08-1976 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
08-00001976
Property Address:
44400 BUTTERCUP LN
APN:'
604-083-010-67 -22982 -
Application description:
PLUMBING
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
500
Tiht 4 4 a"
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 Bu iness and Professionals Cade, and my License is in full force and effect.
License Class: C36 �yLicenseNo.: 828264
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 ISec. 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).:
(_ 1 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.).
(_ 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 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:
LQPERMIT
Owner:
BRAZIL BEVERLY
44400 BUTTERCUP LANE
LA QUINTA, CA 92253
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: 12/23/08
------------------------------------------a--
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
f 3/7}00 of the or Code, I shall forth
�with comply with those provisions.
WARNING: FAILURE TO SECURE WORKERS' CONI COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,0001. 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 ounty ordinances and state laws relating to building construction, and hereby authorize representatives
oft county to enter upon the above-mentioned property for inspection rposes—.
Date:/ili:�—Si cure (Applicant or Agent):
Application Number . . . . 08-00001976
Permit . . .
PLUMBING
Additional desc .
Permit Fee
22.50
Plan Check
Fee
5.63
Issue Date . . . .
Valuation
. . .
.
0
Expiration Date . .
- 6/21/09
.Qty Unit Charge
Per
Extension
BASE FEE
15.00
.1.00 7.5000
EA PLB
WATER HEATER/VENT
7.50
-----------------------------------------
Special Notes and Comments
------------------=
--------------=-
INSTALL NEW 40 GALLON
GAS WATER
HEATER
Fee summary. Charged
Paid Credited
Due
---------------------------
Permit Fee Total
----------
22.50
----------
.00
----------
.00
22.50
Plan Check Total
5.63
.00
.00
5.63
Grand Total.
28.13
.00
.00
28.13
LQPERMIT
12/23/2006 11:21 7'607755222 CANON
t
OF COMPLIANCE: RESIDENTIAL
#3907 P.001 /001
3 of 4) CF -IR
3�imr--�
Watenige
7Z >
SEALED DUCTS aad TXVs (or Ahernative Measures)
A signed CF -4R Form most be provided to the building departrnent for each home for which the following. are
0 Scaled Ducts . ail climate zones(Installer tesmZ and cert
TXVs, rtadit aeocssibie (climate Zones 2 and 8.15 only)
testing and cion and HERS Rater field v
Q Refrigerant Charge (clime zones 2 and 8.15 only) (in=
verification required.
OR
D Ahve w Sealed Ducts and Refrigerant Charge (1-(V,
PMjCCt
Climate Zone in the RM Appendix B Table 151-0
and
required.)
and cerr ificabon and HERS
age U Afternabve Package Features for
7-14.
For additions and alterations, duct systems that are not documented to have been prev;ously -
scaled as confirmed duvugh field verification and ding ?mm ming in accordance with procedures in the
Residential ACM Manual and duct syswms'with more than 40 linear feet in unconditioned
spaces shall meet the requirements of Section 150(rn) and duct insulation requimrnents of Package D.
Check box if syst�cm meets criteria of a "Standard" system. Standard system is one gas-fired water heater per
dwelling unit_ If the water healer is a storage type, 50 gallons is the maximum capacity and recsrculabon system rs
not allowed.
13 Check box when using Pteapproved Alternative Water Heating table, Table 54 in Chapter 5 in the Residential
Manual. No water calcttiations are required, and the swum co lies aubomabcall
Check box if syst,cm does not meet criteria of "Standard" system, and does not comply with tate Preapproved
0 Aftniative Water i-Icsring table. In this case, the Performance Method must be used and must be included in the
submittal.
0 Check box to verify first a tune control is required for a recirculating system pump for a system serving multiple
units
svAelm servi w she dweller ellits
I Tank
External
Standby. Insulation
Loss (%) R -Value
1. For small gar storage water heaters (rated irtptrts of less than or equal'to 75,000 Bmthr), electric resistance, and: heat
pump water heaters, list Energy Factor. For latge gas storage water hea=3 (rated input of gmater Than 75,000
Bm/hr), list Rated Input, Recovery Efficiency, Thertnsl Efficiency and Standby Loss_ For instantaneous gas water
heaters, list Rated Input and Thermal Efficiencies.
Pipe IIS} oel (knelt tines ? 3/4 inches) Ali hot water pipes from the hesfwg source to the kitchen fixtures that are'/a
inches or gamin diameter sbali be dmmally insulated as specified by Section 150 0) 2 A or 150 0) 2 B.
Residential Compliance Forms . March 2005
Rated I
Enemy
Tank
! En
1 Tank
Input �
Factor o r
i External
Water Heater
Distribution
Number(kw or ( Capacity
Thermai Standby'
Insulation
T uel TXpe
Type
in System t3a✓hrs tows
Efficiency Loss '%
R -Value
in Svsem
ants)
l (rarwos)
Efficiency
I Tank
External
Standby. Insulation
Loss (%) R -Value
1. For small gar storage water heaters (rated irtptrts of less than or equal'to 75,000 Bmthr), electric resistance, and: heat
pump water heaters, list Energy Factor. For latge gas storage water hea=3 (rated input of gmater Than 75,000
Bm/hr), list Rated Input, Recovery Efficiency, Thertnsl Efficiency and Standby Loss_ For instantaneous gas water
heaters, list Rated Input and Thermal Efficiencies.
Pipe IIS} oel (knelt tines ? 3/4 inches) Ali hot water pipes from the hesfwg source to the kitchen fixtures that are'/a
inches or gamin diameter sbali be dmmally insulated as specified by Section 150 0) 2 A or 150 0) 2 B.
Residential Compliance Forms . March 2005
f
!
i
! En
1 p�
I Tank
'Factor; r
Water Heater
Disuibution
Number
(kw or
Capacity
Thermal
I
Type
Tvve
in Svsem
ants)
l (rarwos)
Efficiency
I Tank
External
Standby. Insulation
Loss (%) R -Value
1. For small gar storage water heaters (rated irtptrts of less than or equal'to 75,000 Bmthr), electric resistance, and: heat
pump water heaters, list Energy Factor. For latge gas storage water hea=3 (rated input of gmater Than 75,000
Bm/hr), list Rated Input, Recovery Efficiency, Thertnsl Efficiency and Standby Loss_ For instantaneous gas water
heaters, list Rated Input and Thermal Efficiencies.
Pipe IIS} oel (knelt tines ? 3/4 inches) Ali hot water pipes from the hesfwg source to the kitchen fixtures that are'/a
inches or gamin diameter sbali be dmmally insulated as specified by Section 150 0) 2 A or 150 0) 2 B.
Residential Compliance Forms . March 2005
aim
P&n* 14*1P.O.
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A C(W
A. P. Number
City Of La Quints
e � Safety 1�Ivfsforl
Box 1504, 7&495 Cade Tampico
U Quints, CA 92253 - (760) 777.7012
p `� Btaidmg Permit Application and Tracking Sheet
:� �.Y �i Oavna's Name: 1 a Z ,
f.
/)
Address: V
Legal Description:
City, ST, Zip:
contractor cng V(
Tdepbona . `
Address
, f .
Des�ption: C i
City, ST, Zip: I'
vv
T:7
State Lic. 0:
City Lic. #547r6'
Arch, Eap. Dwip
Address:
City, ST, Zip:
Tom:
C usbuction Type: Oxnpaucy:
State Lic. C
Project type (tuck one): New Add' n Alta Repair Demo
Sq. FL: S Stories: q Units:
Name of Contact Person:
Telephow # of Contact Person:
BS1imsted Value of Project
APPLICANT: DO NOT WRITE BBAW THIS LINE
Y
Sobntdal
Req'd
_XM'd
TBACKM
PERM FEES
?tau Seb
Pin Cheek submitted
Amount
Structural Cates.
RcvkW d, ready for corrections
Phu Chock Deposit
Truss Cates.
CROW Coetset Peron
Plan Ckec k Balance
Title 24 Cake.
Piaus picked Lip
Coastrsctio.
Flood plain plan
than resubmitted
Mechanical
Gradiq ph■
Review, ready for earrectioasAssue
Fiearieal
Subtoatactor Iasi
Catled Contact Person
Ptunbing
Gant Dad
Anus pcked rp
S.M.L
HAA Approval
Ptm resubmitted
corad'mg
IN HOUSE:-
I Review, ready for correetloos%-c
Developer Impact Fee
Phases Approval
Called Couttet Person
A-LP.P.
Pub. Wks. Appr
Date of permit lssoe
Scbool Fes
Tota! Permit Fes
)z