07-0419 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
pp C07-00000419 ,
Property Address: 54260 AVENIDA RUBIO
APN: 774-235-001-24 -000000-
Application description: PLUMBING
Property Zoning: COVE RESIDENTIAL
Application valuation: 500
Applicant:
Tity/ 4 e4� Q"
Architect or Engineer:
P /A
------------------
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
I hereby affirm under penalty of perjury that I am licensed der provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and P ofess' als Code, and my License is in full force and effect.
License Class: CC3��66 License No.: 828264
ate Z a l �ti ( ontractor.
1101 7oo
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.).
1 _ 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.).
(_ 1 1 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: P1 11
LQ7RMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 2/07/07
Owner:
JERRY CHAFFIN n a
54260 AVENIDA RUBIO
LA QUINTA, CA 92253
_ FEB 212007
�[
Contractor: I CITY OF LA QUINTA
FOY; SCOTT A. FINANCE DEPT
43579 MAIN STREET
INDIO, CA 92201
(760)775-9405
LiC. No.: 828264
------------------
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 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 be c bject to the workers' compensation provisions of Section
3700 of the Labor Code, I s II f rthwith comply with those provisions.
/i
Ke: Z(� cant:
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 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 fallowing 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 inform on is correct. I agree to comply with all
city and un
ordinances and state laws relating to building construc - n, and hereby authorize representatives
of th' '7county/to enter upon the above-mentioned propert o ins ec n purposes.
ate:li_Z` - ature (Applicant or Agent):
i N
u)roro I
Ft N (D I
aan+
H 'nn' rt
rt P) PV Ik<
Fl
00
rr
rt
�ro
pJ
I N -
p,
0001
0001
I
I
I
r t�
N N t
00 In N I (D
H 0) Ln 1
W W O
I
I
I
I
tij 'd co I
rW'd
Wz d (D
HNH I O
H rt
F -I M (D
Halm 1
xa�
; -
H 1 to
t+j C] I o
x10 1 0
X10
Vt. 1
H(D 1 w
F-3
rrt
m i
1P !
O I
row
w co
I t+j
hj
I HW
I taj t17
I �
I
rx
H
I �
1C
I z
1H
wHro>1ro
m (D ¢ fD
1dm�¢+n
N- GP- Fl
ift Fl 0)i O rt Pft
w 0) hxj 0
0 rr (D a
x
dmmN
�• � . (D
rr rr m
(D
n
a
W
ro
r
m 00
O N H
m N 'Z
I- • 0
o U1
J o
N I%'
G P)
a
p n
X
rIj
(D
(D
ro
N-
a
rr
0
z
G
�r
m
n
Dill it
City of LaQfffh7ta
BuildlnD F,rSafety Division
hTnilt t1 S2J�/' ' P-0. Box 1504, 78-495 Elle Tampico
" La Quints, CA 92253 - (760) 777-70 f 2
l Building Permit Application and Tracking Sheet
1'rojeetAit—ddress: S"`�L�U C�JfCJlI'� /'fl�� Owncr'sNwne:.
A. P. Number: G Add—GI /7 1 n!i n . i...
Conuacutr. _-pc
Atldrecs: C_. 17 jIrLi
Lin. ST,_jP• b the
Telephone:_ -77 vi– 0,
1 Slaw Lie d j�
l Arch., Er r., Designer:
>"r'\�d'dr`css::
City: ST, Zip:
Tolephona:
Stale Liv. R:
Nanta of Coninct Perron:
Telephone 4 ofCotttucl Petstm:
H Sulanlital Req'd
plan Sets
Structural 6:alc.
Taus Calcs.
rill 24 (Sirs.
Mood plain pitm
Golding plan
Sukcentsaor Ust
Grant Deed
11.0.4. Approval
IN HOUSE:-
Ylaanlag ApprorMl
Pali. MC. Appr
School FCC:; I
1
City, ST, Zip: tCk_aUjy)H&
b C'_ t TelephoLe: r�wTina»t�-
n C 1 YrojcctDtscdp itm:
G2, G C) t E r, `,rte .r lr�n,. ;_.� r ,rw .n1 r►r v vrn� to
City U 4:
;7rx tc R N- _ Constnrction T
R3X_"•o %>r.y ix �.'yr+. y?}�. 'tet
Projcci twos (circle ones Ner. Add'n /User cR pair nano
Sq. FL: 15toriLs: N Units:
_-- Fstinmtcd value Of Pmjcc't 't5Cr1 t L
APPLICANT: DO NOT WJRITF RFi n?Al Tune a rare
Recd
TRACMG – r P£R]►1t717EFS ._ �..
Pion Check subtaitted Frew Amount
r-it�r carrcctioas
? Plan Check Deposit
JCalled CoattacrPerson
Plan Check Baluttw
Maas picked up
4 Constroetion
Plans resubmitted
1lfechnoica1
21 Review, ready ror eorrectioR<rUme
Electrical
Called Contact Person
Plamfo"re,
Plans picked up
S.M.I.
Plans resubmitted
Grading
F eview. ready for eorreetloas/issue
r (Developer Impact Fee
Called Contact Ptrson
r
(bate olpermit issue
It
Total Permit Fees 1
0_
CERTIFICATE OF COMPLIANCE: RES TJf AL (?ipa of
,
f
D
Date
CF -IR
A signed CF -41K Form must be provided to the building department for each home for which the following. are
required.
I/
Distribution
Type
O
Seated Ducts ail clirrrate zones)-(Irrstallerthsting and certification and HERS rater field verif cationrequired.)
13
TXVs, readily accessible (climate zones 2 and 8-15 only)
Installer testing and certification and HERS Rater field verification required.)
D
Refrigerant Charge (climate zones 2 and 8-15 only) (Installer testing and certification and HERS Rater field
verification ' q uired.
OR
❑ IAlternative to Sealed Ducts and Refrigerant Charge frXVs (See Package D Alternative Package Features
Pro'e ct Climate Zone in the RM Appendix B Table 151-C, Footnotes 7-14.
OR
For additions and alterations, duct systems that are not documenteddo have been previously -
17 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
aces shall meet the requirements of Section 159(m) and duct insulation requirements of Package D.
yrIfti_rIn nr.Ajimis bYJ1E1VIN
VI
Distribution
Type
Number
in System
1
Check box if system meets criteria of a "Standard" system. Standard system is one gas-fired water heater per
O
dwelling unit. If the water heater is a storage type, 50 gallons is the maximum capacity and recirculation system is
not allowed.
O
Check box when using Preapproved Alternative Water Heating table, Table 5-4 in Chapter 5 in the Residential
Manual. No water heating calculations are required,and the system complies automatically.
Check box if system does not meet criteria of "Standard" system, and does not comply with the Preapproved
13
Alternative Water Heating table. In this case, the Performance Method must be used and must be included in the
submittal.
❑
Check box to verify that a time control is required for a* recirculating system piunp for a system serving multiple
units
Water Heater
Type/Fuel Type
(4614141
Distribution
Type
Number
in System
1
Rated
Input' Tank
(kW or Capacity
Bwft) (goIons
�5C1Z�
Energy Tank
Factor' or External
Thermal Standby' Insulation
Efficiency Loss % R Value
RZ
oyaaCtn bCrYruL' multiple awemn9 units
Water Heater
Type
Distribution
Type
Number
in System
Rated Energy
Input' Tank Factor or
(kW or Capacity Thermal
BWhr) (gitltons Efficiency
Tank
External
Standby Insulation
Loss % R -Value
• • ... muau sa, Storage water heaters (rated inputs or less than or equal to 75,000 BhAr), electric resistance, and heat
pump water heaters, list Energy Factor. For large gas storage water heaters (rated input of greater than 75,000
Btu/hr), list Rated lnput, Recovery Efficiency, Thermal Efficiency and Standby Loss. For instantaneous gas water
heaters, list Rated Input and Thermal Efficiencies.
Pipe Insulation (kitchen lines > 3/4 inches) All hot water pipes from the heating source to the kitchen fixtures that are 3/a
inches or greater in diameter shall be thermally insulated as specified by Section 150 6) 2 A or 150 0) 2 B.
Residential Compliance Forms
March 2005
f
sl
4-0
CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 1 of 4) CF -IR
Address
Documentation Author
Compliance Method (Prescriptive)
Telephone
Climate Zone
Date
Building Permit tl
Plan Check / Date
Field Chock / Date
Enforcement Agency Use Only
✓ C3 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 -1 R page 3)
For Package D Alternative see Appendix B Table 151-C Footnotes 7-14
GENERAL IlOORMATION
Total Conditioned Floor Area (CFA) ft Average Ceiling Height: f1
Maximum Allowed West Facing Fenestration Products Per Table 151-B or 151-0 --(5% X CFA) ftZ
Maximum Allowed Total Fenestration Products Per Table 151-B or 151-C — (20% X CFA) g
O Building Type: (chock one or more) Single Family Multifamily Addition Alteration
(if adding fenestration fill out WS -4R, Fenestration Maximum Allowed Area Worksheet and see Section 8.3.2
for Additions and 8.3.3 for Alterations.)
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 2.4.8-15)
OPAQUE SURFACES INCLUDING OPAQUE DOORS
Component
Type (Wall,
Roof, Floor,
Slab Edge,
Doors)
Frame
Type
(Wood
or Metal)
� Assembly U -
factor (for
Cavity Continuous wood, metal
Insulation Insulation frame and mass
R -Value R -Value assemblies 21
Joint
Appendix
IV
Reference
Roof Radiant
Barrier 1.=tion/Comments
Installed (attic, garage,
Yes or No tyeical, etc.
1) See Joint Appendix IV in Section 1V.2, IV.3 and IV A, wtuch is the basis for the Li -tactor criterion. u-tactorZS oml 11UL
exceed prescriptive value to show equivalence to R -values.
Residential Compliance Fors
March 2005
T I
SPECIAL FEATURES NOT REQUIRING HERS VERIFICATION (add extra sheets if necasary)
Indicate which special features aro part of this project. The list below only represents special features relevant to the
✓ I
Feature
Required Forms if applicable)
Description
O
Metal Framed Walls
CF -IR
Refrigerant Charge
❑
Radiant Barriers
CF -IR
CF -611 part 6 of 12
❑
Exterior Shades
WS -4R
N/A; Attach CRRC Label to
❑
Cool Roof
Forms.
0
Dedicated Hydronic Heating
Performance Calculation
system
Required; Attach Run to Forays.
Performance Calculation
❑
Combined Hydronic System
R uired; Attach Run to Fors.
❑
Gas Cooling
Performance Calculation
Required.
❑ 1
Buried Ducts
N/A; indicate on building plans.
❑
Kitchen Pipe Insulation
See Section 5.6.2 Distribution
Systems in Residential Manual.
Multiple Water Heaters Per
See Table 5-13 or use
13
PerformanceUnit Performance Calculation and
attach Run to Forms.
❑
Central Water Heating System
Performance Calculation and
Serving Multiple DwcJlings
attach Run to Forms.
❑
Non-NAECA Large Water
CF -IR
Heater
See Table 5-13 or use
❑
Indirect Water Heater
Performance Calculation and
attach RVn to Forms
See Table 5-13 or use
❑
Instantaneous Lias 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 Foriyu
❑
1 Wood Stove Boiler
Performance Calculation and
attach Run to Forms
SPECIAL FEATURES REOUMNG HERS RATER VERIFICATION
(add exi.7a sheets if necessary) Indicate to the HERS Rater which credits are part of this project and need
verifiralinn
Ir
Feature
Required Forms if applicable) Description
❑
Duct Scaling
CF -6R part 4 of 12
❑
Refrigerant Charge
CF -6R part 5 of 12
❑
Thermostatic Expansion Valve
CF -611 part 6 of 12
Residential Compliance Forms
March 2005
JAN -19-2007 15:56 FROM -home depot expeditors
+97607752687
T-299 P.002/003 F-454
DETAIL STARTS HERE
Date: 01/19/2007
FAX PURCHASE
ORDERS
Page: 2
FAX: (760)
775-2687
FROM: THE HOME DEPOT
PHONE: (760)
347-8722 Ext. 382
STORE 6630: LA QUINTA
79900 HIGHWAY 111
LA QUINTA, CA 92253
this number to invoice The Home Depot) P.O.
Nbr 30459958==O==_=
CHAFFIN# JERRY=====_=
_
For customer:
293-867 WATER HEATER INSTALLATION
INSTALLATION SITE:
PHONE: (760)
564-5035 Ext.
CHAFF7:N, JERRY
54.260 RUBIO AVE
LA QUINTA, CA 92253
TRIP CHARGE: $0.00
CUSTOMER NAME: JERRY CHAFFIN
(760) 564-5035 WORK
Ext
PHONE:
ORDER: 198247 REF #: 1p4
No merchandise selected.
MERCHANDISE WILL ARRIVE AT SITE VIA•THE
FOLLOWING:
WATER HEATER INSTALLATION
OPTIONAL LABOR PURCHASED:
15 ...PERMIT AS REQUIRED (SEE PRICE
LIST)
LA QUINTA
1.00 UM: EA Price Ea.:
$22.00
Extension: S 22.00
Quantity:
SPECIAL INSTRUCTIONS:
PERMIT
$22.00
-T,07-7/6
INSTALLATION LABOR SUB -TOTAL:__ ---$2 2.00
--
INSTALLATION LABOR TOTAL: !1
9 $2
00002200 ________= nd P.O. Nbr 30459958=======
•
,r