09-0303 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T4ht 4 4a 9"
Applicant: Architect or Engineer:
-----------------
LICENSED CONTRACTOR'S DECLARATION
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 Business and Professionals Code, and my License is in full force and effect.
Licens�jlass: C36 LicenseNo.: 828264
ate7•� %tractor: 3
OWNEIBUILDE561ECI ARATION
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 1$5001.:
(_) 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 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: 4/02/09
Owner:
SAHARA SANDOVAL
53080 AVENIDA RUBI
LA QUINTA, CA 9229
Contractor:
FOY, SCOTT A- .
43579 MAIN S •REET 0,9
INDIO, CA 9220
(760) 775-9405
Lic. No.: 828264 :. ii ••
------------------
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 subject to the workers' compensation provisions of Section
3700 of the Labor Code shall forthwith comply with those provisions.
te: rC�plicanr. 1 ! 5)i1'
WARNING: FAILURE TO SECURE WORKERS' COMPS SATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES 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 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
of this county to enter upon the above-mentioned property for inspection purpo;a .
te:/;�•—r—/' cure (Applicant or Agent): _
Application Number:
09°=00-00'030.3��
Property Address:
5 -3 -0 -"—AVE N_ I_DA7__iUB 10
APN:
774-043-004-21 -000000-
Application description:
PLUMBING
Property Zoning:
COVE RESIDENTIAL
Application valuation:
500
T4ht 4 4a 9"
Applicant: Architect or Engineer:
-----------------
LICENSED CONTRACTOR'S DECLARATION
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 Business and Professionals Code, and my License is in full force and effect.
Licens�jlass: C36 LicenseNo.: 828264
ate7•� %tractor: 3
OWNEIBUILDE561ECI ARATION
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 1$5001.:
(_) 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 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: 4/02/09
Owner:
SAHARA SANDOVAL
53080 AVENIDA RUBI
LA QUINTA, CA 9229
Contractor:
FOY, SCOTT A- .
43579 MAIN S •REET 0,9
INDIO, CA 9220
(760) 775-9405
Lic. No.: 828264 :. ii ••
------------------
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 subject to the workers' compensation provisions of Section
3700 of the Labor Code shall forthwith comply with those provisions.
te: rC�plicanr. 1 ! 5)i1'
WARNING: FAILURE TO SECURE WORKERS' COMPS SATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES 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 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
of this county to enter upon the above-mentioned property for inspection purpo;a .
te:/;�•—r—/' cure (Applicant or Agent): _
Application Number . . . . . 09-00000303
Permit . .
. PLUMBING
Additional desc .
Permit Fee . . .
. 22.50
Plan Check Fee
5.63
Issue Date . . .
.
Valuation . . .
. 0
Expiration Date .
. 9/29/09
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00. 7.5000
EA PLB WATER
HEATER/VENT
7.50
----------------------------------------------------------------------------
Special Notes and
Comments
REMOVE & REPLACE
40 GALLON ELECTRIC
WATER HEATER
----------------------------------------------------------------------------
Other Fees . . .
. . . . . . BLDG STDS ADMIN (SB1473)
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
1
CERTIFICATE OF CQMPLIANCE: RESIDENTIAL (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 de building department for each home for which the following. are
OR
❑ Alternative to Sealed Ducts and Refrigerant Charge /IXVs (See Package D Alternative Package Features for
Project Climate Zone injthe RM Appendix B Table 151-C, Footnotes 7-14.
OR
For additions and alterations, duct systems that are not documented to have been previously
❑ 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 150(m) and duct insulation requirements of Package D.
if
Check box if system meets criteria of a "Standard" system. Standard system is one gas-fired water heater per
dwelling unit. If the water heater is a storage type, 50 gallons is the maximum capacity and recirculation system is
not allowed.
Check box when using iPreapproved Atterrtative Water Heating table, Table 5-4 in Chapter 5 in the Residential
❑ Manual. No water heati 11 ng calculations are required, uired, and the system complies automatically.
Check box if system does not meet criteria of"Standard" system, and does not comply with the Preapproved
[I Alternative Water Heating table. In this case, the Performance Method must be used and must be included in the
submittal.
❑ for a recirculating system pump for a system servingjmultiple
Check box to verify that a time control is required
units
5 servin single dw,ellin
utreu.
❑
Sealed Ducts all climate zones Lnstaller testing and certification and IRS rater field verification re aired.
Ener
TXVs, readily accessible (climate zones 2 and 8-15 only)
❑
Installer testing and certification and HERS Rater field.veri.fication required.)
Refrigerant Charge (climate zones 2 and 8-15 only) (Installer testing and certification and HERS Rater field
❑
verificationrequired.)
OR
❑ Alternative to Sealed Ducts and Refrigerant Charge /IXVs (See Package D Alternative Package Features for
Project Climate Zone injthe RM Appendix B Table 151-C, Footnotes 7-14.
OR
For additions and alterations, duct systems that are not documented to have been previously
❑ 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 150(m) and duct insulation requirements of Package D.
if
Check box if system meets criteria of a "Standard" system. Standard system is one gas-fired water heater per
dwelling unit. If the water heater is a storage type, 50 gallons is the maximum capacity and recirculation system is
not allowed.
Check box when using iPreapproved Atterrtative Water Heating table, Table 5-4 in Chapter 5 in the Residential
❑ Manual. No water heati 11 ng calculations are required, uired, and the system complies automatically.
Check box if system does not meet criteria of"Standard" system, and does not comply with the Preapproved
[I Alternative Water Heating table. In this case, the Performance Method must be used and must be included in the
submittal.
❑ for a recirculating system pump for a system servingjmultiple
Check box to verify that a time control is required
units
5 servin single dw,ellin
units
Ener
Tank
Rated
Input] Tank
Factorvor
Thermal
Standby!
External
Insulation
Water Heater
Distribution
Number
(kw or Capacity
Efiicienc
Loss %
R -Value
e/Fuel T
Type
in S stem
Btwily (gallons)
o Z
Energy
Tank
sery ig multiple dkwellin
units
Rated
Factor or
External
Water Heater
Distribution
Number
Input' Tank
(kw or Capacity
Thermal
Efficient
Standby;'
Loss %;
Insulation
-Value
T e
T e
in S stem
atu/hr aeons
_E
--------------------------
r), electric
sisiance, and
1. For small gas storage) water heaters (rated inputs of esas i than orage°pater heaters (ratequal to 0ed input of greater than 75,000 heat
pump water heaters, lust Energy Factor. For large g
Bttt/hr), list Rated Input, Recovery Efficiency, The
Efficiency and Standby Loss. For instantaneous gas water
heaters, list Rated Input and Thermal Efficiencies.
pii=tion (kitchen hes ? 3/4 inches) All hot water Pipes from the heating source to the kitchen fixtures that are '/4
inches or greater to diametershall be thermally insulated as specified by Section l50 (j) 2 A or 150 (j) 2 B.
March 2005
Residential Compliance Forms
Bin #
City of La Q ' nta
suff fig ar Safety Division
P.O. Box 1504, 78=495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Perrtgt #
0 a 3
Project Address:
Owner's Name: Sq k. a. r6 ` %1 oua
;
A. P. Number:
Address: 5; 3 00 j a
ll, Q
Legai Description:
Contractor: S C"C'A4V �
? I (,t rr) J i
City, ST, Zip: LO .1
Telephone: ?
Project Description: V0
Address: 4 31:� 7 9 0.t.
city, sc, zip:- r (� G� G
Telephone:
Stat. Li.. #: 0 2$ 2 y
1 r Q
City Lic'. C S `i, 47 p
Arch., Bag., Designer.
Address:
City., ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person:
Telephone # of Contact Person:
y Construction Type: Occupancy:
+project type (circle one): New Add'n Alter Repair Demo
Sq. Ft: # Stories: # it its:
Estimated Value of Projec_ ,5
APPLICANT:,DO NQT WRITE_BEWW.THIS LINE_
#
Submittal
Req'-d.,__
Rtc':d
TRACKING
PERMIT FEES
Plan SW
Plan Check submitted
Item
Amount
&,uctural meq,
Reviewed, ready for corrections
Plan Check Deposit
Truss gyp,
Caped Coated Person
Plan Cheek Balance.
Tide 24 tales
Pb- picked up
Conatrnctlon
Flood plain Plan
Plans resubmitted
Mechanical
Grading
2°" Review, ready for correctionsIlsaue
Electrical
Snbeontactor List
Called Contact Person
Plumbing
Ghat Deed
Plans picked IIP
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:
Reyiew, ready for cormctiowrissue
Developer Impart Fee
Planning Approval
Called Coaiact Person
A.I.P.P.
'
Date of perkilt issue
Pub. Wks. Appr
School Fees
Total Permit Fees