11-0767 (PLBG)1. -
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 11 -000007671 -
Property Address: 44030 CRISTOL PL
APN: 604-143-025-210 -23269 -
Application description: PLUMBING
Property Zoning: 'LOW DENSITY RESIDENTIAL
Application valuation: 150
Applicant:
c&ty/ 4 4.0"
Architect or Engineer:
PIA
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
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 Business and Professionals Code, and my License is in full force and effect.
License Class: C36 License No.: 731855
/ue, ontractor: �� /f��
✓ vOWNER-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).:
1 _ 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
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 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
Owner:
GRETCHEN HOLM
44030 CRISTOL PLACE
LA QUINTA, CA 92253
I
Contractor:
STATE WIDE PLUMBING
70244 CATANIA COURT
INDIO, CA 92203--0
(760)393-6115
Lic. No.: 731855
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/14/11
JUL 14
2011
0W.;
s�i-.i�rt.�r-•�.9
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 EXEMPT Policy Number EXEMPT
Pacertify 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 C I shall forthwith comply with those provisions.
ate: A ant: no t
WARNING: FAIL E TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,0001• 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, indemnity 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 prQggD.y ter.Fespecti`on purposes.
D?� Si lure (Applicant'or Agent): V C_ —/
Application Number . . . . . 11-00000767
Permit . . .
PLUMBING
Additional'desc .
Permit Fee . . . .
22.50
Plan Check
Fee
5.63
Issue Date . . . .
Valuation
. . .
. 0
Expiration Date
1/10/12
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
1.00 7.5000
EA PLB
WATER HEATER/VENT
7.50
-------------------------------------------------------------------7--------
Special Notes and Comments
INSTALL NEW 50 GALLON
GAS WATER
HEATER.
2010 CODES.
-----------------------------------7-------------------7--------------------
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
n
LQPERMIT
Prescriptive Certificate of Compliance: Residential CF -IR -ALT I
Project Name:/—
m' / J 0
Climate Zone # I. # of Stories
General Information
Site Address:Jq a Y 14tt W-forcement Agency: Date:
Building Type Single Family O Multi Family Circle the Front Orientation: N, E, S. W, or degrees
Conditioned Floor Area (CFA): C) Project Type: O Alteumons O Envelope O Fenestration O Roof O HVAC
Replacement or Change Out O Duct Replacementater Heater
N T : This form is not to be used for Newly Constructed Buildings or Additions
Insulation Values For Opaque Surfaces (for Furring use the Mass and Furring Strips Construction table below)
Assembly Alteration
O Opening of framed cavity alone— Alterations that involve the opening of the framed cavity of o wall, ceiling, or floor must install the
mandatory minimum insulation value per §150 for the altered assembly. Fill in Columns A -C and enter mandatory insulation value in Column H.
O Replacement of entire assembly— Replacement of an entire wall, ceiling, or floor assembly requires the installation of Component
Package- D insulation values in Table 151-C Fill in Columns A — J.
Opaque Surface Details For the furred portioned of Mass Walls see Furring Strips Construction Table below.
A B C D E F G I H I I I J
Proposed see Noce Standard Values From JA4 Table
Ta�
ID
Framing
Assembly Name Material
or T ' and Size2
Thickness,
Spacing, U- JA4 Table
or Othe? factor' Numbers
Framed Continuous JA4 Proposed
Cavity insulation Assembly Assembt
R-�alue6 R -Value Cell Valuer U -factor
Proposed Properties of Masonry and Concrete
Added Interior or Exterior Insulation
Walls From Reference
in Furring Space from Reference
Joint Appendix
Table 4.3.5,4-3.6.4.3.7
Joint Appendix Table 4.3.13
Note. For furred assemblies, accouming jos Continuous Insulation R -value. see Page JA4-3 and Equation 4-1. For calc ulsting furred walls use the Mars and
Furring Consauction table below.
1. For T09.9D indicate the identification name that matches the building plans.
2. Indicate the Assembly Name or type: RoofiCeiling, Walls, Floors. Slabs, Crawl Space, Doors and etc... Indicate the Frame type and Size: For
Wood. .Metal. Metal Buildings, Mass, enter 2x4. 2x6. or etc... see JA4 for other possible frame type assemblies.
3. Enter the thickness for mass in inches or Spacing between framing members enter; 16 "or 24 "OC: or Other for all other assembly description
such as Concrete Sandwich Panel. Spandrel Panel, Logs, Straw Bale Panel and etc....
4. Based on the Climate Zone: enter the Standard U factor from Table 151-B. C or D for each different assembly Name or type.
J. Enter the Table number that closely resembles the proposed assembly.
6. Enter the R -value that is being installed in the wall cavity or between the framing; otherwise, enter -0 ".
7. Enter the Continuous Insulation R -value for the proposed assembly; otherwise, enter -0 ".
8. Enter the row and column of the U factor value based on Column F Table Number and enter the Assembly U factor in Column J
9.7he Proposed Assembly U factor, Column J, must be equal to or less than the Standard U factor in Column E to comply.
Furring Strips Construction Table for Mass Walls Only
A
B I C D 7
E
F
G H I J I
K
L M
Proposed Properties of Masonry and Concrete
Added Interior or Exterior Insulation
Walls From Reference
in Furring Space from Reference
Joint Appendix
Table 4.3.5,4-3.6.4.3.7
Joint Appendix Table 4.3.13
Assembly I -
j
° c S
Final
Mass
Name or JA4 Table v —y'
W
L
E - ` a 2
v >
Assembly
Thickness
i
T Number a>
T>
e U
N
a>
L
U -factor ' Comment
Registration Number:
2008 Residential Compliance Forms
Registration Date. Time:
HERS Provider:
August 2009
HVAC SYSTEMS- HEATING
gas or propane fired. and may not exceed 50 gallons. Hot water pipe insulation from the DH W heater to the kitchen(s) and on all underground
hot water pipes is required in all omponent packages in all climate =ones.
Minimum Duct or Piping
Configuration
Heating Equipment
Type and C acity1 ='
Efficiency- Distribution insulation
(AFUE or HSPF) Type and Location' R -Value
Thermostat (Central. Split.
Type Space. Package or H •dronic)
External Tank
Water Heater Type/Fuel
Distribution Type
Number in
Tank
Energy Factor or
1. Indicate Heating Type (Central Furnace. {call Furnace. Heat pump, Boiler. Electric Resistance. etc.)
1. Electric resistance heating is allowed only in Component Package C. or except where electric heating is supplemental (i.e.. if total capacity
_ 2 k N' or 7.000 Btu/hr electric heating is controlled by a time -limiting device not exceeding 30 minutes). See $151(6)3 exception.
3. Refer to the HERS Verification section on Page 4 of the CF- I R -ALT Form for additional requirements and check applicable bares.
4. Indicate Type or Location (Ducts. Hydronic in Floor. Radiators, etc.)
HVAC SYSTEMS - COOLING
Thermal Efficiency
R -Value'
Minimum
v a
Efficiency
Duct or Piping
Configuration
Cooling Equipment
Type and Capacity"
(SEER/EER or
COP)
Distribution Insulation
Type and Location' R -Value
Thermostat
Type
(Central. Split.
Space. Package or H •dronic
1. indicate Cooling Type (A%C. Heat pump. Evap. Cooling, etc)
2. Refer to the HERS Verification section on Page 4 of the CF -I R -ALT Form for additional requirements and check applicable bares.
3. Indicate Type or Location (Ducts. H dronic in Floor, Radiators, etc.
WATER HEATING
List water heaters and boilers for both domestic hot water (DHW) heaters and hydronic space heating. Individual dwelling DHIV heaters must be
gas or propane fired. and may not exceed 50 gallons. Hot water pipe insulation from the DH W heater to the kitchen(s) and on all underground
hot water pipes is required in all omponent packages in all climate =ones.
External Tank
Water Heater Type/Fuel
Distribution Type
Number in
Tank
Energy Factor or
Insulation
T ypel(Standard
Recircutatin )2
S stem
Capacity (al)
Thermal Efficiency
R -Value'
a
v a
1. Indicate Type (Storage Gas. Heat Pump. Instantaneous, etc.)
1. Recirculating systems serving multiple dwelling units shall meet the recirculation requirements of JI 50(n)
not allow the installation of a recirculating water heating system for single dwelling units.
3. The external water heating tank and pipes shall be insulated to meet the requirements of§150(j).
Tire Prescriptive requirements do
SPECIAL FEATURES The enforcement agency should pay special attention to the Special Features specified in this checklist below.
These items ma • require written 'usti tcation and documentation and special verification.
NEW ROOF ASSEMBLY - Radiant Barrier
The radiant barrier requirement of § 151 2 does not apply to roof alterations.
Slab Edge (Perimeter) Insulation O YES O NO
YES: In Climate Zone 16 in Component Packages D. R-7 insulation is required.
Heated Slab Insulation O YES O NO
YES: Slab edge insulation required for all heated slabs in all Climate Zones. See details in Table 118-A of the standards.
Raised Slab Insulation O YES 0 NO
YES: In Climate Zones 1.2. 11. 13. 14 & 16. R-8 insulation is required: in Climate Zones 12 & 15. R4 is required under component Package D.
Thermal Mass
To obtain Compliance Credit for the installation of thermal mass. use the Performance Approach.
Registration ."umber: _ Registration Date Time:
2008 Residential Compliance Fornts
HERS Provider:
A ugust 20
C
Prescriptive Certificate of Compliance: Residential
Residential Alterations
% , a-w_"A. -% ,.
CF -IR -ALT
Pa e 5 of 5
_ _A.:.#-of.Stocies—
HER VERIFICATION SUMMARY The enforcement agency- should pay special attention to the HERS Measures specified in this �
checklist below.. completed and signed CF -4R Form for all the measures specified shall be submitted to the building inspector before final
inspection.
Duct Sealing & Testing HERS verification is required for this measure.
❑ YES ❑ NO YES: In Climate Zones 2 and 9-16. if more than 40 linear feet of new or replacement ducts are installed in unconditioned
space. the ducts are to be sealed per §152(b)IDii and the newly installed ducts are to be insulated per §I51(f)10.
❑ EXCEPTION: Existing duct systems that are extended, which are constructed, insulated or sealed with asbestos.
❑ YES ❑ NO YES: In Climate Zones 2 and 9-16, if the existing space -conditioning system (HVAC equipment and ducting) is replaced. the
ducts are to be sealed per §152(b)IDi.
❑ YES ❑ NO YES: In Climate Zones 2 and 9-16. if the existing HVAC equipment is replaced (including the replacement of the air handler.
outdoor condensing unit of a split system. cooling or heating coil. or the furnace heat exchanger) the ducts are to be
sealed per §I52(b)IE.
❑ EXCEPTION: Duct systems that are documented to have been previously sealed confirmed through HERS
verification in accordance with procedures in the Reference Residential Appendix RA3.
O EXCEPTION: Duct systems with less than 40 linear feet in unconditioned space.
❑ EXCEPTION: Existing ducts stems constructed, insulated or sealed with asbestos.
Refrigerant Charge -Split System HERS verification is required for this measure.
0 YES ❑ NO YES: In Climate Zones 2 and 8-15. when the existing HVAC equipment is replaced (including the replacement of the air
handler. outdoor condensing unit of a split system A/C or heat pump, cooling or heating coil. or the furnace heat
exchanger) a refrigerant charge measurement shall be verified per§152(b)IF.
Central Fan Integrated (CFI) Ventilation System and Fan Watt Draw
The ventilation requirements of § 15 o do not apply to existing residential homes.
Ducted Split Systems -Air Conditioners and Heat Pumps: Airflow HERS verification is required for this measure.
0 YES 0 NO YES: in Climate Zones 10 through 15, when the existing space -conditioning system (HVAC equipment and ducting) is
replaced. the airflow and fan watt draw shall be verified per § 152(b)ICi to meet the requirements of § 151(f)7B.
Documentation Author's Declaration Statement
• l cerci that this Certificate of Compliance documentation is accurate an m tete.
N
(
Sign r
rVC
Co y: `
--
dD-7
h�
/
Addres;i C ` / , L
r� l� T
If Applicable ❑ CEA or ❑ CEPE
7
(Certification #):
City/ ip:
in.
Responsible Buildi Designer's Declaration Statement
• 1 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 energy, features and performance specifications for the building design identified on this Certificate of Compliance confortr
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 fora roval with this building permit application.
Name:
Signature:
Company:L j
Date:
Address: !
License:
City/State/Zip:.
Phone:.
For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300.
Registration A'umber: Registration Date Time: _ _ _ HERS Provider:
2008 Residential Compliance Forms
August 21
Din # Cit/ Of La Quinta
Building 8z Safety Division
P.O. Box 1504, 78495 Calle Tampico
Permit # ^ I„ La Quinta, CA 92253 - (760) 777-7012
k L `.(! Building Permit Application and Tracking Sheet
Project Address:
Owner's Name:
/
A P. Number.
Address'-/
a
Legal Description:
City, ST, Zip:
L.{ h
Contractor
Address: T
Telephone:
Project Description:
City, ST, Zi : p --�'!a
-
Telephone:
l p
State Lic.# : g SS City Lie.
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
�'
Construction Type: Occupancy:
State Lie. 4:4111�
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: I� CA Q
CC,Sq.
Ft-.
#Stories:
F#Tjnits."
Telephone # of Contact Person: -
Q
Estimated Value of Projee
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACMG
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cases.
Reviewed, ready for correctiow
Plan Cheek Deposit
Truss Calcs.
Called, Contact Person
Plan Check Balance,
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2i° Review, ready for corrections/issue
Electoral
Subeontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M I.
H.O.A. Approval
Plans resubmitted
Grading
IN-HOUSE:-
Reylew, ready for correcdonslissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.LP P.
Pub. Wks. Appr
Date of permit issue
School Fees
Ll
Total Permit Fees