09-0064 (PLBG)a
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Tit!t 4 4, Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-70:11
INSPECTIONS (760) 777-7153
Date: 1/28-/09
Application Number: 09-0000'0064 Owner:
Property Address: 53960 AVENIDA CORTEZ CLARK, SANDRA
APN: 774-,142-025-15 -000000- 53960 AVENIDA CORTEZ
Application description: PLUMBING LA QUINTA, CA 92253
Property Zoning: COVE RESIDENTIAL (
Applicatio_n valuation: 5.00
Contractor:
Applicant: Architect or E gineer: FOY, SCOTT A.
43579 MAIN STREET
C INDIO, CA 9.2201
(760)775-9405 �_ c; ! f
Lie. No.: 828264 f '.'r;,fI
_______
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I em licensed under provisionsof Chapter _9(commencing with Thereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of,the.Business and Professionals Code, and my.License.is1n full force and effect. _ I, haveend-will maintain wcertificatwaf consent -to self -insure for workers' compensation, as provided
License,Class:. C36 ,License 828264 for by Section 3700:of`the Labor Code, for the performanoeof the:work for which this permit is
jq�— - issued.
Date:/ G// r Contractor. S I . _ I have an will maintain workers' compensation insurance;as required by Sea ion 3700 of the Labor
Code,for the performance of the work for which this permit is issued. My workers"compensation
OW R -BUILDER_ CLARATION insurance carrier and policy number are:.
I hereby: affirm under penalty of.periury that I am exempt from the Contractor's State License LaW for the, Carrier FIRST COMP. INS 'Policy Number -_WS1.004451
following: reason (Sec. 7031..5, Business: and Professions Code: Any city or county thabrequires a:permit to _ I. certify that,+in the performance of the work for Which this permit is issued; I shall notemploy any
construct, alter, improve,'deioolish, or repair any structure, prior to itsissuance, alcorrequires-the applicant for the personin any^manner so as to. become subject to.the workers' compensation laws of California,
permit files signed statement that he or she is licensed pursuant to the provisions of tha - ntraotor's,$tate and agree th8t, &I shiwld become subject t6 the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section J000) of Division,3 of the Business and Professions Code) or 3700 of the Labor Code, I shall 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
any applicant for woermit subjectathe applicanttoa civil pen6fty-of not more than five hundred dollars ($500).: Dater Applicant:
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 WARNING:; FAILURE`TOSECURE. WORKERS' COM -ENSATIO OVERAGE'IS°UNLAWFUL, AND SHALL
Contractors' State License Law does, notepply to an owner of property who builds or improves: thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UPTO ONE HUNDRED THOUSAND
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, improvernent,is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
oneyear of completion, the owner -builder will have'the.burden of proving; that he or she did,not build or
improve,forthe purpose:of sale.).
(_) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project:(Sec.
7044, Business ahe.Professions Code: The; Contractors' State License Law does not apply to: an owner of
property who builds or improvesthereon, and who contracts for the projects with a contractor(s) licensed
pursuantto:the Contractors' State License. Law.).
(_) I am exemptunderSec. 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 performanceof the
work for which this permit is'issued (Sec..3097,'Civ: C.)..
Lender's Name: _
Lender's Address:
LQPERMIT
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 on4his application.
1. Each person upon whose behalf4his application is made, each.pemon 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 theapplicant,: each agrees to, and shall defend, indemnify and hold harmless thwCity
of La Quints, its officers, agents and.employess for.any, act or omission related to the workbeing
performed under or following issuance of this permit.
2. Any permit issued as a result of'thWapplication.becomes-hull and void if woWis not commenced
within 180 days from date of issuance of such permit,-oreessation.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 c_ rect. I agree to`cornply with all
city'and county ordinances and state laws relating to building ,construct ion, .a he horiie representatives
of this county to enter upon the above-mentioned property for inspectio sea.
Date: J Z' + ignature (ApplicantorAgent):
Application Number . . . . . 09-0000.0064
Permit . . . PLUMBING
Additional d'esc . .
Permit Fee 22.50
Plan Check Fee
5.63
Issue Date . . . .
Valuation . . .
. 0
Expiration Date . . 7/27/0.9
Qty Unit Charge Per
Extension,
BASE FEE
15.00
1.0.0 7.5000 EA PLB WATER
HEATER/VENT
7.50
--- ------------------------------------------------------------------------
Special Notes and Comments
REMOVE & RPLACE 50 GALLON LIQUID
PROPANE WATER HEATER.
------------------------------------------------------------
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
.0.0 .00
29.13
LQW.R Mrc
CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 3 of 4) CF -1R
SEALED DUCTS and TXVs (or AMEW v„ ve Measures)
A signed CF -411 Form must be provided to the building department for each home.for which the following. are
required.
Alternative to Sealed Ducts and Refrigerant Charge /TXVs (See Package D Alternative Package Features for
Project Climate Zone in the RM Appendix B Table 151-C. Footnotes 7-14.
OR
For additions and alterations, duct systems that are not documented to have been previously
C3 sealed as confirmed through field verification and diagnostic testing in accordance with procedures in the
Residential ACM Manual and duct systems with more than 40 linear feet in unconditioned
spaces shall meet the requirements of Section 15:0(m).and duct insulation requirements of Package D.
WATRR AF.ATlrN(_.QVc'rVMC
Distribution
Type
❑
Sealed Ducts all climate zones taller testing and certification and HERS rater field verificationrequired.)
❑
TXVs, readily accessible (climate zones 2 and 8 -IS only)
Installer testing and certification and HERS Rater field verificationrequired.)
❑
'Refrigerant Charge (climate zones 2 and 8-15 only) (Installer testing and certification and HERS Rater field
verificationrequired.)
Alternative to Sealed Ducts and Refrigerant Charge /TXVs (See Package D Alternative Package Features for
Project Climate Zone in the RM Appendix B Table 151-C. Footnotes 7-14.
OR
For additions and alterations, duct systems that are not documented to have been previously
C3 sealed as confirmed through field verification and diagnostic testing in accordance with procedures in the
Residential ACM Manual and duct systems with more than 40 linear feet in unconditioned
spaces shall meet the requirements of Section 15:0(m).and duct insulation requirements of Package D.
WATRR AF.ATlrN(_.QVc'rVMC
Svstems serving single dwelling units
Water Heater
TypetFuel Type
Distribution
Type
Number
in System
Check box if system meets criteria of a "Standard" system. Standard system is one gas-fired water heater per
Tank
Capacity
tons
dwelling unit. If the water heaterAs a storage type, 50 gallons is the maximum capacity and recirculation system is
Standby
Loss %
not allowed.
❑
Check box when using Pr+eapproved Alternative Water Heating table, Table 5-4 in Chapter 5 in the Residential
Manual. No water heaticalculations arexequit4 and the system com lies automatically.
c50
Check box if system does not meet criteria of "Standard"' system, and does not comply with the Preapproved
❑
Alternative Water Heating table. In this case, the Performance Method must be used and must be included in the
submittal.
❑
1Check box to verify that a time control is requited for a recirculating system pump for a system serving multiple
units
Svstems serving single dwelling units
Water Heater
TypetFuel Type
Distribution
Type
Number
in System
Rated
Input'
(kw or
Btu/hr)
Tank
Capacity
tons
Energy
Factor or
Thermal
Efficiency
Standby
Loss %
Tank
External
Insulation
R -Value
�� lIilQ
140
c50
°vO
Svstem serving multiple dwelling units
Water Heater
Type
Distribution Number
Type, in System
Rated
Inputl
I^ or
Btu/hr
Tank
Capacity
Ions
Enerlp
Factor or
Thermal
.Efficiency
Standby
Loss %
Tank
External
Insulation
R -Value
1. For small gas storage water heaters(rated inputs of less than or equal to 75,000 Btu/hr), electric resistance, and heat
pump water heaters, list Energy Factor. For large gas storage water heaters (rated input of greater than 75,000
Btu/hr), list Rated Input, Recovery.Efficiency, Thermal Efficiency and Standby Loss. For instantaneous gas water
heaters, list Rated Input and Thermal Efficiencies,
Pipe Ioulation (kitchen lines > 3/4 inches) All hotwater pipes from the heating source to the kitchen fixtures that are %
inches or greater in diameter shall be thermally insulated as specified by Section 150 Q) 2 A or 150 0),2 B.
Residential Compliance Forms March 2005
1d
in # .
City of La Quints
Building er Safety I)fttm
P.O. Box 1504, 78-495 Calfe Tampico
La Qldnta, CA 92253 - (760) 777-7012
Buil Permit Application and Tracking Sheet
Perlrtlt #
iding
rroOct Addt was: 3 CQC7
Owner's Name: S CL �i(d �Cl CA -0,r
A. P. Number:
Address: 3 Q CQ n 19V1P i'
L) Q Z
Legal Description:
City, ST, Zip: Cl V(; 40J O 9 2Z
Contractor: S C,0 -LT -CQ
jamj
? 1 u rrN Ln
Telephone: .
Address: 4 35 79 0. n
Project'Description:
city, sT, zip: ---s-- n d -, D C p
9"01
5D &r,
-'
Telephone: luo -175-- - C)9 I (
State Lia # :
,ro
Arch., E ngr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair 'Demo
Sq. Ft.:
p Stories:
# Units:
Telephone # of Coact Person:
Estimated Value of Project-tc3 ac On
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKNG
PERMIT FEES
Plea Sets
Pian Cheek submitted
Item
Amount
Structural Cala.
Reviewed, ready for corrections
Plan Check Deposit
Trasa CaleL
Called Contact Person
Plan Check Balance.
Tide 24 Cala.
Plaos:piehed up
Construction
Floodplain pian
Plans resubmitted
.Mechanical
Grading plan
P° Review, ready for eorrectionaftsne
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Dad
Plans picked up
MI.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
r"` Review, ready for correedonallssae
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Win, Appr
Data of permit Blue
School Fen
Total Permit Fees