Factor or Insulation
Thermal Efficiency -Value'
�
—R
o
4/1
t. tnarcate type rWorage Uas. Heat Pump. Instantaneous. etc.)
2. Recirculating systems serving multiple dwelling units shall meet the recirculation requirements of §150(n). The Prescriptive requirements d.
not allow the installation of o recirculating water heating system for single dwelling units.
3. The external water heating tank and pipes shall be insulated to meet the reauirements of 61506).
SPECIAL FEATURES The enforcement agency should pay special attention to the Special Features specified in this checklist below.
These items ma • require written justi tcation and documentation and special verification
NEW ROOF ASSEMBLY - Radiant Barrier
The radiant barrier requirement of § 151 2 does not apply to roof alterations.
Slab Edge (Perimeter) Insulation O YES O NO
YES: In Climate Zone 16 in Component Packages D. R-7 insulation is required.
Heated Slab Insulation O YES O NO
YES: Slab edge insulation r' uired for all heated slabs in all Climate Zones. See details in Table 118-A of the standards.
Raised Slab Insulation O YES G NO
YES: In Climate Zones 1.2. 11. 13. 14 & 16. R-8 insulation is required: in Climate Zones 12 & 15. R4 is required under component Package
Thermal Mass
To obtain Compliance Credit for the installation of thermal mass. use the Performance ADDroach.
Registration Number:___ Registration Date Time. HERS Provider:
2008 Residential Compliance Furors Augu
HERS VERIFICATION SUMMARY The enforcement agency should pay special attention to the HERS Measures'specified in this
checklist below. A completed and signed CF -4R Form for all the measures specified shall be submitted to the building inspector before final
inspection.
Duct Sealing & Testing HERS verification is required for this measure.
❑ YES ❑ NO YES: In Climate Zones 2 and 9-16. if more than 40 linear feet of new or replacement ducts are installed in unconditioned
space. the ducts are to be sealed per §1 52(b)l Dii and the newly installed ducts are to be insulated per § 15l (f)10.
❑ EXCEPTION: Existing duct systems that are extended, which are constructed, insulated or sealed with asbestos.
❑ YES ❑ NO YES: In Climate Zones 2 and 9-16, if the existing space -conditioning system (HVAC equipment and ducting) is replaced. the
ducts are to be sealed per § 152(b)1Di.
❑ YES ❑ NO YES: In Climate Zones 2 and 9-16. if the existing HVAC equipment is replaced (including the replacement of the air handler.
outdoor condensing unit of a split system. cooling or heating coil. or the furnace heat exchanger) the ducts are to be
sealed per § 152(b) t E. ,
❑ EXCEPTION: Duct systems that are documented to have been previously sealed confirmed through HERS
verification in accordance with procedures in the Reference Residential Appendix RA3.
13 EXCEPTION: Duct systems with less than 40 linear feet in unconditioned space.
❑ EXCEPTION: Existing ducts stems constructed, insulated or sealed with asbestos.
Refrigerant Charge - Split System HERS verification is required for this measure.
❑ YES 13 NO YES: In Climate Zones 2 and 8-15. when the existing HVAC equipment is replaced (including the replacement of the air
handler. outdoor condensing unit of a split system A/C or heat pump. cooling or heating coil. or the furnace heat
exchanger) a refrigerant charge measurement shall be verified per 152(b)I F.
Central Fan Integrated (CFI) Ventilation System and Fan Watt Draw
The ventilation requirements of § I 50(o) do not 491y to existing residential homes.
Ducted Split Systems - Air Conditioners and Heat Pumps: Airflow HERS verification is required for this measure.
YES 13 NO YES: In Climate Zones 10 through 15, when the existing space -conditioning system (HVAC equipment and ducting) is
replaced. the airflow and fan watt draw shall be verified per § 152(b) I Ci to meet the requirements of §11S1(f)711.
Documentation Author's Declaration Statement
• 1 certify that this Certificate of Compliance documentation is accurate and fete.
t
Si a
�
L�-�
tCofflqgiVde— r / / �� t date(C t '.
Address:. D If Applicab a 0 CEA or 0 CEPE
'
(Certification fl):
City � =Ct (�
Responsible BuildingDesigner's Declaration Statement
• 1 am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the building design identified on
this Certificate of Compliance.
• I certiA- that the energy features and performance specifications for the building design identified on this Certificate of Compliance conforr
to the requirements of Title 24. Parts t and 6 of the California Code of Regulations.
• The building design features identified on this Certificate of Compliance are consistent with the information provided to document this
building design on the other applicable compliance forms. worksheets. calculations. plans and specifications submitted to the enforcement
agency for approval with this building permit application.
Name:
Signature:
Company:
Date:
Address:
License:
City/State/Zip:
Phone:
For assistance or questions regarding the Energy Standards, contact the Energy Hotline at. 1-800-772-3300.
Registration Number: Registration Date Time: _ _ HERS Provider:
2008 Residential Compliance Forms
August
Telephone:ix t:onsmicuon iype: vua,pau�y.
State Lic. . �µ Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: �// (� (' Sq. FL: # Stories: # Units:
Telephone # of Contact Person & 19og go
Estimated Value of Projectff
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req-d
Recd
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 Check Balance.
Tide 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for correctionvissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.L
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
''a Review, ready for correcdons/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees