PLBG (07-1336)53584 Avenida Madero
07-1336
t
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
• BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 07-00001336
Property Address: ---53584-AVENIDA MADERO
APN: 774 -103 -003 -22. -000000 -
Application description: PLUMBING
Property Zoning: COVE RESIDENTIAL
Application valuation: 500
Applicant: Architect or Engineer:
9
~ 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.
Licen Clas C36 Li c rtse No.: 828264IV
'
Date:ontractor:
OW ER -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 1, 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 contractors) licensed
pursuant to the Contractors' State License Law.). -
1 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: '
0111
Lender's Address: .
LQPERMTT
Owner:
MERRIL HADLEY
-53584 AVENIDA MADE
- LA QUINTA, CA 9225
Contractor:
FOY, SCOTT A.
43579 MAIN STREET
INDIO, CA 92201
(760)775-9405
LiC. No.: 828264
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/03/-07.
=------------------------ -----------------------
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 performarice of the work for which this permit is
/ issued.
Y1 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
'(nsurance carrier and policy number are:
Carrier ENDR.INS Policy Number WEN000882301
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 of the Labor Code, I shall forthwith comply..wilh those provisions.
tSiy .9 — plicant:
WARNING: FAILURE TO SECURE WORKERS' CIMP14SATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS 1$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 to laws relating to building constructio andby auth ize representatives
of this cou y to ter upo a above-mentioned property for inspection
Dat ignature (Applicant or Agent):
Application -Number . . . . . 07-00001336,
Permit PLUMBING
Additional desc .
Permit Fee 22.50
Plan Check
Fee
5.63
Issue Date
Valuation
0
Expiration Date .10/30/07:
Qty Unit Charge Per
Extension.
BASE
FEE
15.00
1.0-01 7.5000 EA PLB WATER HEATER/VENT
7.50
---
Special Notes and Comments
INSTALL 30 GALLON ELECTRIC WATER
HEATER.
Fee summary Charged.
Paid Credited
Due
Permit Fee Total 22.50
.00
.00
22.50
Plan Check Total 5-6.3
00
00"
5.63
..
Grand Total 28.13
.00
00
28.13
LQPERMIT. - • - ..
-.
t• .i u
Dill it U .
— c6 tN Of Lia 4uinta
Btfihcirrrg 8r Safety Division
• P.O. Box 1504, 78-495 Calle Tampico
P,4ntft /!
... 13 Quints, CA 92253 - (a 60) 777-7012
i,`e'
1 Building Permit Application and Tracking Sheet
s
Project Address acj 4 Ajer,ido. mcx\,er( Owner's Dlt;arlt
- Mrrl k 1 GCGlf
A.'P."Nwliocr: k Addrea SSb f i 1!✓`Ck ft—C,&5-C)
1
Ixeml 13crcrlpllon-. ^ y
Contractor. C . _ t ;ted + Telephone: GO- Z'3 C1 ~` ``".'.h ''r"` ;
fiw i " act
Project Deszription:
cin sT,Lip_ inelr>ca22C:,tnj- er 1('fltnl areVi'en
Tele 1 _
llnllc / I 'iti oi-5
f y. qwY s T
w Me. d: Dgi ) (o City Lic.
Y-5-14" 39
3P-1-9r..
Designer:
1
S Addresa: --
t
cir; , ST, Zip:
--
z;:.= M2: <:-.:-•_' m —
Telephone: t t. > ( ( Orcu :tncy
srif' Cartstruction Typ
State Lit:. m:
Projrei typz (circle one). Nei: Add'n Mier Repwr 0Cn0
"
Name of Contura Pm. on: S Ft.:
4• K Statics: b Unit:
ic1e11hene of Contuct !'etson: Esiimetedi Value of Proi
APPLICANT: DD r4oT WME BELOW TMS UNE
TRAC"s
MG p>>Irr tis
- . L--.
N
Sullmltrel
'd ReNd
11120 Sets
'1 P130 Check submitted tees, Amnunlm
titractaral Cnic_
RE%ietzi;k ready for cerrecfioas " Plan Check Deposit
i rllss:Cnlcs.
1 —
Called Cauacr'I+erson PisrL Check Bolancc
Tillee 24 «Ies.
Flsss icked up u
P Co0struetian.
Flood plain pinn
p
F' Plans resubmitted Medmaiul
G.zndin -plAn
poReview, veady•rorcorrectiormu me Et tsicDl
c
Subrehlactor Ust
( altrd contnd person
Plumbi„ -
(inns Dced
Plans picked op
S.M.).
11.U.4. Lppwvnl
t
r .t'1nns.resv¢uni9ted
Crad'tttg
IN iIOUSE:-
,
" Feview, ready for eorrecdourAssue
(Developer Impact Fte
Planning Approtml
Called Com'scr Parson
c AI.P-P.
Pulp. \4'kc. Appr
11 IIate ot'Fermit issue
School Fca I
C
1
1
1
Tole! Permit Yet --
I
3 ► 39
r
CERTIFICATE OF C®IVPLUNCE: REST ENTUL (Page'3 of 4) CF -IR
Project Title Date
SEALED DUCTS and TXVs (or Alternative Measures)
A signed CF -4R Form must be provided to the building department for each home for which the following. are
renuired.
led Ducts all'clinrAe zones Installer testing and certification and HERS rater field verification required.)
TXVs, fly accessible (climate zones 2 and 8-15 only)
Installer testi d certification and HERS Rater field verification uired
Refrigerant Charge (c . to zones 2 and 8-15 only) (Installer testing and certification and HERS Rater field
verification ictipirtd.
AT
❑ Alternative to Sealed Ducts and Refrigerant a fIXVs (See Package D Alternative Package Features for
Project Climate Zone in the RM Appendix B Table -C, Footnotes 7-14.
OR
For additions and alterations, duct systems that are not docum6ntZatsJiave been previously
0 sealed as confirmed through field verification and diagnostic testing in acro with procedures in the
Residential ACM Manual and duct systems with more than 40 linear feet in un
condi
aces shall meet the requirements of Section 15 m and duct insulationconrequirements e Pac
WATER MRATtNV- CVCTF1Vifi
Water Heater
Type
RatedEnergy
Input' Tank Factor or
n Number (kW or Capacity Thermal Standby'
Type —I—wsyswm Btuthr) (galions Efficiency Loss %o
Tank
External
Insulation
R -Value
Check box if system meets criteria of a "Standard" system. Standard system is one gas-fired water heater per
Energy Tank
dwelling unit. If the water heater is a storage type, 50 gallons is the maximum capacity and recirculation system is
Distribution
not allowed.
Q
Check box when using Preapproved Alternative Water Heating table, Table 5-4 in Chapter 5 in the Residential
Type/Fuel Type
Manual. No water heating calculations are ui and the system complies automatically.
in S stemBturhr
1
Check box if system does not meet criteria of"Standard" system, and does not comply with the Prcappiovcd
❑
Alternative Water Heating table. In this case, the Performance Method must be used and must be included in the
submittal.
0
Check box to verify that a time control is req red for a recirculating system pump for a system serving multiple
uni
Water Heater
Type
RatedEnergy
Input' Tank Factor or
n Number (kW or Capacity Thermal Standby'
Type —I—wsyswm Btuthr) (galions Efficiency Loss %o
Tank
External
Insulation
R -Value
Rated
Energy Tank
Water Heater
Distribution
Number
Input'
(key or
Tank Factor' or External
Capacity Thermal Standby' Insulation
Type/Fuel Type
Type
e e CAY► C
in S stemBturhr
1
:.a
tons Efficiency Loss % R -Value
O dec+6
lC
wYi►r1P .ei c n
-
Water Heater
Type
RatedEnergy
Input' Tank Factor or
n Number (kW or Capacity Thermal Standby'
Type —I—wsyswm Btuthr) (galions Efficiency Loss %o
Tank
External
Insulation
R -Value
---v— --------»- - + •. •.... •uyuw va . .O uRaj, vl u4ucu W 1J,uuv nrwnr/, ctectrtc resistance, and heat
pump water heaters, list Energy Factor. For large gas storage water heaters (rated input of greater than 75,000
Dttt/hr), list Rated Input, Recovery Efficiency, Thermal Efficiency and Standby Loss. For instantaneous gas water
heaters, list Rated Input and Thermal Efficiencies.
Five Insulation (kitchen lines > 3/4 inches) All hot water pipes from the heating source to the kitchen fixtures that are 3/
inches or grcttter in diameter shall be thermally insulated as specified by Section 150 0) 2 A or 150 0) 2 B.
Residential Compliance Forms
March 2005
ryt
r CER'TMCATE 'OF COMPLIANCE:. RESIDENTIAL (Page 1 of 4) CF -1R
Project Title Date
Project Address Building Permit #
Documentation Author Telephone Plan Check / Date
Field Check / Date
Compliance Method (Prescriptive) Climate Zone Enforcement Agency Use Only
✓ Alternative Component Package Method: (check one; C D D (Alternative)
° Package C and Package D choices require HERS rater field verification and/or diagnostic testing (see CF -1R page 3)
For Package D Alternative see Appendix B Table 151-0 Footnotes 7-14
GENERAL INFORMATION
Total Conditioned Floor Area (CFA) ff Average Ceiling Height: R
Maximum Allowed West Facing Fenestration Products Per Table 151-B or 151-C — (5% X CFA) ftZ
Maximum Allowed Total Fenestration Products Per Table 151-B or 151-C (20% X CFA) g
✓ ❑ Building Type: (check one or more) Single Family Multifamily Addition Alteration
(if adding fenestration fill out WS -411, Fenestration Maximum Allowed Area Worksheet and see Section 8.3.2
for Additions and 8.3.3 for Alterations.) r
Number of Stories: Number of Dwelling Units:
Floor Construction Type: Slab/Raised Floor (circle one or both)
Front Orientation: North / South / East / West / All Orientations (input front orientation in degrees from True
North and circle one).
❑ RADIANT BARRIER (required in climate zones 2.4,8 6)
OPAQUE SURFACES INCLUDING OPAQUE DOORS
- Com pnent
Type a
Rooi; Floor,
Slab Edge,
Doors)
me
Type
(Wood
or Metal)
Assembly U-
factor (for
Continuous wood, metal
Insulation ion frame and mass
R -Value R -Value blies '
Joint
Appendix
IV
Reference
Roof Radiant
Barrier Location/Comments
Installed (attic, garage,
Yes or No typical, etc.
1) see Joint Appendix_ IV in Section 1V.2, 1 V .i and i V .4, wtucn is me oasis ror uie u -Tactor crnerton. v-iacwl uai nut
exceed prescriptive value to show equivalence to R -values.
f '
March 2005
Y
,<
+'
® CON WLIANCE: RESIDENTY A.I. (Page 4 of 4) CF-1R
CERTIFICATE
Date
t project Titic
essarYl
extra sheets if t to
UIRINt. HERS VERIFKATION ec
SPECIAL FEATURES NOT
RE al features relevand d►e
The list below only represents sp
Indicate which special features are Part of this project.
reseri tive method_
Required Forms if a livable Oestri tion
F
.'
✓ Feature
O Metal Framed Walls
CF-1R
Vii,
+
❑ Radiant Barriers
CF-1R
WS4R
❑ Exterior Shades
'
N/A; Attach CRRC Label to
❑ Cool Roof
Forms.
Dedicated Hydronic Heating
Performance Calculation
[3,S
R uired- Attach Run to Forms.
stem
Performance Calculation
❑ Combined Hydronic System
Re uired; Attach Run to Forms-
performance Calculation
❑ Gas Cooling
R uired.
❑ Buried Ducts
N/A; Indicate on buildin laps-
See Section 5.6.2 Distribution
❑ Kitchen Pipe Insulation
S stern.;. Residential Manual.
See Table 5-13 or use
Multiple Water Heaters Per
perfonnance Calculation and
Dwelling Unit
attach Run to Forms.
Central Water ficating System
performance Calculation and '
0 Servrn Multi le Dwellin
attach Run to Forms.
Non-NAECA Large Water
CF-IR
❑ Heater
See Table 5-13 or use
❑ Indirect Water Heater
Performance Calculation and
attach to Forms
See Table 5-13 or use -
❑ Instantaneous Gas Water Heater
Performance Calculation and '
attach Run to Forms
See Table 5-13 or use
❑ Solar Water Heating System
Performance Calculation and
attach Run to Forms
performance Calculation and
0 Wood Stove Boiler
attach Run to Forms
SPECIAIL FEATURES RELTEMG HERS RATER VERIFICATIOproject and need
are of this
Tadd exi n sheets if neceM§W
Indicate to the HERS Rater which credits part
verification-
✓
R6 uired Forms if a licablc Desc 'tion
Feature
❑ Duct Scaling
CF-6R art 4 of 12
❑ Refri erant Ch a
CF-6R 5 of 12
13 Thermostatic Expansion Valve CF-6R art 6 of 12
- l
44
P.O. BOX 1504
Building53-584 Avenida Madero LA QUINOTAC
Address CALIFORNIA 92253
Owner
Rannetb R88beM
Mailing
Address 53-584 Aeeni
City Zip
%a Quiinta
Contractor
Mr. Rooter
Address
P.G. Box 3385
I.
(619) 779-0190
City Palin Desert Zip 92261 Tel. (610 779-0190
State Lic. City
& Classif. 610657 Lic. # 1602
Arch., Engr.,
Designer
Address Tel.
City Zip State
1 Lic. #
LICENSED CONTRACTOR'S'QECLARATION
I hereby affirm that I amflicensed underprovisions f Chapter 9 (commencing with Section
70 00) of Division 3 otfthe'Business and p.ofes ons Code, and my license is in frill force "nd
effect. /3- — 1( s e
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5, Business band Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to file a,signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. he 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, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon and who does such work himself or through his own employees,
provided that such 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 did not build or improve for the purpose of sale.)
❑ I, as owner.of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thg 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.
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days.
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 the above-.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
No. 12642
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number
Legal Description
Project Description &at Hater Heater ReplacAment
Sq. Ft. No. No: Dw.
Size Stories Units
New Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
AMOUNT
Driveway Enc.
Infrastructure
TOTAL $ •
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Seiliack from Center Line
Rear_Setback from Rear Prop. Line -
Side Street Setback from Center Line
FINAL DA
Issued by
Validated
Validatior
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL.SQ. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
2ND FL. SQ. FT. @
FORMS
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT. ®
OTHER APPJEQUIP.
DRAINAGE PIPING
WALL SQ. FT.
TEMP. POLE
DRINKING FOUNTAIN
SQ FT ®
GROUT
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
_$
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
SPARK ARRESTOR
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LATHING
SQ.FT.GAR ® 3/ac
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
% h
•
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION ,
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL