09-1251 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: �7985'0"PECAN VALLEY
APN` 762=023-009-
0
Property Address: '9-000'01251
Applicant: Architect or Engineer:
BUILDING & SAFETY' DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury thatt'an
•i licensed under provisionsof Chapter 9 (commencing with
Section 7000) of Division�3 of the Business and Professionals Code, and my. License is in full4orce and effect.
License Class: C36ense No.: 880103 x `
Dat1 e: /� -..�G y /Conti • � -
OWNER -BUILDER DE S 'ION
I.hereby affirm under penalty of perjury that I am exemi i 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 anystructure, 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 m
(comencing with Section 7000) of Division 3 of the Business and.Professions Code) or
that he or. she is exempt therefrom andthe.basisfor the'alleged exemption: Any violation of Section 7031.5 by
any applicant for permit.subjects the applicant to a civil. penalty of riotmore than five -hundred dollars ($500).:• -
(_ 1 I, as owner of, the. property, -or my;employees with wages as their sole compensation, will do the work, and
the'structulre isnot intended or offered far 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 uvh6 does'the work himself or Herself. througfi, his or her own employees, provided tFiat the
improvements are not intended or -offered -for sale. If, however, the building or improvement is sold within
one year •.of.completion, the ownei-builder will have the burden of proving that he or she did not'build or
'improve for.the ptGpose 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 contractors) 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:
IT
Owner:
ARNOLD JOHN
79850 PECAN VALLE
LA QUINTA, CA 92253
(303)941-4639
Contractor:
ALVAREZ, JORGE A.
PO BOX 984;
THERMAL, CA 92274
.(760)777-3613
Lic. No.: 880103
VOICE (760) 777-7012
FAX (760) 777-7011
'TIONS (760) 777-7153
��'-'• (�• � - Dai�� l/ 12/08/09
------------------
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty ofperjury one of the following declarations:
I have and will maintain acertificate of consent to self -insure for workers' compensation, as provided '
., for by Section 3700 of the tabor Code; for the performance oftfie,warkfor which this permit is'
issued. �•''-
' _ I have and will maintain workers' compensation insurance, as required by Section 3700of the Labor
Code, for the performance of the.work for which this permit is issued. My work compensation
insurance carrier and policy number are: - -
Carrier EXEMPT Policy Number EXEMPT
_ 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.l shouldbecome subject to the workers'•cornpensation provisions of Section •
3700 of the Labor C _ shall fo comply with those provisions.
Date /Z-�-oy fApplicanL .t / -
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION C ERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVILFINES'UP•TO ONE HUNDREcrTHOUSAND
'DOLLARS ($:100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IM
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. 7
' APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of.8uilding and Safety for a'permit subject to the •
conditions and restrictions set forth on this application. � -
1 . Each person upon whose behalf this apptication•is made, each person at whose request and for
' whose benefit work is performed under or pursuant to -any permit issued as 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 180days will subject
permit to cancellation.
I certify that -I have read,thisapplication 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 (pr y mspectlPPn-�r�jm �es/
Date: 1�7
a -��./ Signkature•IApplicantor.AgentC��� `��7 ...
LQPER111
' - -
Application description:
PLUMBING
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
1300 ,
BUILDING & SAFETY' DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury thatt'an
•i licensed under provisionsof Chapter 9 (commencing with
Section 7000) of Division�3 of the Business and Professionals Code, and my. License is in full4orce and effect.
License Class: C36ense No.: 880103 x `
Dat1 e: /� -..�G y /Conti • � -
OWNER -BUILDER DE S 'ION
I.hereby affirm under penalty of perjury that I am exemi i 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 anystructure, 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 m
(comencing with Section 7000) of Division 3 of the Business and.Professions Code) or
that he or. she is exempt therefrom andthe.basisfor the'alleged exemption: Any violation of Section 7031.5 by
any applicant for permit.subjects the applicant to a civil. penalty of riotmore than five -hundred dollars ($500).:• -
(_ 1 I, as owner of, the. property, -or my;employees with wages as their sole compensation, will do the work, and
the'structulre isnot intended or offered far 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 uvh6 does'the work himself or Herself. througfi, his or her own employees, provided tFiat the
improvements are not intended or -offered -for sale. If, however, the building or improvement is sold within
one year •.of.completion, the ownei-builder will have the burden of proving that he or she did not'build or
'improve for.the ptGpose 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 contractors) 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:
IT
Owner:
ARNOLD JOHN
79850 PECAN VALLE
LA QUINTA, CA 92253
(303)941-4639
Contractor:
ALVAREZ, JORGE A.
PO BOX 984;
THERMAL, CA 92274
.(760)777-3613
Lic. No.: 880103
VOICE (760) 777-7012
FAX (760) 777-7011
'TIONS (760) 777-7153
��'-'• (�• � - Dai�� l/ 12/08/09
------------------
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty ofperjury one of the following declarations:
I have and will maintain acertificate of consent to self -insure for workers' compensation, as provided '
., for by Section 3700 of the tabor Code; for the performance oftfie,warkfor which this permit is'
issued. �•''-
' _ I have and will maintain workers' compensation insurance, as required by Section 3700of the Labor
Code, for the performance of the.work for which this permit is issued. My work compensation
insurance carrier and policy number are: - -
Carrier EXEMPT Policy Number EXEMPT
_ 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.l shouldbecome subject to the workers'•cornpensation provisions of Section •
3700 of the Labor C _ shall fo comply with those provisions.
Date /Z-�-oy fApplicanL .t / -
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION C ERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVILFINES'UP•TO ONE HUNDREcrTHOUSAND
'DOLLARS ($:100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IM
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. 7
' APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of.8uilding and Safety for a'permit subject to the •
conditions and restrictions set forth on this application. � -
1 . Each person upon whose behalf this apptication•is made, each person at whose request and for
' whose benefit work is performed under or pursuant to -any permit issued as 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 180days will subject
permit to cancellation.
I certify that -I have read,thisapplication 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 (pr y mspectlPPn-�r�jm �es/
Date: 1�7
a -��./ Signkature•IApplicantor.AgentC��� `��7 ...
LQPER111
Application Number . . . . . 09-00001251
Permit . . .
PLUMBING
Additional desc . .
Permit Fee . . . .
22.50
Plan Check Fee
5.63
Issue Date . . . .
Valuation . . .
. 0
Expiration Date
6/06/10
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 7.5000
EA PLB WATER
HEATER/VENT
7.50
----------------------------------------------------------------------------
Special Notes and Comments
REPLACE (2) 50 GALLON
WATWER HEATERS
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
1411
-j7o)r\t\
CERTIFICATE OF COMPLIANCE: RE51DENTIAL (Page 3 of 4) CF -IR
—
Project Title bate
UA
'
' '
SEALED DUCT'SlandWslor AIt��'e Nleasules)
A signed 0`411 Form nitist b� provided to the bilOduli-', &P011111clit for each home for \vIlich (lie followine. arc
0
reg urea.
Sealed Ducts (all climate zones)(I nstal I or testing and certification and H ERS rater field verification required.)
TXVs, readik accessihie (ciii-riate. zones all only)
0
�mcertification and HFAS Rater field verification required.
aller tes P
(Illst and liefrikerant Charge (climate zones? and.8-1 only) (lit taller testing and certification and HERS Rater field
0
0
verification required.)
Olt
\Is (See Pickaoe D Alternative Package Features flor
A Iternative to Scaled Ducts and'Re(ri-!liflA 0):MIC
Ej Project CIimatc Zone in dic ki.-M A ppendix 8 ]"OhIc 151-C, Footnotes 7 -Id.
For additions and atc5ti(MS, duets flimt nre not doe neli[ed (C; Fmve, been previously
co
sealed as confirmed through field asci dizign.clslic testing, ill ,(:' r(lance with procedures ill the
0 Residemial ACM N'tanual 1--ind duct .� a. 'Feet ill unconditioned
j. -Ins \vkh n-.6re than 40, hhear
—ispaces.slial . l'inect 111L . -L_ _Le( �tj !jf_Ljjjcjlts_of Page D.
of Section 1.50(m) and duct
X.VA'rVO UTV &'C(NC' SVC-ITV'C�
SN,stem servinL, multiple dwelling units
Energy
Tank
Rated I
Factors or External
Ulrkti. Tank I
Distribu-tioll 1; 'Number 1 -l"hernijal. Standby
Water Heater I Capacity 'CL Loss/u)
Insulation
Svstelll rit"Alf) Icle
1 --value
f fri ' ncv Loss M
I. For small ell7as SIOM2 'C 'Vater heaters i. rated input- ot, icss 111.111 or equal to 75,000 Bimilir), electric resistance, and heat
Pump water licaters, lis( Enerf!v f'acior. For kii-e gas st onwe water he'aters (rated input of greater than 75,000
Btuilir), list Rated Input: Rccovery Ffficlency. Thermal'Efficlency and Standby Loss. For instantaneous gas water
heaters. list Rated llll)Lft and ThHlmi
Pipe Itistilatiori (kitchen lines _;1 31!-4 inches) All hot pipes FrOln the I)Catill� source to the kitchen Fixtures that are -3/4
inches or greater in diameter shall be. illSillaWd as specified by Section 150 (j) 2 A or 150 (j) 2 B.
Residential Compliance forms
I
,March 2005
Tank
i Rated
I ,
Input'
Water Heater Distributi0l) i kv
Check box if systern nicels, criterie. of ;i "Standard` syslern. Standard system is one v.as-fired water heater per
0
dwellinE;.1stem is
unit. If dic water healer is -j• So,_,zilloii,,istli,�iiiaxi,iiiunicipa5:ityltiI recirculatioli\s
or
Type/Fuel Type 1 in SvSlk..ii ki./hr)
not allov.-ed.
Ali-1'-rnati%-(: (Vater FlUiting tableTzible 5-4 in Chapter 5 in the Residential
Check box when using Preapprove d .
Efficiencv Loss
0
Manual. No water heatirif, calculrmons are redun_t:d^alld the. systein com ties automatically- _
Check box if wstetil does not meet criteria of"Stailmand " systcm. and (.docs not con -,ply with the ('reapproved
0
:alternative Water Heminc, table. In !1w., case.. dic Perforr6ince Nlcihod must be used and must be included in the
submittal.
box to verifythat a ti.ille comrol is required -for a recil-CUlating'systern pump for it system serving 111111hPle
o
I.Check
units
SN,stem servinL, multiple dwelling units
Energy
Tank
Rated I
Factors or External
Ulrkti. Tank I
Distribu-tioll 1; 'Number 1 -l"hernijal. Standby
Water Heater I Capacity 'CL Loss/u)
Insulation
Svstelll rit"Alf) Icle
1 --value
f fri ' ncv Loss M
I. For small ell7as SIOM2 'C 'Vater heaters i. rated input- ot, icss 111.111 or equal to 75,000 Bimilir), electric resistance, and heat
Pump water licaters, lis( Enerf!v f'acior. For kii-e gas st onwe water he'aters (rated input of greater than 75,000
Btuilir), list Rated Input: Rccovery Ffficlency. Thermal'Efficlency and Standby Loss. For instantaneous gas water
heaters. list Rated llll)Lft and ThHlmi
Pipe Itistilatiori (kitchen lines _;1 31!-4 inches) All hot pipes FrOln the I)Catill� source to the kitchen Fixtures that are -3/4
inches or greater in diameter shall be. illSillaWd as specified by Section 150 (j) 2 A or 150 (j) 2 B.
Residential Compliance forms
I
,March 2005
Tank
i Rated
I ,
Input'
Water Heater Distributi0l) i kv
Tank
Capacity
Factor or
Thermal Standby'
External
Insulation
or
Type/Fuel Type 1 in SvSlk..ii ki./hr)
110!15'1
Efficiencv Loss
R -Value
SN,stem servinL, multiple dwelling units
Energy
Tank
Rated I
Factors or External
Ulrkti. Tank I
Distribu-tioll 1; 'Number 1 -l"hernijal. Standby
Water Heater I Capacity 'CL Loss/u)
Insulation
Svstelll rit"Alf) Icle
1 --value
f fri ' ncv Loss M
I. For small ell7as SIOM2 'C 'Vater heaters i. rated input- ot, icss 111.111 or equal to 75,000 Bimilir), electric resistance, and heat
Pump water licaters, lis( Enerf!v f'acior. For kii-e gas st onwe water he'aters (rated input of greater than 75,000
Btuilir), list Rated Input: Rccovery Ffficlency. Thermal'Efficlency and Standby Loss. For instantaneous gas water
heaters. list Rated llll)Lft and ThHlmi
Pipe Itistilatiori (kitchen lines _;1 31!-4 inches) All hot pipes FrOln the I)Catill� source to the kitchen Fixtures that are -3/4
inches or greater in diameter shall be. illSillaWd as specified by Section 150 (j) 2 A or 150 (j) 2 B.
Residential Compliance forms
I
,March 2005
,;Bin # � � ty of �.. aQulnt�--------
�.
J' Building & Safety Division
Permit: # P.O. Box 1504, 79-49.5 Calle Tampico
1La Quinta, CA 92253 - (760) 777-7012
aL1'tldina Permit Application and Tracking Sheet
1_Projcc.! d.dress:
A. 1'. Number: -!_L _`�•�l'r__ rlx����- -
4 LQ P^ v
i; Legal Description:
Contractor:
r 'f P,�v
City, s
Zip: C,�r Q-) 7 -7U Y
Telephone.'•�//
- >�, 1�' t r a� P t 1.��C e— � CI, NO � aAfr 94,
I: / lD�r� % �.� (n 1 rs ; s ��E•r�-•�,3 t.{eY,z-...�,.�� ��(i
State tate Lic. 8 :
,� �s�o ►o,�, City Lic ft
II Arch., 13ngr., Designer:
li Address:
---._._._..—.._.._...,..
City, S1', dip_
_ ...._._..... ._
..
'Celephone:
rt ' h� !
xt Construction'rype.;
Uccupattc)
State Lic. It:
_--__�.-....«� I ��. 4L� Y' T - 5 , S Y•a- J �—_..--re-^'zTmTre>4l _
Projecttype Ncc•: �s
Demo
I ,3 -n tc 't (circle.
olie)y Add'n Alter 1ti,pair
Name ofC:onract Person
fnits
-� r L -11 Sy_ Ft.: �
1 it Stories: it,U :
"Telephone # of Contact Person: Value of'apro�}ec-t:
O O
—Estimated
_ _A
APPLICANT: n0 fV0'i WRITE BELOW '!'!•fts
LINE
5 Y, Submittal
Rcc d TRACKl`NG ll,
flan Setsi
_Reca'd
rERIYIPI' F'EIS
t
y� ���s: Ilan Check submitted
ltcw
Amount
p
Structure! Gales.
Reviewed, ready for corrections
flan Check Deposit
Truss C:AICS. t�
! Called Contact Person
N, flan Check valance
w
k
Energy CRlcs.
I
tt 1'hns Flanked up -Y
4—
Construction
Floodplain plan €
�!'tans resubmitted
�
------ ttt`!
n
� 1.1ecllanical
i�
Grading plan
_
the Review, ready -lite
`Electrical
subcoltactor 1.D$t
Called Cbll[aeL I'1 a'Ynll
,�
I'lllllllling
Grant Deed
11
-
Il
Plans picked ull
if
ILU.A. Approval
i
flans resubmitted
Grading
( 1
1N HOUSE:
$ •h
1rf Review, ready for corrcctiuns/issuc
� Developer impact Fee
Planning tlppl ova8
Called Contact Person
Pub. Whs. Appy
Date of permit issue
School Fees
l
l ut;al Permit Fees