PLBG (08-1831)4 P O. BOX 1504 ^�
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253. BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: ( 08-00001831 Owner:
Property Address: 51650 AVENIDA MENDOZA LAWSON BRIAN D
APN: 773-143-025-19 -000000- 51650 AVENIDA MENDOZA
Application description: PLUMBING LA QUINTA, CA 92253
Property Zoning: COVE RESIDENTIAL
Application valuation: 500 I D
c
Contractor: i
Applicant-. Architect or Engineer: FOY, SCOTT A.
43579 MAIN STREET
INDIO, CA 92201
(760)775-9405
Lic. No.: 828264
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: C36 License No., 28264
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 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 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
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/07/08
e �
gay 07 2008
CITY OF LA
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 FIRST COMP INS Policy Number WS1004457
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 su ject to the workers' compensation provisions of Section
��� of the Lab od , I hall fo comp)µ with those p ons.
Dat Applica I ' . A
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 rbstrictions 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 const- ction, and hereby autho a epresentatives
of this n to ente upon the above-mentioned prop for insp iah purposes -
Dat( Signature (Applicant or Agent):
Application Number . . . . . 08-00001831
Permit . . . PLUMBING
Additional desc . .
Permit Fee . . . . 22.50 Plan Check Fee 5.63
Issue Date . . Valuation 0
Expiration Date 5/06/09
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 GAS WATER HEATER WITH NEW 40
GALLON GAS WATER HEATER.
Fee summary Charged
----------------- ----------
Permit Fee Total 22.50
Plan Check Total 5.63
Grand Total. 28.13
LQPERMIT
Paid Credited Due
---------- ---------- ----------
.00 .00 22.50
.00 .00 5.63
.00 .00 28.13
CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 3 of 4) CF -1R
Project Title
R
SEALED DUCTS and TX -Vs (or Alternative Measures)
A signed CF -4R Form must be provided to the building department for each home for which the following. are
required.
OR
O Alternative to Sealed Ducts and Refrigerant Charge /TXVs (See Package D Alternative Package Features for
Project Climate Zone in the RM Appendix B Table 151-0, Footnotes 7-14.
OR
For additions and alterations, duct systems that are not documented to have been previously
0 sealed as confirmed through field verification and diagnostic testing in accordance with procedures in the
Residential ACM Manual and duct systems with more than 40 linear feet in unconditioned
spaces shall meet the requirements of Section 15 m) and duct insulation requirements of Package D.
WATER HEATING SYSTEMS
Distribution
Type
O
Sealed Ducts all climate zones(Installer testing and certification and HERS rater field verification required.
Tank
Capacity
loos)
TXVs, readily accessible (climate zones 2 and 8-15 only)
Standby`
Loss %
(Installer testing and certification and HERS Rater field verificationrequired.)
Refrigerant Charge (climate zones 2 and 8-15 only) (Installer testing and certification and HERS Rater field
O
verificationrequired.)
OR
O Alternative to Sealed Ducts and Refrigerant Charge /TXVs (See Package D Alternative Package Features for
Project Climate Zone in the RM Appendix B Table 151-0, Footnotes 7-14.
OR
For additions and alterations, duct systems that are not documented to have been previously
0 sealed as confirmed through field verification and diagnostic testing in accordance with procedures in the
Residential ACM Manual and duct systems with more than 40 linear feet in unconditioned
spaces shall meet the requirements of Section 15 m) and duct insulation requirements of Package D.
WATER HEATING SYSTEMS
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Water Heater
Type/Fuel Type
ct..,.,...... .,It;..te
Distribution
Type
Number
in System
Check box if system meets criteria of a "Standard" system. Standard system is one gas-fired water heater per
Tank
Capacity
loos)
dwelling unit. If the water heater is a storage type, 50 gallons is the maximum capacity and recirculation system is
Standby`
Loss %
not allowed.
Check box when using Preapproved Alternative Water Heating table, Table 5-4 in Chapter 5 in the Residential
O
Manual. No water heating calculations are required, and the system complies automatically.
Tank
Check box if system does not meet criteria of "Standard" system, and does not comply with the Preapproved
O
Alternative Water Heating table. In this case, the Performance Method must be used and must be included in the
Water Heater
submittal.
Number
Check box to verify that a time control is required for a recirculating system pump for a system serving multiple
O
unit
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Water Heater
Type/Fuel Type
ct..,.,...... .,It;..te
Distribution
Type
Number
in System
Rated
p
(kW or
Btwbr)
Tank
Capacity
loos)
Enec
Factory or l
Thermal
Efficient
Standby`
Loss %
Tank
External
Insulation
R -Value
�-5AL�i
Rated
Input
Tank
Factor or
External
Water Heater
Distribution
Number
(kw or
Capacity
Thermal
I
Insulation
Type
Type
in System
BUOU)
kg8floru)
Efficienc •
Loss %
R -Value
A-11;.., vanire
�.i JWau JG� ♦ iYW
Enerv,
Tank
Rated
Input
Tank
Factor or
External
Water Heater
Distribution
Number
(kw or
Capacity
Thermal
Standby'
Insulation
Type
Type
in System
BUOU)
kg8floru)
Efficienc •
Loss %
R -Value
I. For small gas storage water heaters (rated input of less than or equal to 75,000 tsuunr), ClUkAf1f; ccaiaLa+nc, anu Ilez
pump water heaters, list Energy Factor. For large gas storage water heaters (rated input of greater than 75,000
Btu/hr), list Rated Input, Recovery Efficiency, Thermal Efficiency and Standby Loss. For instantaneous gas water
heaters, list Rated Input and Thermal Efficiencies.
Pipe bsWatlon (kitchen lines >_ 3/4 inches) All hot water pipes from the heating source to the kitchen fixtures that are 3/4
inches or greater in diameter shall be thermally insulated as specified by Section 150 0) 2 A or 150 0) 2 B.
Residential Compliance Forms Manch 2005
A
10/.12/20114 TUE 8:53 FAC 760 777 71.12 Bl.dg & Saftey
Birt #
Permit # A�3k
6�
Project
A. P. Numbcr:
Contracwr:
Address: J
City, ST, Zip:_ - . W D
Tclephon�7s-���
State Lie. 4 : � xw
Arch., Ergr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. 0:
Name: of Contact Person
Telephoned of Contact Person:
N Submittal Req'd
Plan Sets
Structural Cales.
TnM Cafes.
Title 24 Coles.
Flood plain plan
Grading plan
Sullcontactor List
Grant Deed
Ii.O.A. Approval
IN ROUSE:
Planning Approval
Pub. Wks. Appr
School Fees
City of La Quinta
Building 8t Safety DMdon
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777.7012
Building Permit Application and Tracking Sheet
VOwner's Name:, b r i
Addre:-.-:5' A t
City, ST, Zip: I n i l o 4 G PA
Project Description:
Lic. 4:
Ci
(1001/001
Total Permit Fees
rr 3:tMIN, NOConstruction
Type: Occupancy:
Project type (circle one): New Add'n Atter Repair Dano
Sq. Ft.:
Stories:
4 Units:
Estimated Value of Project
APPLICANT: DO NOT WRITE BELOW THIS LINE
Recd TRACMG
PERMIT FEES
Plan Check submitted
Item
Amount
Reviewed, ready for corrections
Pian Cheek Deposit
Called Contact Person
Plan Check Balance
Pians picked up
Construction
Plans resubmitted
Mechanical
y°" Review, ready for correctionsilssue
Electrical
Called Contac. Person
Plumbing
Pians picked op
Plans resubmitted
Grading
"0 Review, ready for eorreedonslissue
Developer impact Fee
Called Contact Person
A.U.P.
Date of permit issue
Total Permit Fees