11-0904 (PLBG)P.O.' BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: :-- rr=p0000904_n_
Property Address: 51800 AVENIDA"MONTEZUMA
APN: 773-151-001-1 -000000-
Application description: PLUMBING
Property Zoning: COVE RESIDENTIAL
Application valuation: 1000
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BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Applicant: Architect or Engineer:
------------------
LICENSED CONTRACTOR'S DECLARATION
herebyaffirm 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:. - License No.:
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 repairany 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 Se6tion-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
ani applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
(X ) 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, as owner of the property, am exclusively contractin with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: The Cont tors' State License Law does not apply to an owner of
property who builds or improves thereon, and w o ontracts for the projects with a contractor(s) licensed
pursuant to the Contractors` State License Law. .
1 _ 1 I am exempt under Sec. BAP.C. for thi rei son
YDate: �"� 1% Owner: - -
J� i
CONSTRUCTIONJtN DING AGENCY -
hereby affirm under penalty of perjury that there is a construction lending agency for the pf rmance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name: _
Lender's Address:
LQPERMIT
Owner:
BROWNING JOHN/ARMENDAREZ ED'
8562 W WEST KNOLL DR #11
WEST HOLLYWOOD, CA 90069
-----------------------------
Contractor:
Owner
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
-------------------
WORKER'S COMPENSATION DECLARATION
Date: 8/22/11
o
i
r i
AJ 03 2 2011.
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 work for which this permit is
issued. -
I have and will maintain workers' co p nsation insurance, as required by Section 3700 of the Labor
Code, for the performance of th w rk for which this permit is issued. My workers' compensation
insurance carrier and policy nu er re:
Carrier Po cy Number
` certify that, in the performance f th work for which this permit is issued, 1 shall not employ any
person in any manner so as t bec me subject to the workers' compensation laws of California,
and agree that, if I should be me ubject to the workers' compensation provisions of Section
�,3�700 of the Labor Code, I s 11 f hwith' omply with those provisions. -
Date: yLY I\ Applicant: -
WARNING: FAILURE TO SECURE WORKE 5' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINE$ UP TO ONE HUNDRED THOUSAND
'DOLLARS (5100,000). 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 permitsubject 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 ecomes null and void if work is not commenced
within 180 days from date of issuance of suc ermit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that th a ve information is correct. I agree to comply with all
city and county ordinances and state laws relating to buil in construction, and herd by authorize representatives
of this county to enter upon the above-mentioned proper y f r inspe n purposes. -
CDate: o _� L— k Signature (Applicant or Agent):
1. *•!,_
-
Application Number . . . . . 11-00000904
Permit . . . PLUMBING
Additional desc .
Permit Fee 21.00 Plan Check
Fee
5.25
Issue Date Valuation
. . .
. 0
Expiration Date 2/18/12
Qty Unit Charge Per
Extension '
BASE FEE
15.00
1.00 6.0000 EA PLB FIXTURE
6.00
-----------
Special Notes and Comments
POOL PUMP CHANGE OUT - HAYWARD-ECOSTAR
[SP3400VSP] PER CEC APPROVED PUMP LIST.
2010 ENERGY CODE.
August 22, 2011 5:01:37 PM AORTEGA
-----------------_------------------------------------------------
Other Fees . . . . .. . BLDG STDS ADMIN (SB1473)
2.00
Fee summary :Charged Paid` Credited
Due
Permit Fee Total 21.00 .00
.00
21.00
Plan Check Total 5.25 .00
.00
5.25
Other Fee Total 2.00 .00
.00
2..00
Grand Total 28.25 00
.00
28.25
PSEtt
AGLAi YON=CERTIFICATE 1 CYi-6R-MEC'H-03
And S a `Heatin Systems a e 1' oI2
ddress:
Enforcement Agency: Permit Number:
Pool and Spa Heating Systems requirements
§114(a): Systems and Equipment.
O I. "Heater has a.thermal efficiency that complies with the Appliance Efficiency• Regulations.
2. Hasa readily accessi
O ble on-off switch mounted outside of the heater.
❑ 3. Weatherproof plate or card containing operating instructions for the pool or spa heater. r
O 4. No electric resistance heating except for listed package units that has fully insulated enclosures and tight fitting
covers that are insulated to at least R-6. Or if documentation is provided that at least 60 % of the annual heating
energy is from site solar energy or recovered energy.
❑ 5. Heating system has no pilot light.
§114(b): Installation.
O 1. System is installed with at least 36" of pipe between the filter and heater, o'r dedicated suction and return lines,
or built-in or built-up connections for future sow heating.
❑ 2. A cover for outdoor pools or spas that have a heat pump or gas heater.
❑ 3: Pool system has directional inlets to adequately mix the pool water
❑ 4. Time switch which will allow the pump to be set or programmed to run during off-peak periods only
§150(p) Pump Sizing and flow rate specification .
1. The pump specified is listed in the CEC database of certified pool pumps.
❑ 2. The pump flow rate shall be calculated based on pool sing table below.
O 3. The pump is capable of operating at 2 or more speeds (not applicable if pump is less than I horsepower).
❑ 4. Each auxiliary pool load is served by either a separate pump, or the,system is -served by a multi -speed pump.
Pool civina rV.1—n
Max Pool
Volume
(gallons)inches
%us UUTc1 Katz; UK V- LLVuls
Min Pipe D or Greater Min Filter Area or more
(square feet
Max Pump
Flow m
Return
Suction
Cartrid a Sand
-DE
13,000
1.5
1.5
100 2.4
20
36
17,000
1.5
2
130 3.1
25
47
21 000
2
2
160 3.9
30
58
28 000 ,
2
2.5
210 5.2
40
78
42,000
2.5
3
3207.8 1
60
117
49,000
3
3
36t1 I it o 1
7n
133
Note: For pumps greater than I hp. The maximum Pump Flow is the lowest speed default filtration
❑ 5. Calculated volume of pool (gallons):
13 6. Return Pipe Diameter (inches).
O 7. Suction Pipe Diameter (inches).
❑ 8. Filter Type (Cartridge, Sand, DE).
❑ 9. Filter Surface Area (sf), .
❑ 10. Max Pump Flow (gpm),
.2008 Residential Compliance Forms August 2009
EVSTALLATION CERTIFICATE CF-6R-MECH-03
Pool And S a Heating Systems (Page 2 of 2
Site Address: Enforcement Agency: Permit Number:
/ System Piping
❑ 1. The suction side pipe is straight for at least 4 pipe diameters before entering the pump (See table below for the
required straight run lengths for various pipe sizes).
D 2. The design uses low pressure drop fittings (sweep90's)
Pipe Diameter
inch
Required Pipe Length
leading into pump (inch)
1.5
6
2
g
2.5
10
3
12
Filtration Equipment
D 1. If a backwash valve is used: The diameter of the backwash multi -port valve is 2 inches or as large as the
circulation pipe, whichever is greater
DECLARATION STATEMENT
• 1 certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct.
• I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized
representative of the person responsible for construction (responsible person).
• l certify that the installed features, materials, components, or manufactured devices identified on this certificate (the installation)
conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the
enforcement. agency.
• l reviewed a copy of the Certificate of Compliance (CF -1 R) form approved by the enforcement agency that identifies the specific
requirements for the installation. I certify that the requirements detailed on the CF -IR that apply to the installation have been met.
• 1 will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the building
Permit(s) issued for the building, and made available to the enforcement ages ,tor all applicable inspections. I understand
that a signed copy of this Installation Certificate is required to be includedt the documentation the builder provides to
the building owner at occupancy.
Company Name: (Installing Subcontractor or General Contractor or Builder/Own)
Responsible Person's Name: �V1r ✓� Responsib e P 1 n' ignature:
CSLB License: Date Signed: Position th Company (Title):
2008 Residential Compliance Forms August 2009
P.O. BOX 1504
LA QUINTA, CALIFORNIA 92247-1504
78-495 CALLE TAMPICO
LA .QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
(7 60) 777 -70 12
FAX (760) 777-7011
PROPERTY OWNER'S PACKAGE
Disclosures & Forms for Owner -Builders Applying for Construction Permits
AMOUNT! NOTICE TO PROPERTY OWNER
Dear Property Owner.
'An application for a building permit has been submitted i your name listing yourself as the builder of the property
improvements specified at _ s�'kQ.t In
y N ,i a� cy��t . Iti, L%
We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of your
responsibilities and possible risk you may incur by having this permit issued in your name as the
Owner -Builder. We %rill not issue a building.permit until you have 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.
and initial each statement below to signify you understand or verify this information.
' ` 1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder'
building permit that erroneously implies that the property owner is providing his or her own labor and material personatly. 1, as
an Owner -Builder, 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
injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers
ip{r�y P�rtl'. .
' (I/' 2. I understand building permits are not required to be' signed by property owners unless they are responsible for the
construction and are not hiring a licensed Contractor to assume this responsibility.
�YI'l understand as an "Owner -Builder" I am the responsible party of record on the permit, I understand that I may protect
myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my
4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on
rmits and contracts.
ng� I understand if I employ or otherwise engage any'persons, other than California licensed Contractors, and the total value
df my construction is at least five hundred dollars ($500), including labor.and materials, 1 may be considered an "employer'
under state and federal law.
4/6
. I understand if I.am considered an "employer" under state and federal taw, I must register with the state -and federal
government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemploymea
compensation for. each "employee." I also understand my failure to abide by these laws.may subject me to serious fnancia
risk.
4s7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residentii
ctures cannot legally build them with the intent to offer them for sale, unless all work is performed by license
subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performs
under contract with a licensed general building Contractor.
B►n.#..
City of La Quina, .
Building 8f' Safety Division
P.O. Box .1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012.-`
Building Permit. Application and Tracking Sheet
Permit #
Project Address:
AN4- vO a�
ati}.e}
Owner's Name: J OIC IJY
A. P. Number:
Address: !�
Legal Description:
Contractor:
Ci ST, Zi l� t�
p i '
Telephone: ''l'p '07..� Q�t'l,0 e�
Address:
Project Description:
City, ST, Zip:
EAU�.� rd1. �:1 Y ilk
Telephone:
I::>>:: v::
State Lic. # :
City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person:
:.:.....
jX
,.:...:.>i:'}�:?�:'s.: �:.}
��
Construction Type: Occupancy:
Project type (circle one): New ' Add'n Alter Repair Demo
Sq. Ft.: # Stories: # Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Plan Sets
Req'd
Rec'd
TRACI@IG PERMIT FEES
Plan Check submitted Item Amount
Structural Cala.
Reviewed, ready for corrections Plan Cheek Deposit
Truss Cala:
Called Contact Person Plan Check Balance
Title 24 Cala.
Plans picked up Construction
Flood plain plan
Plans resubmitted Mechanical
Grading plan
Y! Review, ready for correctionsflssue Electrical
Subcontactor List
Called Contact Person Plumbing
Grant Deed
Plans picked up S.M.I.
H.O.A. Approval
Plans resubmitted Grading
IN HOUSE:-
Review, ready for correctionVissue Developer Impact Fee
Planning Approval
Called Contact Person A.I.P.P. .
Pub. Wks. Appr
Date'of permit issue
School Fees
Total Permit Fees