10-0286 (PLBG)P.O. BOX 1504
78-495 CALLS TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 10-00000286
Property Address: 54300 AVENIDA RUBIO
APN: 774-235-026-23 -000000-
Application description: PLUMBING
Property Zoning: COVE RESIDENTIAL
Application valuation: I • 600
Applicant: -
T4ty�
"
BUILDING & SAFETY DEPARTMENT
. BUILDING PERMIT
Architect o/r Eang�ineer:
--------------------------------------------------
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.
LicenseeCClass: C36 kense No.. ----9'7 8 9 2 1
abate:! o Contractor:
OWNER-BUILDEpncityor
ATION
I hereby affirm under penalty of perjury that I am exempt from thtor's State License Law for the
following reason (Sec. 7031.5, Business and Professions Code: county that requires a permit to
construct, alter, improve, demolish, or repair any structure, priorance, 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.).
(_) 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.I.
Lender's Name:
Lender's Address:
LQPERA11T
Owner:
PALMER CAROLYN
54300 AVENIDA RUBIO
LA QUINTA, CA 92253
(
_ Contractor:
PACIFIC EXPRESS INSTLL/SVC I
P.O. BOX 2590
CARLSBAD, CA 92018-2590
.(760)720-1613
Lic. No.: 878921
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/06/10
------------------
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 TOWER SELECT Policy Number WD9331035310
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 wor 'compensation laws of California,
and agree that, if I should become subject to the work ' co pensation provisions of Section
3700 of the Labor Code, I shall forthwit comply w' those rovisions.
\Date: Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATIO OV AGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIV F S UP TO ONE HUNDRED THOUSAND
DOLLARS 1$100,000). IN ADDITION TO THE COST OFC NSATION, 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 Ouinta, 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 1 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 construct' and hereby authorize representatives
of thiscounty' to enter upon the above-mentioned ro spectio urposes.
/
Date: "f —& (Ci Signature (Applicant or Agent):. / 9
Application Number . . . . . 10-00000286
Permit . . . . . PLUMBING
Additional desc .
Permit Fee . . . . 22.50
Plan Check
Fee
5.63
Issue Date . . . .
Valuation
. . .
. 0
Expiration Date 10/03/10
Qty Unit Charge Per
Extension
BASE
FEE
15.00
1.00 7.5000 EA PLB
WATER HEATER/VENT
7.50
----------------------------------------------------------------------------
Special Notes and Comments
(1)WATER HEATER CHANGE OUT GAS
STANDARD
--40--GALLON TANK CAPACITY-.
_: _...
_.... _ • .
----------------------------------------------------------------------------
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
LQPERMTT
Prescriptive Certificate of Compliance: Residential CF -IR -ALT
Residential Alterations a e 1 of 5
Project Name: (� Climate Zone # # of Stories
5y3M �V�eln 1 Jc, X 10 - _ /.�
"mnFrai
PA a,l
General informationi.
.S 4v, ( ,
Site Address:
Enforcement Agency:
Date: _/
Building Type mgle Family ❑ Multi Family
Circle the Front Orientation: N, E, S, W, or degrees
Conditioned Floor Area (CFA):
Project Type: ❑ Alterations 0 Envelope O Fenestqtqon ❑ Roof ❑ HVAC
Comment
Replacement or Change Out ❑ Duct ReplacementA ReplacementWater Heater
NOTE: This form is not to be used for Newly Constructed Buildings
or Additions
Insulation Values For Opaque Surfaces (for Furring use the Mass and Furring Strips Construction table below)
Assembly Alteration
❑ Opening of framed cavity. alone—Alterations that involve the opening of the framed cavity ofa wall, ceiling, orfloor must install the
mandatory minimum insulation value per §1 S0 for the altered assembly. Fill in Columns A —C and enter mandatory insulation value in Column H.
❑ Replacement of entire assembly— Replacement ofan entire wall, ceiling, or floor assembly requires the installation of Component
Package- D insulation values in Table 151-C Fill in.Columns A —J.
Opaque Surface Details For the furred rtloned of Mass Walls see Furring Strips Construction Table below.
A B I C D- E F G I H I T-7 J
Proposed see 140te Standard Values From JA4 Table
Framing
Tap/ Assembly Name Material
ID or and Size
Thickness, Framed
Spacing, U- JA4 Table Cavity
or Othe? factor4 Numbers R-value6.
Continuous JA4 Proposed
Insulation Assembly Assembl
R -Value Cell Values U -facto
Added Interior or Exterior Insulation
in Furring Space from Reference
Joint Appendix Table 43.13
Final
Assembl
U-facW 7
Comment
Mass
Thickness'
0 w
Assembly
Name or JA4 Table f a
Type? Number' Q
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o g •a o Veo u.
7 o a o o a
x I °P. '
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')Vote: For furred assemblies, accounting for Continuous Insulation R -value, see Page JA4-3 and Equation 4-1. For calculating furred walls use the Mary and
Furrin Construction table below.
1. For Tag/ID indicate the identification name that matches the building plans.
2. Indicate the Assembly Name or type. Roof/Ceiling, Walls, Floors, Slabs, Crawl Space, Doors and etc ... Indicate the Frame type and Size: For
Wood Metal, Metal Buildings, Mass, enter 2x4, 2x6, or etc... see JA4 for other possible frame type assemblies.
3. Enter the thickness for mass in inches or Spacing between framing members enter; 16 "or 24 "0C, or Other for all other assembly description
such as Concrete Sandwich Panel, Spandrel Panel, Logs, Straw Bale Panel and etc....
4. Based on the Climate Zone, enter the Standard Ufactor from Table /51-B, C or D for each different assembly Name or type.
5. Enter the Table number that closely resembles the proposed assembly.
6. Enter the R -value that is being installed in the wall cavity or between the framing; otherwise, enter "0".
7. Enter the Continuous Insulation R -value for the proposed assembly; otherwise, enter "0 ".
-8: Enter-the-row-andcolumn -of-the-{- -factor-value-based-on-Column F Table Number and -enter -the Assembly U -actor in- Eo(umn J
9. The Proposed Assembly U factor, Column J, must be equal to or less than the Standard U factor in Column E to comply.
Furring Strips Construction Table for Mass Walls Onl
A B C D I E
F I G H I d I K
L
M
Proposed Properties of Masonry and Concrete
Walls From Reference
Joint Appendix Table 43.5 43.6 43.7
Added Interior or Exterior Insulation
in Furring Space from Reference
Joint Appendix Table 43.13
Final
Assembl
U-facW 7
Comment
Mass
Thickness'
0 w
Assembly
Name or JA4 Table f a
Type? Number' Q
� �
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o g •a o Veo u.
7 o a o o a
x I °P. '
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Registration Number: Registration Date/time: HERS Provider.
2008 Residential Compliance Forms August 2009
Certificate of
Residential Alterations .
Project Name:
: Residential
Veva do
CF -IR -ALT
(Page 4 of 5)
Climate Zone # I # of Stories
HVAC SYSTEMS - HEATING
!List water heaters and boilers for both domestic hot water (DHii) heaters and hydronic space heating. Individual dwelling DHW heaters must be
gas or propane fired, and may not exceed 50 gallons. Hot water pipe insulation from the DHW heater to the kitchen(s) and on all underground
Minimum
Duct or Piping Configuration
Heating Equipment
Type and Capacity'
Efficiency Distribution
AFUE or HSPF Type and Location°
Insulation Thermostat (Central, Split,
R -Value Type Space, Package or H dronic
External Tank
Water Heater Type/Fuel
Distribution Type
Number In
Tank
1. Indicate Heating Type (Central Furnace, Wall Furnace, Heat pump, Boiler, Electric Resistance, etc.)
2. Electric resistance heating is allowed only in Component Package C, or except where electric heating is supplemental (i.e., if total capacity
< 2 KW or 7,000 Btulhr electric heating is controlled by a time -limiting device not exceeding 30 minutes). See §151(6)3 exception.
3. Refer to the HERS Verification section on Page 4 of the CF -JR -ALT Form for additional requirements and check applicable boxes.
4. Indicate Type or Location (Ducts, Hydronic in Floor, Radiators, etc.)
HVAC SYSTEMS - COOLING
Minimum
Efficiency Duct or Piping Configuration
Cooling Equipment (SEER/EER or Distribution Insulation Thermostat (Central, Split,
Type and Capacity 1.2 COP) TylN. and Location R -Value Type Space, Package or H dronic
1. Indicate Cooling Type (A/C, Heat pump, Evap. Cooling, etc)
1. Refer to the HERS Verification section on Page 4 of the CF -JR -ALT Form for additional requirements and check applicable boxes.
3. Indicate Type or Location(Ducts, H dronic in Floor, Radiators, etc.
WATER HEATING
!List water heaters and boilers for both domestic hot water (DHii) heaters and hydronic space heating. Individual dwelling DHW heaters must be
gas or propane fired, and may not exceed 50 gallons. Hot water pipe insulation from the DHW heater to the kitchen(s) and on all underground
hot water pipes is required in all co nein . clra es in all climate zones.
External Tank
Water Heater Type/Fuel
Distribution Type
Number In
Tank
Energy Factor or
Insulation
T
Standard, Recirculatin 2
System
Capacity
Thermal Efficient
R -Value
S
1. Indicate Type (Storage Gas, Heat Pump, Instantaneous, etc.)
2. Recirculating systems serving mule., welling units shall meet the recirculation requirements of §150(n). The Prescriptive requimmentr.da
not allow the installation of a recirculating water heating system for single dwelling units.
3. The external water heating tank and i es shall be insulated to meet the requirements o 150 ' .
SPECIAL FEATURES The enforcement agency should pay special attention to the Special Features specked in this checklist below.
These items may require writtenjustification and documentation and special veri rcation.
NEW ROOF ASSEMBLY - Radiant Barrier
The radiant barrier requirement of § 151 2 does not apply to roof alterations.
Slab Edge (Perimeter) Insulation ❑ YES ❑ NO
YES: In Climate Zone 16 in Component Packages D, R-7 insulation is required.
Heated Slab Insulation O YES ❑ NO
YES: Slab edge insulation required for all heated slabs in all Climate Zones. See details in Table 118-A of the standards.
Raised Slab Insulation ❑ YES ❑ NO
YES: In Climate Zones 1, 2, 11, 13, 14 & 16, R-8 insulation isrequired; in Climate Zones 12 & 15, R-4 is required under component Package D.
Thermal Mass
To obtain Compliance Credit for the installation of thermal mass, use the Performance Approach.
Registration Number:
2008 Residential Compliance Forms
Registration Date/time:
HERS Provider:
August 2009
Prescriutive Certificate of
Residential Alterations
Project Name:
S 4) 3 6D
Residential
VVIR
CF -IR -ALT
(Page 5 of 5)
Climate Zone # I # of Stories
ITERS VERIFICATION SUMMARY The enforcement agency should pay special attention to the HERS Measures specified in this
checklist below. A completed and signed CF -4R Form for all the measures specified shall be submitted td the building inspector before final
inspection.
Duct Sealing & Testing HERS verification is required for this measure.
❑ YES ❑ NO YES: In Climate Zones 2 and 9-16, if more than 40 linear feet of new or replacement ducts are installed in unconditioned
space, the ducts are to be sealed per §152(b)1Dii and the newly installed ducts are to be insulated per § 151(f)10.
❑ EXCEPTION: Existing duct systems that are extended, which are constructed, insulated or sealed with asbestos.
❑ YES ❑ NO YES: In Climate Zones 2 and 9-16, if the existing space -conditioning system (HVAC equipment and ducting) is replaced, the
ducts are to be sealed per §I52(b)IDi.
❑ YES ❑ NO YES: In Climate Zones 2 and 9-16, if the existing HVAC equipment is replaced (including the replacement of the air handler,
outdoor condensing unit of a split system, cooling or heating coil, or the furnace heat exchanger) the ducts are to be
sealed per § 152(b) l E.
❑ EXCEPTION: Duct systems that are documented to have been previously sealed confirmed through HERS
verification in accordance with procedures in the Reference Residential Appendix RA3.
❑ EXCEPTION: Duct systems with less than 40 linear feet in unconditioned space.
❑ EXCEPTION: Existing ducts stems constructed insulated or sealed with asbestos.
Refrigerant Charge - Split System HERS verification is required for this measure.
❑ YES ❑ NO YES: In Climate Zones 2 and 8-15, when the existing HVAC equipment is replaced (including the replacement of the air
handler, outdoor condensing unit of a split system A/C or heat pump, cooling or heating coil, or the furnace heat
exchanger) a refrigerant charge measurement shall be verified per 152 1F.
Central Fan Integrated (CFI) Ventilation System and Fan Watt Draw
The ventilation requirem6nts of § 150(o) do not apply to existing residential homes.
Ducted Split Systems -Air Conditioners and Heat Pumps: Airflow HERS verification is required for this measure.
113 YES ❑ NO YES: In Climate Zones 10 through I5, when the existing space -conditioning system (HVAC equipment and ducting) is
replaced, the airflow and fan watt draw shall be.verified per § 152 b ICi to meet the requirements of §15I(f)7B.-
Documentation
7B.
Documentation Author's Declaration Statement
• I certify that this Certificate of Compliance documentation is accurate and complete.
Name:
Sigtreta
Company : __� ('
J
D t
Address:
If Applicable ❑ CEA or O CEPE
City/State/Zip: Z O ga
P ne
SVS
Responsible Building Designer's Declaration Statement
• 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, Parts 1 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 forapproval with this buildin it application.
Name:
Signature:
Company:
Date:
Address:
License:
City/State/Zip:
Phone:
For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300.
Registration Number:
2008 Residential Compliance Forms
Registration Date/Time:
HERS Provider.
August 2009
Bin #
Permit #
Project Address: 3
A. P. Number:
Legal Description:
C;ILAContractor: ?,2C-;1L-
Address:
ddress: PJ 2—
City,
City, ST, Zip: V(Si
c
Telephone: 7L0 �- I � l?
State Lic. # : �)-7
Arch., Engr., Designer.
Address:
City., ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person
Telephone # of Contact Person: 6,
# Submittal
Plan Sets
Structural Cafes.
Truss Cafes.
Tine 24 Cafes.
Flood plain plan
Grading plan
Subcontactor last
Grant Deed
H.O.A. Approval
IN HOUSE:-
Planning
OUSE:Planning Approval
Pub. Wks. Appr
School Fees
City of La Quinta
Building 8r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and
U 21� C g RU `l c7 Tracking_Sh.eet_
wcr's Name: O.
P,—
Address: Address: SQ
City, ST, Zip: L Q O V s v Q Z Z
reSS Tcl hone: • •§�
y ..
Project Description:
It +e L
Lic. #; %'by?o a
Total Permit Fees
Project type (circle one):
New Add'n Alter Repair Demo
Sq. Ft:
#
Stories:
# Units:
Estimated Value of Project: L' U
APPLICANT:
DO NOT WRITE BELOW THIS LINE
Recd
TRACIONG
PERMIT FEES
Plan Check submitted
Item
Amount
Reviewed, ready for corrections
Plan Check Deposit
Called Contact Person
Plan Check Balance
Plans picked up
Construction
Plans resubmitted
Mechanical
2" Review, ready for corrections/issue
Electrical
Called Contact Person
Plumbing
Plans picked up
Plans resubmitted
Grading
3" Review, ready for eorrcctionslissuC
Developer Impact Fee
Called Contact Person
A.I.P.P.
Date of permit issue
Total Permit Fees