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09-0302 (PLBG)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 4/02/09 Application Number:' 1'09-00000302;_ Owner: Property Address: 55270 SHOAL CREEK. .BRETT DINGERSON APN: 775-142-001- - - 55270 SHOAL CREEK Application description: PLUMBING LA QUINTA, CA 92253 Property Zoning: LOW DENSITY RESIDENTIAL % Application valuation: 500 /lz/// 1 Contractor: U ,t' V Applicant: Architect or Engineer: FOY, SCOTT A. IdA0 43579 MAIN STREET i3 0,9 ?/ INDIO, CA 92201 C/n, ` 0Y (760) 775-9405_//{� P[,q ' Lic. No.: 828264 �,�.��/ryes pip LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION ,. 1 hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations: Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect._ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided License Class: C36 License No.: 828264 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is i issued. - ate/ ntractor. i1[ 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 0 N R-BUILDE ECLARATION insurance carrier and policy number are: I hereby affirm under penalty of perjury that I am exempt from t e Contractor's State License Law for the Carrier FIRST COMP INS Policy Number WS1004457 following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to_ I certify that, in the performance of the work for which this permit is issued, I shall not employ any construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner so as to become subject to the workers' compensation laws of California, permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I should become subject to the workers' compensation provisions of Section - License Law (Chapter 9 (commencing with Section 7000) 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 . .�i any -applicant -for a permit subjects-the-applicantto-a•civii-penalty-of-not more than -five -hundred dollars-($ 500)::--' _ e:-" '= v-- licant:--"- (_ 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 WARNING: F URE TO SECURE WORKERS'CO PENSATIOI COVERAGE IS UNLAWFUL, AND SHALL Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO 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 improvement is sold within --SECTION 3706 OFTHELABOR CODE: INTEREST, AND ATTORNEY'S FEES. - - - - 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.). APPLICANT ACKNOWLEDGEMENT 1 _ 11, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety fora permit subject to the , 7044, Business and Professions Code:. The Contractors' State License Law does not apply to an owner of - conditions and restrictions set forth on this application. property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed 1. Each person upon whose behalf this application is made, each person at whose request and for pursuant to the Contractors' State License Law.). - whose benefit work is performed under or pursuant to any permit issued as a result ofthis application, (_ 1 I am exempt under Sec. , B.&P.C. for this reason the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City Date: Owner: CONSTRUCTION LENDING AGENCY 1 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: I(�/ Lender's Address: p.X LQPERMIT 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 here y authorize representatives of thi ounty to enter upon the above-mentioned property for inspection purpo date:01� ignature (Applicant -or Agent): LQPERMIT Application Number . . . . . 09-00000302 Permit PLUMBING Additional desc . Permit Fee . . . . 22.50 Plan. Check Fee 5.63 Issue Date . . . . Valuation . . . 0 Expiration Date 9/29/09. Qty Unit Chargee Per Extension BASE FEE" 15.00 1.00 7.5000 EA PLB=WATER HEATER/VENT 7.50 Special Notes and Comments -- ------------- - REMOVE & REPLACE,40 GALLON GAS WATER HEATER --------------------- Other Fees . . . . . . . . . 7 ----------- --------- BLDG STDS ADMIN (SB1473) ------ 1.00 Fee summary Changed 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 CERTIFICATE OF CO -,55 z70 5 aLl � CE: RESIDENTIAL tge 3 of 4) CF -1R ►ate SEALED DUCTS and TXVs (or Alternative Measures) A signed CF -4R 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 1 Project Climate Zone in the RMA ndix 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 snaces shall meet the requirements of Section 150(m) and duct insulation requirements of Package D. Check box if system meets criteria of a "Standard" system. Standard system is one gas-fired4ater heater per dwelling unit. If the water heater is a storage type, 50 gallons is the maximum capacity and recirculation system is not allowed. ❑ 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, uired, and the system com lies automatically. Check box if system does not meei 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. ❑ Check box to verify that a time control is required for a recirculating system pump fora system serving multiple units s seiwwng single dwe ting units Ener Tank Rated Factor or External Water Heater Distribution Number (kwu� ut I Tank or Capacity Thermal Standby' Insulation vne/Fuel Tvoe Type in System Btu/hr) (gallons) Efficiency Loss % R -Value serving.multiple dwellin uaits Ener y � Tank Inputt'' Tank Factor or External Water Heater Distribution Number (kw or Capacity Thermal Standby' Insulation Type T e in S stem Bt&hr aeons EfficiencyLoss % 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. Min Insulation (kitchen lines >_3/4 inches) All hot water pipes from the heating source to the kitchen fixtures that are 1/4 inches or greater in diameter shall be thermally insulated as specified by Section 150 0) 2 A or 150' Q) 2 B. March 2005 Residential Compliance Forms requircu. , ❑ Sealed Ducts' all climate zones Installer testingand. certification and HERS rater field verification required.) TXVs, readily. accessible (climate zones 2 and, 8-15 only) ❑ Installer testingand certification and HERS Rater field verification required.) Refrigerant Charge (climate zones 2 and 8-15 only) (Installer testing and certification and HERS Rater field ❑ verificationrequired.) OR ❑ Alternative to Sealed Ducts and Refrigerant Charge /TXVs (See Package D Alternative Package Features 1 Project Climate Zone in the RMA ndix 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 snaces shall meet the requirements of Section 150(m) and duct insulation requirements of Package D. Check box if system meets criteria of a "Standard" system. Standard system is one gas-fired4ater heater per dwelling unit. If the water heater is a storage type, 50 gallons is the maximum capacity and recirculation system is not allowed. ❑ 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, uired, and the system com lies automatically. Check box if system does not meei 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. ❑ Check box to verify that a time control is required for a recirculating system pump fora system serving multiple units s seiwwng single dwe ting units Ener Tank Rated Factor or External Water Heater Distribution Number (kwu� ut I Tank or Capacity Thermal Standby' Insulation vne/Fuel Tvoe Type in System Btu/hr) (gallons) Efficiency Loss % R -Value serving.multiple dwellin uaits Ener y � Tank Inputt'' Tank Factor or External Water Heater Distribution Number (kw or Capacity Thermal Standby' Insulation Type T e in S stem Bt&hr aeons EfficiencyLoss % 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. Min Insulation (kitchen lines >_3/4 inches) All hot water pipes from the heating source to the kitchen fixtures that are 1/4 inches or greater in diameter shall be thermally insulated as specified by Section 150 0) 2 A or 150' Q) 2 B. March 2005 Residential Compliance Forms cf.. V Bin # City of La Quinta Building 8t Safety Division P.O. Box 1504, 78-495 Calle Tampico -La .Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit #I/ 30 0 Project Ad&=: Owner's Name: f n S 6n A. P. Number: Address: '55 2%0 .5))oo C r Legal Description: City, ST, Zip: LQ (A 1 fd a 25,3 Contractor: S C�� �� ? t t (`r) V1'(� Address: 4 3<:� 7 9 0.i (1 S l; City, ST, Zip: ---v- n 6; 0 1 Q 0 ( x( 014 '© Telephone: � j l 8(q Project Description: C U� V1 Telephone: 7 (-00I 7 7 �' State Lic. # : 0 2 $ 2 y City Lia Arch., Engr., Designer. Address: City., ST, Zip: Telephone: $.• },ti . �f Occu en Construction Type: P cY Project type (circle one): New Add'n Alter Repair Demo State Lic. #: Name of Contact Person: Sq. Ft : #Stories: # Units: Telephone # of Contact Person: Estimated Value of Project: •a APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structorw Cwa, Reviewed, ready for corrections Plan Check Deposit Truss CalGy, Called Contact Person Plan Check Balance. Title 24 Cults. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan Zed Review, ready for correctionsAssue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.T. H.O.A. Approval Plans resubmitted Grading IN HOUSE: Review, ready for correctionstissue Developer Impact Fee Called Contact Person A.I.P.P. Planning Approval Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees