07-2291 (PLBG)• P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA,'CALIFORNIA 92253
Application Number:
07-000022:91
Property Address:
53680 AVENIDA CORTEZ
APN:
774-102-0Q9-16 -000000-
Application description:
PLUMBING
Property Zoning:
COVE RESIDENTIAL
Application valuation:
500
Applicant: Ar it ngineer::
------------------
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Thereby affirm•under.penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professionals Code,.and myLicenseis in full force and effect.
License Class:. C36 License No.: 828264
Date: &_��Contractor: .3"Cee6
OWNER11 ER. DECLARATION
I hereby affirm under penalty of perjury that I am exemptfrom the Contractor'sstate 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'repairany structure; prior to its issuance, also requires the applicant for the
permitto fiWa signed statement that,he or -she, is licensed pursuant to the provisionsiof the Contractor's State
License Law (Chapter9 (commencing with Section 7000) of Divisiom3 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 (9500).:
(_ 1 1, as owner of the,property,.or my employees with wages as theirsole compensation, will do the work, and
the structure is not intended or offered for sale (Sec. 70”, 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 woWhimself 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 completion, the owner -builder will have She 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'lwith*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;construetion lending_ agencyforthe performance of the
work for, which this�parmit is issued (Sec. 3097, Civ. C.).
Lender's -Name:
Lender's Address:
LQPERMIT
Owner:
HERNANDEZ RESIDENCE
53680 AVENIDA CORTEZ
LA QUINTA,, CA .92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/13/07
Contractor:
p
FOY, SCOTT A.
43579 MAIN STREE
f r, .1 3 2007 i
INDIO, CA 92201
(760)775-9405
C1TY®_9.��6'.gTA
Li.0 . No.: 8282641
1
�Iyu, f F IM
... _ _
_.._.,-
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
Cade, for the performance of the work for which. this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier ENDR INS Policy, Number WEN000882301
_ I certify that, in the performance of the work.for which this permit is issued, I shallnot 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 subjectto the, workers' compensation provisions of Section
3700 of the Labor Code; I shall forthwith comply with those provisions.
Date:-- l Applicant: 9i
WARNING: FAILURE TO SECURE WORKERS' 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 OF2THE 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 an 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,arxf hold harmlesstheCity
of Le Quintai its officers,agents and employees for any act or omission related_ to the work being
performed under or followingissuance 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 uponthe above-mentioned property for inspection purposes.
Dater-�ignature (Applicant oL Agent):
"
Application Number . . . . . 07-00002291
Permit 'PLUMBING
Additional desc . .
Permit Fee . . . . 22.50
Plan Check
Fee
5.63
Issue Date
Valuation
. . .
.
0
Expiration Date 2/09/08
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 50 GALLON WATER HEATER GAS UNIT
Fee summary Charged
Paid Credited
Due
Permit Fee Total 2'2.50
.00
.00
22.50
Plan Check 'Total 5.63
.00
.00
5.63
Grand Total. 28.13
.00
.00
28.13
LQPERMIT
Afn
City of La Quints
Bifift 8i Safety Dlv dDn
P.O Box 1504, 78-495 Calle Tampko
1a QldnU, CA 92253 - (760) 777-7012
Building Permit Application and Tracidng Sheer
Pmt
r1Ar
1
kftqjactAddrew:�W-60y r_-,rG(V C�Q, (00
Owner's Nara e— l d L7��N
A. P. Numbs.
Address: Q Nen U y
Legal �aM:
City, sT, a a. C� G zz5
Contractor: �Q
Telephone:
Project Descriptim-
Address: 5 G �'ri St •
City. ST, Zip. ZU C.%,:"f
OL InecacR
T&Phorle. `3A' � 8
State I.& P City Lie. C
Cil I e\e C ,
Ardl., Sm.. Decrier:
Adm
city" W. Zip:
'1
ConsWction Type: C aU Oaarpancy:
%xic Lim e:
Project type (cele one): New Add'n Alter Repair Dano
WMMm of CaMmea %wn: ` eSq.
4
Ft.:
# Stories: 7
#Units:
Tel im of call mot person: P,014-61608 _ 0
Fshmated Value of Project
APPLICANT: DO NOT WRITE BELOW THIS LINE
e
RuNfiHesl
RWd
Ree-d
TRACKM
PERMIT Ft31?S
Poe Seb
Pian Cheek submftd
Item
Amount
Awnetwel Cala.
RevieWed, ready tw. corrections
Plan Cheep Deposit
Tvws Colts
Galled Contact Person
Plan Check Rahme
Mile 24 Luka.
Flaw picked up
Construction
Flow tUM plan
Plans resubmitted
Metbaulal
C.Nftptau
2� Review, ready for rortectionvlo a
Electrical
5nbtontacter Ust
Called Contact Person
Plumbing
Cavum Dad
plana picked up
ULL
H.U.A. Approval
Piam resubmitted
Grading
IN HOUSE:-
''' Review, ready for eorreedooslsae
Developer Impact Fee
Preuelag Approval
Called Cosset Person
A.LP.P.
pub- Win. Appr
Date of permit issue
&bwl Fera
Total Permit Fees
CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 3 of 4) CF -1R
Project Title Date
SEALED DUCTS and TXVs (or Alternative Measures)
A signed CF -411 Form must be provided to the building department for each home for which the following. are
required.
V
Distribution
Type
❑
Sealed Ducts all climate zones Installer testing and certification and HERS rater field verificationrequired.)
❑
TXVs, readily accessible (climate zones 2 and 8-15 only)
Installer testing and certification and HERS Rater field verificationrequired.)
13
Refrigerant Charge (climate zones 2 and 8-15 only) (Installer testing and certification and HERS Rater field
verificationrequired.)
UK
Alternative to Scaled Ducts and Refrigerant Charge /TXVs (See Package D Alternative Package Features for
hrojecl Climate lune in the RM Appendix B Table I51 -C, Footnotes 7-14.
VK
For additions and alterations, duct systems that are not documented to have been previously
U waled as cunfirmed through field verification and diagnostic testing in accordance with procedures in the
Rmideatial ACM Manual and duct systems with more than 40 linear feet in unconditioned
s s shall meet the requircracrits of Section 150(m) and duct insulation requirements of Package D.
WATER HEATING SYSTEMS
I?
Distribution
Type
Number
in System
Check box if system meets criteria of a "Standard" system. Standard system is one gas-fired water heater per
13
dwelling unit. If the water heater is a storage type,.50 gallons is the maximum capacity and recirculation system is
Standby
Loss %
not allowed.
13
Check box when using Preapproved Alternative Water Heating table, Table 54 in Chapter 5 in the Residential
Manual. No water heating calculations are required, and the system complies automatically.
5�
Check box if system does not meet criteria of"Standard" system, and does not comply with the Preapproved
O
Alternative Water Heating table. In this case, the Performance Method must be used and must be included in the
submittal.
G
Check box w verify that a time control is required for a recirculating system pump for a system serving multiple
unity
serving sintle dhvel 'nit units
venter Ileater
Typal"UCITYIN
Distribution
Type
Number
in System
Rated
Input'
(Mor
Btulhr)
Tank
capacity
low
Energy
Factor or
Thermal
Efficiency
Standby
Loss %
Tank
External
Insulation
R -Value
G: e-keC4 .
ekecwc1
4r.) W
5�
Ryntem nervine muldule dweWnQ units
------ --- - -
Watcr Heater
TYPC
Distribution
I -Yoe
Number
in System
Rated
inuTank
(tw or
Btuthr)
Enerpy
Factor or
Capacity Thermal
loin) Efficiency
Standby t
Loss %)
Tank
External
Insulation
R -Value
I _ For smal l 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 IneUlation (kitchen lines > 3/4 inches) All hot water pipes from the heating source to the kitchen fixtures that are -11a
inches nr greater in diameter shall he thermally insulated as specified by Section 150 0) 2 A or 150 0) 2 B.
Residential Compliance Forms
March 2005