13-1504 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
r...�
Application Numberl3 OOp:01504
Property Address: 566'4`8 PALMS
APN: 764 -020 -005 -
Application description: PLUMBING
Property Zoning: LOW DENSITY
Application valuation: 850
Applicant:
DR - -
RESIDENTIAL
Architect or
Engineer:
440
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
HAMMOND JAMES
56.648 PALMS DRIVE
LA QUINTA, CA 92253
(760)777-7271
Contractor: "
ALVAREZ, JORGE A.
P.O. BOX 984
THERMAL, CA 92274
(7*60) 777-3613
Lic. No.: 880103
CI'
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
N ' 26 2013
IJ
Date: 11/26/13
LICENSED CONTRACTOR'S DECLARATION.
WORKER'S COMPENSATION DECLARATION.
I hereby affirm under. penalty of perjury, that I am licensed under provisions of Chapter .9lcommencing with
hereby affirm
I hereby affirm under penalty of perjury one of the following declarations:
70001 of Division`3 of the Busine 'and Professionals Code, and my License is in full force and effect.
I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class :',iC36� -.- - License No.: 880103
for by'Section 3700 of the Labor Code, for the' performance of the work for which'this permit is
e Date *(�Contractor�
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
OWNER -BUILDER DECLARATION'insurance
carrier and policy number are::
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
Carrier EXEMPT Policy Number EXEMPT
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires.a permit to
_ I certify that, in the performance of the work for which this permit is issued, I'sball not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
person in any manner so as to become subject to the workers'. compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
ome subject to the workers' compensation provisions of Section
and agree that, i4WERS'COMPENSATION
License Law (Chapter 9 (commencing with Section 7000) of Division Sof the Business and Professions Code) or
3700 of the Lab -forthwith comply with those provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5,by
a� - -
��'`�04�'
any applicant for a permit subjects.the applicant to a civil penalty of not more than five hundred dollars ($500).:
��`Oa„ to _Mpplicant:
(_ 1 1, as owner of the property, or my employees with wages as their sole compensation; will do the work, and
#°"
the structure isnot intended or offered for sale (Sec. 7044, Business.and Professions Code: The
WARNING: FAILURE TO SECURCOVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License:Law not apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
_does
and who does the work himself or herself through his or her own employees, provided that the
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements, are not intended or offered for sale. If, however, the building or improvement is sold within
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S. FEES.
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.).
- APPLICANT'ACKNOWLEDGEMENT
(_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044, Business and ProfessionsCode: The Contractors' State License Law does not apply to an owner of
conditions and restrictions set forth on this application.
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
1. Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License Law.).
whose benefit work is performed under or pursuant to any -permit issued as a result of this application,
1—) -1 am exempt under Sec. , B.&P.C. for this reason
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
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
of La Quinta, its officers,agents ana.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.
1 certify that Ihave 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 buildiconstruction, and hereby authorize representatives
of this county_to enter upon the above-mentioned propeq or in1pection purposes.
Application Number . . . . . 13-00001504
Permit . . . PLUMBING 2013
Additional desc . .
Permit Fee . . . . 11.92
Plan Check Fee
.00
Issue Date . . . .
Valuation . . .
. 0
Expiration Date . . 5/25/14
Qty Unit Charge Per
Extension
1.00 11.9200 EA PLBG WATER
HEATER/VENT
11.92
----------------------------------------------------------------------------
Special Notes and Comments
WATER HEATER CHANGE OUT 50 GALLON GAS.
[2008 ENERGY] CARBON MONOXIDE ALARM(S)
TO BE INSTALLED PRIOR TO FINAL
INSPECTION. 2010 CBC.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
PERMIT
ISSUANCE M/P/E
90.57
PLAN CHECK, PLUMBING
7.15
Fee summary Charged Paid
-------------------------------------
Credited
--------------------
Due
Permit Fee Total 11.92
.00 .00
11.92
Plan Check Total .00
.00 .00
.00
Other Fee Total 98.72
.00 .00
98.72
Grand Total 110.64
.00 .00
110.64
LQPERMIT
Project Address: t
A. P. Number:
Address: A].0 2L�)
City, ST, Zip-`O�,m�
Telephone: --7 ( �C) _ (OC& -Q
State Lie. # : B(a010
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lie. #:
Name of Contact Person:
Telephone # of Contact Person:
City of da Quinta
Building. er Safety Divislon
P.O. Box 1504, 78-495 Calle Tampico
La Quinta; CA 92253 - (760) 777-7012
Building Permit. Application, and Tracking Sheet
Owner's Name: (S� ,
Address: (� (0.. \`C�-/yvS . bok
City. ST, Zip: QW r\A-c - C c
Telephone: 0 ,% 7 %- -7 277 t
AM
Project Description:
��-
Lie. #:
#
Submittal
Req'd
Rec'd
TRACKING PERMIT FEES
Plan Sets
Plan Check submitted [tem Amount
Siractural Cates.
R"tewed, ready for corrections Plan Check Deposit
Taus Cala.
Called ContactPerson Plan Check Balance.
Title 24 Cates.
Plans picked up Construction
Flood plain plan
Plans resubmitted Mechanical
Grading plan
2" Review,, ready for correctionstlasue Electrical
Subcontactor List
Called Contact Person Plumbing
Grant Dad
Pians picked up S•M l•
N O.A. Approval
Plans resubmitted Grading
IN HOUSE:-
''" Reyiew, ready for comcdonsrwae Developer Impact Fee
Planning Approval
Called Contact Person A.i.P.P.
Pub. Wks. Appr
Date of permit issue
School Fes
Total Permit Fees
PRESCRIPTIVE CERTIFICATE OF COMPLIANCE u CF-IR=ALT;
Domestic'Hot Water Alteration / Replacement a: e... +.' ; , . a 'e -l'of 2
Site Address:
.Enforcement..Agency:.. ..
Date:
St ye
: Lo_ 0�w Rocs
P,errnKNurnher:
"Climate Zone:.:, . ': ,.
l3ui1dineXype:... _ ..
Single Family ❑ Multi Family
NOTE: This, form is not to be used for.-Newly Constructed Buildings, Additions or Other
Alterations
WATER HEATING
List newly installed water heaters and boilers for both domestic hot water (DHGI) heaters and hydropic space,
heating. Newly installed DHW heaters and boilers must. be gas, propane. or use the existing fuel type. ,
External
Water HeaterTank
Tank
Type/Fuel
Distribution Type
Number..
Capacity
Energy•Factor or
Insulation
Type I
Standard, Recirculating.)2
3n System
(gal), j j, ,
,.Thermal Efficient
R-Ualue3
-t G
_7f.7
1. Indicate Type .(Storage Gas,''Heat Pump, `Instantaneou`s;' etc.)'
2. Recirculating systems serving multiple dwelling units shall meet the recirculation requirements of §150(n).
The'Prescriptive requirements do not`allow the`installation'of a recirculating'wdter hea'tin'g system for single
dwelling units. ;
3. The external water heating tank and pipes shall be insulated to meet the requirements o 1 SO ).
Documentation' Author / Re"sponsilile Building Designer's beclaratidn+Statement
• I certify that this .Certificate of Compliance documentation is accurate and complete.,
• 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 eiieigy features and pecfoi mance specifications for the building design identified on this
Certifcate 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 for approval with
this building ermit application.
Name:
Signature:
A\�c
Company:
Date:
Address:
License and Expiration:
City/State/Zip:
Phone: ,
ci2�-�
G2c0-
r
For assistance or questions regarding tfi'eEnergy Standnrds, contact the California Energy Commis'sion's
Energy Hotline at: 1-800-772-3300.
INSTALLA,TiON CERTIFICATEM
" - CF=6R ECH;-011
Domestic Hot Water(DHN.) Alteration / Replacement ;:;; ;; : ; i . (Page •2:. of 2);
I. WaterHeatin
,5....§terns: _ .. _..._.......... ... ,_ _. �.. .....__......
P
CSLB License:
j
Distribution
Rated
CEC
Type
if
# of
Input (kW
Tank
Standby
Heater.
Certified Mfr NameA Model
(Std, Point of-
._Recirculation,
Identical._
.. . or _
Volume
Efficiency
Loss
T e
Number,
Use etc
Control Type ,.,Systems,,
Btu/hr
(gallons)
Note, 1: -For small.gas storage (rated input less.dhan.or.egual to..75,000 Btulhr)„ electric.resistance and heat pump>water heaters,.list-Energy
Factor (EF). For'large gas`storage>water. hearers' (rated input ofgredter. than 75;000 Btu/hr), list Recovery'Efciency; (RE), TA6r nal, ;
Efficiency, Standby Loss and Rated Input. For instantaneous gas water heaters, list the Thermal Efficiency and Rated Input._ •..
2. Mandatory Measures.. _..._ ..
TO COMPLY-- ALL.B4OXES MUST BE. CHECKED _.
❑ §110-§1.13: Water:heaters, showerhdad, and faucets.are certified by the California Energy. Commission.
§!506): Water System Pipe and Tank insulation. And Cooling Line -insulation '
'1. Storage tank insulation
❑ A. Storage gas water heaters rated with an Energy Factor no greater tlian the federal minimal standard are.extenially wrapped with
insulation having an�installed thermalresistance:of R-12 or greater; and
❑ B..Unfired,storage.tanks.or.oilier'indirecl,hot`v✓ater tanks•have.R-12.exterial.insulation of R=1'6 internal.insulatioti where,the.intemal
insulation R -value is indicated on the exterior of the tank.
t
2. Water piping and -cooling system -line -insulation thickness and conductivity -(AL-L• THREE BOXES-BELOWAPPLYTO
NEWLY INSTALLED AND REPLACED PIPING)
❑ First 5 feet of hot and'*cold water pipes closest to' wafer heater tank, non -recirculating systems, and`entire length of recirculating
sections of hot water pipes are insulated per Standards Table 150-8, typically 1 inch thick R4 `insulation; and
,❑ Pipe :insulation for.steam hydronic heating systems.or hot water systems>15 psi,,,meets, the requirements of Standards Table 123-A.
❑ insulation is protected from damage, including that due to proximity to the flue, sunlight, moisture, equipment maintenance,, and
wind.
-3 Central"Water Heating in Buildings with`Multiple Dwelling ,Units (required for -pr escriptivie) '
TO COMPLY - ALL BOXES MUST BE` CHECKED
❑ All hot water piping in main circiilating loop is insulated to"requirements of'§ 1500) (APPLIES TO NEWLYINSTAL'LED,4ND'REPLACED
PIPING)
❑ Central hot water systems serving six or fewevdwelling units which have (1) less than 25'; of distribution piping! outdoors; -(2) zero
distribution piping underground; (3) no recircu1ation.pump;.and.(4) insulationyon,distribution piping that meets the,requirements of
Section 1500) (APPLIES ONLY TO NEWLY 1NSTALLED WATER HEATING SYSTEMS,, NEWLY INSTALLED, WATER HEATER AND
PIPING)
❑Central hot water systems serving more than 6 dwelling units - presence of either a time control or a time/temperature control
DECLARATION .STATEMENT
• .1 certify under penalty of perjury, under the• laws of,the State of California, the information provided on this form is trueij:
and correct.
• 1 -am eligible under Division 3 of•the Business -and,Professions-Code•to.accept-responsibility for constriction, or an
authorized representative of the person responsible for construction (responsible person).
• I certify that the installed features, materials, components, or manufactured devices identified on this certificate (the
installation). conforms, to all.applicable codes andregulations, and .the.install ation.is consistent with the.plans and . ..
specifications approved by the enforcement agency.
• I reviewed a copy of the Certificate of Compliance (CF -1R) form approved by the enforcement agency that identifies the
specific requirements for the installation. I- certify that the requirements detailed on the CF -1 R that apply to the installation
have been met. -
• I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the
building permit(s) issued for the building, and made available to the enforcement agency for all applicable
inspections. I understand that a signed copy of this Installation Certificate is required to be included_ with the
documentation the builder provides to the building owner at occupancy.
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
Responsible Person's Name:
'Respoii§ible Peison's'Sigriature:,'"
CSLB License:
Date Signed:
Position With Company (Title):