08-1867 (MECH),P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 08-=00001867-=�,
Property Address:
52420 _AVENIDA VELASCO
APN:
773-265-009-9 -000000-
Application description:
MECHANICAL
Property Zoning:
COVE RESIDENTIAL
Application valuation:
3600
a '40
. Tjht 4
BUILDING &:" SAFETY DEPARTMENT
BUILDING PERMIT
Applicant: Architect or Engineer:
Owner:
JON LOUTSENHIZER
52420 AVENIDA •VEL.
LA QUINTA, CA 922
Contractor:
Owner .
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/18/08
----------------------------------------------------------------------------------------------
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: - License,No.:
Date: Contractor:
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.). "
(_) I, as owner of the property, am exclusively contractingwith 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 La��''.).
(_) I am exempt under Sec. B.&P.C.'for�fyiis reasAr gryr
Date:.
r NVRION LENDING AGENCY
I hereby affirm under penalty of ,perjury hat th re is uction lending agency for the performance of the
work for which this permit is issued (Se 3 7, Civ
Lender's Name: fl"
Lender's Address:
LQPERAIIT
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 Policy Number -
I certify tfiat, in the performance of the work for which t7hi is issued, I shall not employ any
person in any manner so as to becom ublect to the orkers' compensation laws of California,
and agree that, if I should became s lett to the m ensavon.provisions of Section
3700 of the Labor Code, I shall fc w mpy with those provisions.
WARNING: FAILYI(E TO SECA W/PLT;IES
ATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRMIND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,0001. IN ADDI IONOF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR ODND 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 on truction and hereby authorize representatives
of this county to enterupon the above-mentioned property for i pection rposes.
te: gnature (Applicant or Agent
Application. Number 08=00001867
'
Permit MECHANICAL INV FEE ,
-. _.,,Additional_desc
Permit Fee 66.00 Plan Check Fee
8.25
Issue Date Valuation
0
Expiration Date 5/17/09
Qty Unit Charge Per
Extension
BASE FEE
30.00
1.00 18.0000 EA MECH FURNACE <=100K
18:00 .
1.00 18.0000 EA MECH B/C <=3HP/100K BTU
18.00
------------
Special Notes and Comments.
INSTALL.4'TON SINGLE PACKAGE GAS
HEATING/ELECTRIC COOLING UNIT:.
INVESTIGATION FEE ASSESSED PER 1997
UNIFORM ADMINISTRATIVE CODE §304.5 FOR
WORK BEGUN WITHOUT BUILDING PERMIT.
'Fee summary Charged. Paid Credited
Due
Permit Fee Total 66.00 .00 .00
66.00
Plan Check Total- 8..25 .00 .00
8.25
Grand Total 74.25 .00 .00
74.25
LQPEINIIT -
.
CERTIFICATE OF CO1VxPI;IAN
M. RESIDENTL4L (Pa t;,`l of4)
Project Title . `
2t -I ZC2 P.�a`�1Q�-------------
0,4D ate
P[oject Address
Bvildu�g Patnit at
Documentation
Author Telephone �"/
Vat
Compliance Method (Prescriptive) Field.(ak/pats
Cliriiate Zone
Fa ("wiiaK A9*Xy Use only
r'C7 Alternative Component Package Method: (check one
. ) C D' .D (Alternative) . -
Package Cand Package D choices require H BPx rater pod venfcation and/or dwgnostic test7ing (see CF -IR page 3).._
For Package D Alternative see 'Appendix:l3 Tabte'l51-C Footr�otGs x=14
GENERAL INFORMATION .
Total Conditioned FloorArea CSA
( ):1 ZN._fe Average tkiling Height; R
Maximum Allowed West.Faciag Fenestration' Prodticts Pei Table ISI-$ or I51 -C'--- (5°6 X CFA) .
Maximum AUowed Total Fenestration Products Per Tabk 151-8 or 151-C (20•/ X CFA) ft
1 LD Building-Typ ( one or more
of add` f )L X— Single Famr7y - Multifanu'iy Addition Alteration .
adding enestraSon fll.oui V S- . "F
R, eriestratioa Maximum Allowed Area.Wodcsficd and see Section 83'.2
• . for Additions and $33 for. Alterations.3 .: = •
Number of Stoner
Number of Dwelling 1�nit
• :door Constiiection
Front Orientation? , sedFloor it ck orae of both)
'e NOS' / / est / Urieatations. (input &on{
orientation in d
North and circle one). eggrees from True
J) ✓ �, RADIANT nAD orp aired. in climate zones 4 8-1
UP_ ROUE SIIRRACES
UD TG O 'A • UE DOORS
Componout . Asstmbty U.
TYPe n't'�1; Frame fad6r for
Rood Floor, Type Cavity pDpt!nuous• ( Joint . RoofRadiant
Scab Edge, (Wood Insulation Insulation frame an tnass metal Appcndrx $ l I.ocatign/Comments
' _.Doors crMetai R -Value r IV Installed (atfic,.&ira8e,
R Yalue. i ssemblics Reference . Yrs or No
• teal, etc.
I) Sce J d presppendixdV in Suction 7 V.Z,1Y.3 and IY.4; which is the basis for the, U -factor criterion. U -factors can -not '
exceed presCEWIVe. value to show equivalence to R -values:.
Residential Compliance.Forms
-March 2005
CERTIFICATE OF COMPLIANCIJ; R SiDENTIA,Le
(rte 2 of
4) C&IR
Project Title--------------
Date'
FENESTRATION PRODUCTS —'U-FACTOR AND ISHGC '
❑ FENESTRATION MAXIMUM ALLOWED AREA WORKSHEET WS-4R—must
Additions and Alterations.: be included
New.Coitstru ctton,
Fenestration
.#/Type/pos.
(Front, Left, Orien- •
Exterior.
Rear' Right, tation, Area
S Ii t I1, S Wt . U=factor SHE3C '.
ft U-fadot�
Shading/Overhangs6, 7
./ box if WS-3R is
. Source' SHGG'� S
Sourcei
included
d •
❑". .
❑.
1) Skylights ars now included in West facing feneshatibn area ifthe s li ❑
when'the pitch is less than 1:12. See § 15I(f)3C and in Section 3
or titled in any direction
. 2)
of the Residential Manual
Bruer. values m this column am either NFRC Rated value or from standards default Table 116A.
3) Indicate source either from NFRC '
or, Table 116A,
4) Enter values in this column' from NERC or from Standards
Default Table 1168 oradjusbed SHC1C from WS 3R
5) Indicate source either -from NFRC or Table 116B.
6) Shading Devices are defined in Table in the Residential Manuale WS-3R to calculate Exterior Shading devices.
7) See Section 3.2.4. in the Residential Manan ual • and se- '.
HVAC SYSTEMS
If eating Equipment Minimum, DistH alien..
-.
Type and Capacity Efficiency.
Type and.Loca Dud or Pi in
fumax t boiler etc P g Thermostat
AfVE or HSP , ducts atti etc.-Valliegut
ation
it or �
Cooling Equipment • Minimum
Type and Capacity. Efficiency Duct.Location Duct Thermostat
A/C beat urtf en ..cook SBBRor>rER attic'etc.
Configuration
R-Value
S
liter'
y r�
Residential Compliance Forms
March 2005
4
CERTIFICATE OFCOMPLIANCE; RESIDENTIAL a
^) (p ge 3 of 4) CF=1 R
Project Title
Date .
SEALED DUCTS and TXVs or Alternative Measures
//!: �► signed R.Form must be provided to the buading.department or home forwhich the following. are
TXVs readil. - - " ana ceruricCa ion and HERS rater.field verification wired:
p. y accessible (climate zones 2 and 8-15 only) ..
staller testis and certification and HERS Rater field verification. iced:
o Refrigerant Charge (climate zones 2 and 8-15 only).(Installer.testing and certification and HERS Rater field
verification uired. .
OR.
E
b . Alternative to Sealed Ducts and Refrigerant e
Pio, Climate Zone in the RM Charg. /T'XVs.(See Package D Alternative Package Features for.
�R ndix B Table 151.. Footnotes 7-14.
For additions and alterations, dud gystems that are not d
S
as confirmed through field verification and di ocrmented to.have been previously'
Residential ACM Manual and dud . agrrogtie testing in accordance with Procedures in the
systems with more than 40 linear feet in, unconditioned
aces shall meet the r u"u+ements of Section 1S0 m
WATER REATING SYSTEMS and dud insulation r uirerrents of P e D.
Check box •if system meets criteria ofa "Standard» stem.
0 dwelling unit. If the water heater is a sto a Standard stem is onegas-flied water heater per
not allowed. tYl?e� SO'gallons is the m urn -capacity and, recirculation system is
13 Check box when using PreapProved Alternative Water H
Maneating tabic, Table 5-4 in Chapter S in the.Residential
}i ual. No water heatia ca)culations are
Check box if system does E3 not meet criteria of "Standard the stem corn lies automaticall ,
Alternative Water Heatin sys, and does not comply.with the Preapproved
submittal: g table. In this case, the Performance Method must be used and must be included in
athe
Check box to verify the. 'a time control is required for a reciicul
units ahng systCm Pump fora system serving multiple
S stems servin sin le dwellin . units
Rated Tank
Water Heater Distribution Number. Input' Tank Factor or External
uel a in. stem (kW or � Capacity Thermal Standby' Insulation
Bauer . tom Efficien Loss % R -Value
S stem servin multi le.dwelliri units
Rated Energy .Tank
Water Heater Distribution Inpuf' Tank Factor or External
• Number
e in .stem; (Mor Capacity Thermal Standby' Insulation
Ions Efficien Loss % R -Value
I. For small gas storage water heaters (rated inputs .of less than or equal to 75,000 .fto r), electric resistance, and heat
Pump water heaters, list Energy Factor.. For large gas storage water -heaters (rated in of greater than 75,000
13tu/hr), list Rated Input, Recovery VM For
Thermal Efficiency and Standby Loss.' For instantaneous gas water
1 heaters; list Rated Input and Thermal Efficiencies,
Pipe Insulation. (kitchen lines >_ 3/4 inches).All hot waterpipes
inches or greater in diameter shall be thermally. insulated as specified by Soheating 0 (j) source tore kitchen
fomes that ate a�
Residential Compliance Forms
March 2005
E
CERTIFICATE OF COMPLIANCE;
RESIDENT
.. M . (Page 4 of 4) ' Cr
Project Title
- •
Date
SPECIAL FEATYTRES NOT RE
Indicate which special feat fires
PRUNG HERS VERIF7CATTON add
res cri five method.
e
are part of this. projeic.. l 1me list below on xtra sheets if necxs
y represents special features relevant to the
Feature. '
❑ Metal Frarned•Walls
Re uired Form's if a licable ]Descri tion
CF
❑ RadiantBarriers
❑ Exterior Shades
-IR.
CF -IR
❑ : Cool Roof.
NA; Attach CRRC Label to
❑ Dedicated Hydronic H eating.
., .
Forms.
Performance Caleulatioin
stem
13 Combined Hydronic System
R " uired•. Attach Run to Forms.
Performance Calculation
❑ Gas Cooling
R uired•.Attach Run to Fomes;
Performance Calculation '
.. ❑ Buried Ducts
R fined.
❑ Kitchen Pipe Insulation
Indicate on buildin tans.
See $ectiOn 5.62 Distribution
Multiple Water Heaters Per
stems in Residential. Manual.
See Table 5-13 or use
Dwelling.Unit •
Performance Calculation and
�. Central Water H e� System
Servin
attach Run to FOmrs.
Performance Calculation
�1 Multi le Dwellin
❑ Non-NAECA Large Water
and
attach Run to Forms.
Heater
❑ Indirect Water Heater :
See Table 5=13 or use*
Performance. Calculation
and
attach Run to Forms
❑ ..Instantaneous Gas Water H
See Table 5-13.or use •
Performance Calculation and
Mach Run to Forms
❑ Solar. Water ii eating System
SeeTable 5713 or use
Performane� Calculation
❑ Wood Stove Boiler
and
attaeh.Run to Forms
Performance Calculation
and
attach Run to Forms
SPECIAL FEATURES .RE iIERW,(G HERS
add extra sheets 'f necess RATER'wERIFICA�'ION
.
verification.
Liicate to.the HERS Rater which credits are part of this project and need
✓ Feature
R Auct Sealin
.
.
R uired Forums f a livable Descri tion
CF -6R
❑ Refri erant Char e
❑ Thermostatic Ex anion Valve
art of 12
CF -6R alt 5 -of 12
CF=612 art 6 of 12
Residential Compliance Forms
March 2005
TELEPHONE (760) 777-7012 FAX (760) 777-7011
i
OWNER/BUILDER INFORMATION
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified.
For your protection you should be aware that as "Owner/Builder" you are the responsible party of record on such a
permit. Building permits are not required to be signed by property owners unless they are personally performing their .
own work. If your work is being performed by someone other than yourself, you may protect yourself from possible
liability if that person applies for the proper permit in his or her name.
t
Contractors are required by law to be licensed and bonded by the State of California and to have a business license
from the City or County. They are also required by law to put their license number on all permits for which they
apply i
If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be
aware of the following information for your benefit and protection.
If you employ or otherwise engage any persons other than your immediate family, and the work (including materials
and other costs) is $200.00 or :more for the entire project, and such persons are not licensed as contractors or
subcontractors, then you may be an employer.
If you are an employer, you must register with the State and FederalGovernment as an employer and you are subject
to several obligations include State and Federal income tax withholding, federal social security taxes, worker's
compensation insurance, disability insurance costs and unemployment compensation contributions.
There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with
respect to worker's compensation insurance. i
For more specific information. about your obligations under Federal taw, contact the Internal Revenue Service (and, if
you wish, the U.S. Small Business Administration). For more specific information about your obligations under State
Law, contact the Department of Benefit Payments and the Division of Industrial Accidents.
If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their
work personally or through their own employees, without a licensed contractor or subcontractor, only under limited
conditions.
A frequent practice. of unlicensed persons professing to be contractors is to secure an "Owner/Builder" building
permit, erroneously implying that the property owner is providing his or her own labor and material personally.
Building permits are not required to be signed by property owners unless they are performing their own work
personally.
Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your
community or at 1020 N. Street, Sacramento, California 95814. ,
Please complete and return the enclosed owner -builder verification form so that we can confirm that you are aware of
these matters. The building permit will not be issued until the verification is returned.
Very truly yours,
CITY OF LA QUINTA
DEPT. OF BUILDING AND SAFETY
78-495 Calle Tampico
La Quinta, CA 92253
(760) 777-7012
FAX: (760) 777-7011
OWNER'SIGNATU
5�2- � 1 l
PROPERTY ADDRESS
4 7
PERMIT NUMBER(S)
f
,Bin #
City of La Quints
Building 8I Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
N r ^ 1
Project Address:
Owner'sName3o(-\ I—D(}
A. P. Number:
Address: IDOH
Legal Description:
Contractor: 1 1 (-(w r
U
City, ST, Zip:. pfd
Telephone: =" 0
Address:
Project Description:
City, ST, Zip:U
0'L
Telephone-1
qG-
State Lie. # :
Arch., Engr., Designer:
City Lic. #:
Address:
City, ST, Zip:
Telephone:
State Lie. #:
Name of Contact Person:—T#12
f!L Z
Construction Type: I/j�C Occupancy:
Project type (circle one): ew Add'n Alter Repair Demo
Sq. Ft.: U0 #Stories: I Units:
Telephone # of Contact Perso?k'
0? %
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING.
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cates.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cales.
Called Contact Person
Plan Check Balance
Energy Cales.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2°" Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'" Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees