PLBG (11-0641)50445 Los Verdes Way
11-0641
- T
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
- "
11-00000641-
Property Address:
50445 _LOS VERDES WY
APN:
777-260-028-" - -
Application description:
PLUMBING
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
750
Ta!t °f wG%rw
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
----------------- - --------------------------------
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 lass: C36 censeNo.: 880103
ate: 'r
Ill Co ctor:
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.).
(_ 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: 'N\
Lender's Address: `
LQPERMIT
Owner:
AMBER
50445 LOS VERDES WY
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/13/11
Contractor:
ALVAREZ,
JORGE A
O
P.O. BOX
984
THERMAL,
CA 92274
JUN U3 2011
(760)777-3613
Lic. No.:
880103
rtTY OF LA QUIId7A
-----------------------------------------------
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 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 XEMPT Policy Number EXEMPT
certify that, in the performance of the work for which this permit is issued, 1 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 of the Lao e, I shall forthwith comply with those provisions.
ate:&-/a—L TOSEZRE
WARNING: FAILUI WORKERS' COMPENSATION OVERAGE 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 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
'
oft county to enter upo a above-mentioned pro spection p s.
Date. —13-1 I gnature (Applicant or Agent): /
Application Number . . . . 11-00000641
Permit . .
. PLUMBING
Additional desc .
Permit Fee . . .
. 22.50 Plan Check
Fee ..
5.63
Issue Date . . .
. Valuation
0
Expiration Date
12/10/11
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 7.5000 EA PLB WATER HEATER/VENT
7.50
----------------------------------------------------------------------------
Special Notes and
Comments
REPLACE 40 GALLON
GAS WATER HEATER. 2010
CODES.
---------------------------------------------------
Other Fees . . .
7 ---
. . . . . . BLDG STDS ADMIN (SB1473)
7 ------_--------------
1.00
Fee summary
Charged Paid Credited
----------------------------------------
Due
-----------------
Permit Fee Total
22.50 .00
.00
22.50
Plan 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 CF-IR-ALT-DHW
Residential Alterritions Page I of 2
Project Name: -e--it' Climate Zone:I Permit #:
General Information
Site Address: O 15 L-C v ecA
Enforcement Agency: L ' n tv Date: (Q -1.3 I
Building Type: Ia'Sin le Family 0 Multi Family !I
Project Type: a lacement or Change Out of Water Heater
WATER HEATING
• i certify that this Certificate of Compliance documentation is accurate and complete..
List newly installed water heaters and boilers for both domestic hot water heaters (D WH) and hydronie space heating. Newly installed
DI,VH heaters and boilers must lie as, pro ane, or use the existingfidel type.
• I certify that the energy features and performance specifications for the building design identified on this Certificate of Compliance
Water Heater
Distribution Type Number In Tank Enc Factor. or
(Standard, BY
building design on the other applicable compliance forms, worksheets, calculations, plans and specifications submitted, to the
External Tank
:Insulation'
Typr/Fuel Type
Rec tan atin System Capacity (gal) Thermal Efficiency.
R-ulatio
Company:
Date:
Ad
C) '3
License:
OO 10 3
City/State/Zip:
Phone:
C i22 1
-7L00--?-7-7-aG
1. Indicate Tvpe (Storage Gas, Heat Pump. Instantaneous, etc.)
2. Recirculating sysietns seiving multiple dwelling units, shall ineei the recireulatiot► requirements of §150(n).
The Prescriptive
requirements do not allow the installation of a recirculating water heating system for single dwelling units.
J. The external water heating tank and pipes shall be insulated to nneet the requirements of § 150U).
Contractor or Homeowner (Documentation Author's/Responsible Building Designer's, Declaration Statement)
• i certify that this Certificate of Compliance documentation is accurate and complete..
• I 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 certify that the energy features and performance specifications for the building design identified on this Certificate of Compliance
conform to the requirements of Title 24, PartI 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:
Ad
C) '3
License:
OO 10 3
City/State/Zip:
Phone:
C i22 1
-7L00--?-7-7-aG
GAnril?MO
Storage Water Heater Is defined as:
Max Btu/hr per Gallon 30 Gallon 40 Gallon 50 Gallon
4.000 120,000 160,000 200 000
1. Per Section 1500) of the 2008 Energy Efficiency Standards.
GAnril 2010
If rated Energy Factor does not EXCEED minimum
Federal Minimum
Values Below, an External Insulating Blanket (R-12,
Energy Factor -
minimum shall be Installed'
Water Heater Fuel Type
Effective Jan 20 2004
30 Galton
40 Galton
50 Gallon
Gas-fired storage -type water
0,62 - (0.0019 x- V)
0.563
0.544
0.525
heaters
Oil -fired water heaters
0.59 - (0.0019 x V)
0.533
0.514
0.495
(storage and instantaneous
-Electric storage water heaters
(excluding tabletop water
0.931- (0.00132 x V)
0.890
0.877
0.864
heaters
Electric tabletop water
0.90 - (0.00132 x V)
0.890
0.877
0.864
heaters
Gas-fired instantaneous water
0.62 - (0.0019 x V)
0.563
0.544
0.525
heaters
Electric instantaneous water
heaters (excluding tabletop
0.93 - (0.00132 x V)
0.890
0.877
0.864
water heaters
Heat um water heaters
0.93- 0.00132 x
0.890
0.877
0.864
v - .nfaff urnh IM92
in nallnnn
1. Per Section 1500) of the 2008 Energy Efficiency Standards.
GAnril 2010
: Bill If
a
Pemlii #
s msxcmr_%= °
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Building a Safety Division
P.O. Box 1504, 71]1-495 Calle Tainiko
La Quinta, CA 922S3 - (760) 7 77-701 `L
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