08-1139 (PLBG)Atyl
444
r P.O. BOX 1504.
78-495 CALLEtAMPICO
LA QUINTA;,CALIFORNI'A 92253'.'r BUILDING & SAFETY•'DEPARTMENT
BUILDING PERMIT
Application Number:
08-00001139
Property Address:
53865 AVENIDA VELASCO
APN:
774-164-019-7 -000000-
Application description:
PLUMBING
Property Zoning:
COVE RESIDENTIAL
Application valuation:
500
Applicant:
Architect or Engineer:
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.: 828264
Date.!'? Contractor:
OWNER UILDER DECLARATION
1 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 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 proberty 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 _ 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.).
am exempt under Sec. I , BAP.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:
LQPERAIIT
Owner:
LEANN MATHIS
53865 AVENIDA
LA QUINTA, CA
(760)399-9394
Contractor:
FOY, SCOTT
43579 MAIN
INDIO, CA 9
(760)775-94
Lic. No.: 8
VELASCO
92253 /;
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/02/08
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 ACE INC Policy Number 045040239
_ 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, I shallforthwithcomply with those provisions.
DaterApplicant:
WARNING: FAILURE TO SECURE WORKERS' .PEN SA116N 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 1-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 for inspection purposes.
Date7_?,-�Signature (Applicant or Agent):
_r Application Number
08-00001139
Permit -PLUMBING
Additional desc .
Permit. Fee" -•.: . `•: F 22.50.
:. Plan Check
Fee
00
- Issue Date
Valuation
0
Expiration Date 12/29/08
Qty Uriit Charge Per
Extension
BASE,
15.00
1"0'0 7"5000 EA PLB
WATER HEATER VENT
7.50 -
Special Notes and Comments
..REPLACE 50 GALLON PROPANE WATER
HEATER
Fee summary.. Charged
Paid Credited
Due
Permit Fee Total 22.50
.00
.00
22.50
Plan Check Total .00
.00
.00
.00
Grand Total 22.50
.00
.00
22.50
CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 3 of 4) CF -1R
SEALED DUCTS and TX -Vs (or Alternative Measures)
A signed CF -411 Form must be provided to the building department for each home for which the following. are
OR
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
❑ 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 150(m) and duct insulation requirements of Package D.
WATER HEATING SYSTEMS
01
❑
Sealed Ducts all climate zones(Installer testing and certification and HERS rater field verificationrequired.)
Tank
Capacity
TXVs, readily accessible (climate zones 2 and 8-15 only)
❑
(Installer testing and certification and HERS Rater field verification required.)
rD
Refrigerant Charge (climate zones 2 and 8-15 only) (Installer testing and certification and HERS Rater field
❑
verification required.)
OR
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
❑ 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 150(m) and duct insulation requirements of Package D.
WATER HEATING SYSTEMS
Svstems serving sinele dwelling units
Water Heater
Type/Fuel Type
01
Number
in System
Check box if system meets criteria of a "Standard" system. Standard system is one gas-fired water heater per
Tank
Capacity
dwelling unit. If the water heater is a storage type, 50 gallons is the maximum capacity and recirculation system is
Standby'
Loss %
not allowed.
rD
Check box when using Preapproved Alternative Water Heating table, Table 5-4 in Chapter 5 in the Residential
❑
Manual. No water heating calculations are required, and the system complies automatically.
�
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.
FOICheck
box to verify that a time control is required for a recirculating system pump for a system serving multiple
units
Svstems serving sinele dwelling units
Water Heater
Type/Fuel Type
Distribution
Type
Number
in System
Rated
Inp(kWuor
Buvbr(gallons)
Tank
Capacity
Energy
Factor) or
Thermal
Efficiency
Standby'
Loss %
Tank
External
Insulation
R -Value
rD
�
Svstem serving multiple dwelline units
Water Heater
Type
Distribution
Type
Number
in System
Inted
a ut'
(kw or
Btuft)(gallons)
Tank
Capacity
Energy
Factor or
Thermal
Efficiency
Standby
Loss %o
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 Insulation (kitchen lines > 3/4 inches) All hot water pipes from the heating source to the kitchen fixtures that are 3/4
inches or greater in diameter shall be thermally insulated as specified by Section 150 (j) 2 A or 150 (j) 2 B.
Residential Compliance Forms March 2005
a.,
Title 24 Calcs.
City of La Quinta
Plans picked up Construction
Btdkgng er Safety Division
P.O. Box 1504, 78-495 Cane Tampico
Flood plain plan
Permit #
La Qtrinta, CA 92253 - (760) 777-7012
Plans resubmitted Mechanical
Building Permit Application and Tracking Sheet
Project Address: 5
Owner's Name:
A. P. Number.
Address: 5,3 0 S U
Legal Description:
City, ST, Zip ,
Contractor. O
Telephone:
Address: 51di Mttif)4
Project Description:
Grant Deed
City, ST, Zip:
Plans picked up &IV L
Telephone:
H.O.A. Approval
State Lic. # :
City Lic. #:
Pians resubmitted Grading
Arch., Engr•, Designer:
IN HOUSE:
Address:
City., ST, Zip:
Telephone:
.
Constriction Type: Occupancy:
,y h n
t <ti<?'�"3 ^' Project circle one): New Add'n Alter Repair Demo
State Lic. #:
Name of Contact Person:
2A,)I:Z�Sq.
FL:
# Stories:
# Units:
Telephone # of Contact Person: 39 C1 Estimated Value of Project
APPUCANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Reed
TRACKNG PERMIT FEES
Plan Sets
Plan Check submitted Item Amount
Structural Caics.
Reviewed, ready for corrections Plan Check Deposit
Truss Cales.
Called Contact Person Plan Check Balance.
Total Permit Fees
Title 24 Calcs.
Plans picked up Construction
Flood plain plan
Plans resubmitted Mechanical
Grading plan
20° Review, ready for corrections/issae Electrical
Subcontactor List
Called Contact Person Plumbing
Grant Deed
Plans picked up &IV L
H.O.A. Approval
Pians resubmitted Grading
IN HOUSE:
''d Review, ready for corrections/issue Developer Impact Fee
Planning Approval
Called Contact Person A1.P.P.
Pub. Wks. Appr
Date of permit issue
Schodl Fees
Total Permit Fees