13-0056 (PLBG)050-:436X 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 13-00000056
Property Address: `53895—AVENIDA JUAREZ
APN: 774-143-021- -
Application description: PLUMBING
Property Zoning: COVE RESIDENTIAL
Application valuation: 850
Applicant: Architect or Engineer:
. �op
LICENSED CONTRACTOR'S DECLARATION
4
BUILDING & SAFETY DEPARTMENT
Et
BUILDING PERMIT
Owner:
GROUND DEE
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 Busine and Professionals Code, and my License is in full force and effect.
License)Class: C36 License No.: 880103
/ Contrac� -
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 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:
LQPERMIT
Contractor:
ALVAREZ,
P.O. BOX
THERMAL,
(760) 777-
Lic. No..
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/17/13
-----------------------------------------------
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 NXFMPT 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 I should become subject to the workers' compensation provisions of Section
3700 of the Labor Code sh II forthwith comply with those provisions.
Date: 3 Appli nt:
WARNING: FAILURE TO SECURE WORKE '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 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 county ordinances and state laws relating to building construction, and hereby authorize representatives
of this county to enter upon the above-mentioned property fo pe ion purposes.
_Dat `A — / — f '9lgnati� (Applicant or Agee[I:
2. -
Application Number .
. . . . 13-00000056
Permit . . .
PLUMBING
Additional desc . .
Permit Fee . . . .
22.50 Plan Check Fee
5.63
Issue Date . . . .
Valuation . . .
. 0
Expiration Date . .
7/16/13
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 40G GAS WATER
----------------------------------------------------------------------------
HEATER,.2010 CODES
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
I
Prescriptive, Certifleate of Com Trance: Residential CF-LR-ALT-DHW
Residential Alteredlolls Page 1 or
Project t llama ---%US, -n �_� - Climate Zane: Permit 11;
Genend Info mutton
Site Address: _'_5M5Rr:,6,-NUo,c
EnfowenentAEpg: LC ; cam. Date:
Building T e: in le Family 13 Muld Family
it or Chan a Out of Water Heuter
r
List netvly Installed hater Treaters and boilers for. Loth domestic hot ityier. heaters (DWN) and hydrottle space heuthtg. Newly installed
DWH heaters acrd lmilers Incestbe MELM cera, or use the e- istin tea113a.
r
Distribution Typo (Number in Tank Energy Factor or
Water Heater (Standard,
WATER HEATING
List netvly Installed hater Treaters and boilers for. Loth domestic hot ityier. heaters (DWN) and hydrottle space heuthtg. Newly installed
DWH heaters acrd lmilers Incestbe MELM cera, or use the e- istin tea113a.
_
Distribution Typo (Number in Tank Energy Factor or
Water Heater (Standard,
Extemat'1'ank
Insulation
1
TypdFucl Type Kecivcgrtatin System Capacity (gat) lluermat Erfrciency
R_Vahuej
_
d
2-
1. Indicate 7: pe (Storage Cas Hent Pump, instantaneous, etc.)
Z. Recirculating systems serving multiple dwelling' rants shall meet the 'recirculation requirements of §150(nj
The Prescriptive
requirentents do #cit allow the installation of a recirculating nater heating systenn for shigle dtvellhng units
.
.t. The external water heating tank and pipes shall be insulated to nteet therequirements of § 1M.
Contractor or Homeowner (Documentation Author'tdResponsible Building Designer's Declaration Statement)
V i certify that this Certificate of Compliance documentation is accurate and complete.
a ,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.
v I certify that the energy featuies and performance specifications for the building design identified on this Certificate of Compliance
conform to the requirements of Title 74, Part f and 6 of the California Code of Regulations.
"?tt featares idcntiPted on this Certificate of Compliance arc consistent with the information provided to document this
huil:ting design >>n tlue other appiicablo compliance forms, worksheets, calculations. plans and specifications submitted to the
_ cttii�r+,c;rra.at �. t:lac:y'.'cirazti_cv.t1 xitll is� his I;+�il�lini; t?,"t•rnit ap�lic:itiorl,_,..-.-._......_-,._...._,�....__..-.-.......,_..,..- .....,
City/SlnteMp: r�
a
v -
i
:`
SA nril 7n7n
v = tt!{QW YVIY1111W 111
I. Per Section 150Q) of the 2008 Energy Efficiency Standards.
(SA"r;l 2010
2009 Appliance Effici®ncy AegulMlons for Smell Water Heutdrs
Small Water Heater Is defined as:
� e
In ut
Gas Storacle
15.000 Btu/hr or less
Oil Stora a
106;000 Btu/hr or less
Electric Storage
12 kW or less
Gas Instant
200 000 Btu/hr or less
Oil Instant
210.000 Btu/hr or less
Electric Instant
12 kW or less
Heat Pump
124 amps or, fess
v = tt!{QW YVIY1111W 111
I. Per Section 150Q) of the 2008 Energy Efficiency Standards.
(SA"r;l 2010
If rated Energy Factor does not ExcEt+u
minimum
Federal Minimum
Values Below, an External Insulating
Blanket (R-12,
Enerav Factor
minimum) shall be Installed'
Water Heater Fuel i e
Effective Jan 20 2004
30 Gallon 40 Galion
SO Gallon
(has -fired storage -type water
0.62—(0.0019x -V)
0.563 0.544
0.525
heaters
Oil -fired water heaters
0.59 — (0.0019 x V)
0.533 0.514
0.485
(storage and instantaneous
0.93 - (0.00132 x V)
0.890
0.877
0.864
Electric storage water heaters
(excluding tabletop water
heaters
Electric tabletop water
0,93 - (0.00132 x V)
0.890
0.877
0.864
heaters
Gas-fired instantaneous water
0.62 — (0,0018 x V)
0.553
0.544
0'525
heaters
0.93 — (0.00132 x V)
0.890
0.877
0.864
Electric instantaneous water
heaters (excluding tabletop
water heaters
um water heaters
0.93 — 0.00132 x
0.890
0.877
0.864 -
Meat
_J ..t..
.. iw —11nne
_
v = tt!{QW YVIY1111W 111
I. Per Section 150Q) of the 2008 Energy Efficiency Standards.
(SA"r;l 2010
Bin #
Petmft #
ProjectAddress: C( S
A. P. Number:
Legal Description:
Contractor: A
Address:
City. ST, Zip: .
Telephone: _ 9 75
State Lic. # :,ao to 3
Arch., Engr.. Designer.
Address:
City. ST. Zip:
Telephone:
State Lic. #:
Name of Contact Person:
Telephone # of Contact Person:
City of La Quinta
Building ar Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
e—( � 6_c ? Owner's Name: c 1 v
Address:
City. ST, Zip: L(� CPA
V CL —C' Z Telephone: .
Project Description:
Citv Lie. #, lr�S
1
N
Submittal
Req -d
Recd
TRACKING PERMIT FEES
Plan Sets
Plan Check submitted Item Amount
Sir actural Cala.
Reviewed, ready for corrections Plan Check Deposit
Truce Cala.
Called Contact Person Plan Check Balance.
Title 24 Cala.
Pians picked cep Construction
Flood plain plan
Plans resubmitted Mechanical
Grading plan
2"! Review, ready for correctionvissue Electrical
Subcontactor List
Called Contact Person Plumbing
Grant Deed
Pians picked up S.M.I.
H.O.A. Approval
Plans resubmitted Grading ,
IN HOUSE:-
Review, ready for correctionsliasue Developer Impact Fee
Planning Approval
Called Contact Person A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees