08-1889 (PLBG)P.O. BOX 1.504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: (08"000018&9 -._a -
Property Address: 55555 SOUTHERN HILLS
APN: 775-200-011-
Application description: PLUMBING
Property Zoning: SLOW DENSITY RESIDENTIAL
Application valuation: 500 '
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT -
Owner
ALBERT PETERS '
* 55555 SOUTHERN"HILLS
LA QUINTA, CA 92253.
Contractor:
FOY, SCOTT A.
435-79 MAIN STREET.'
INDIO,.CA 92201.
(760)775-9405
LICENSED CONTRACTOR'S DECLARATION -
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.
LicenseClass: C36 Li ense No.: 828264
/ate:/ntractor: N -
OW ER -8 ER 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 (5500).:
(_) 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 orshe did not build or
improve for the purpose of sale.). -
('_) 1, 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.). -
(_ ) . 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
VOICE (760) 777-7012
FAX (760)'777-7011
INSPECTIONS (760),777-,7153
Date: 11/24/08^
Lic. -No.. 828264 "MA
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
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.
[-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:
Carriei FIRST COMP INS Policy Number WS1004457
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
/��of the Labor Code. I shall forthwith comply with those provisions.
te� plicant:
WARNING: FAIL RE TO SECURE WORKERS' MPENSA N 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 ofissuanceof 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 aboveinform n is correct. I agree to comply with all
city and county ordinances and state laws relating to building construction, a ereby authorize representatives.
of this count to enter upo he above-mentioned property for inspection purp
gnature (Applicant or Agent):
Application Number 08-00001889
Permit ... PLUMBING'
Additional desc
Permit Fee 22.50
Plan Check Fee_
5.63
Issue Date
Valuation
0
Expiration Date . 5/23/09
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 NEW'75 GALLON GAS'WATER
HEATER
Fee summary Charged-
Paid- Credited
Due
Permit Fee Total 22..50
.00. 00
22.50
Plan Check Total 5.63
.'00 00
5.63
Grand Total 28.13-
.00 .00
28.13
LQPERMIT
-
CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 3 of 4) CF -1R
Project Title Date
SEALED DUCTS and TX -Vs (or Alternative Measures) .
A signed CF -4R Form must be provided to the building department for each home for which the following. are
required. .
OR
❑ Alternative to Sealed Ducts and Refrigerant Charge / T XVs (See Package D Alternative Package Features for.
Project Climate Zone in the RM Appendix B Table IS I -C, Footnotes 7-114.
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.
�`r'..Ail-w—will-�ie
Distribution
Tym
❑
Sealed Ducts all climate zones nstaller testing and certification and HERS rater field verificationrequired.)
Tank
Capacity
Cgal ions
TXVs, readily accessible (climate zones 2 and 8-15 only)
Standby
Loss %
(Installer testing and certification and HERS Rater field verificationrequired.)
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 / T XVs (See Package D Alternative Package Features for.
Project Climate Zone in the RM Appendix B Table IS I -C, Footnotes 7-114.
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.
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Water Heater
T uel TX
Distribution
Tym
Number
in System
heck box if system meets criteria of a "Standard" system. Standard system is one gas-fired water heater per
Tank
Capacity
Cgal ions
dwelling unit. If the water heater is a storage type, 50 gallons is the maximum capacity and recirculation system is
Standby
Loss %
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, and the s stem com lies automaticall .
i
Check box if system does not meet criteria of "Standard" system, and does not comply with the PreapproIved
❑
Alternative Water Heating table. In this case, the Performance Methodimust be used and must be included in the '
submittal.
Check box to verify that a time control is required for a recirculating system pump for a system serving multiple
❑
units
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Water Heater
T uel TX
Distribution
Tym
Number
in System
-
Rated
input
(kw or
Buvbr)
Tank
Capacity
Cgal ions
EneT
Factor orI
Thermal
Efficiency
Standby
Loss %
Tank
External
Insulation
R -Value
G(5
i
I
,�j{.CjU .lGl • W W li Y..
Water Heater
Type
Distribution
Type
Number
in System
Rated
In P
(kw or
Btu/hr
Tank
Capacity
torts)
Energy
Factor? or
Thermal
Efficiency
Standby'
Loss %
Tank
External
-Insulation
R -Value
i
1. For small gas storage water heaters (rated inputs of less than or equal ;to /D,uw mW 11r), ciwu 1k: ica1aw+n:1., aww ,iva,
pump water heaters, list Energy Factor. For large gas storage water heaters (rated input of greater than 75,000
BnAr), list Rated Input, Recovery Efficiency, Thermal Efficiency and Standby Loss. For instantaneous; gas water
heaters, list Rated Input and Thermal Efficiencies.
Pipe Imuktion (kitchen lines >_ 3/4 inches) A II hot water pipes from the heating source to the kitchen fixtures that are'/a
inches or greater in diameter shall be thermally insulated as specified by Section 150 0) 2 A or 150 0) 2 B.
Residential Compliance Forms
March 2005
J.
City Of La Qidnta
BmIdw & Safety Uvwm
P.O. Box 1504, 78-495 Caue Tampko
1•a WM, CA 92253 • (760) 777-7012
BLdidhg Permit Application and Tracie Sheet
r/ 1
oL4 Owner's Name:
SS
City, STI Zip.
O Telephone.
0
Submittal
R" d
!R=',d
WSM
PERMIT FEES
Pfau Sets
.
Plan Check submitted
item
Amount
Structural Gla.
S 11:.1 1 YI 1 I
�'.Ylllr 1
:111 1 CooW Person:
I M I one):
1 1 1 f. D=o
Trms Cala'
TelepbA=
Plan Check Balance
Title u Cala.
0
Submittal
R" d
!R=',d
TLCf3.IIVG
PERMIT FEES
Pfau Sets
.
Plan Check submitted
item
Amount
Structural Gla.
Reviewed, ready for corrections
Plan Cheri; Deposit
Trms Cala'
C Ued Comaet.Person
Plan Check Balance
Title u Cala.
Ptaus ply up
Coa:troctioa
Flood per+ tin
Pian resubmitted
Mccbaukaj
plan
z-! Review, ready for e,rrvctiomri w
kcal
SubcoaftCtor Liss
Called Contact Person
Plumbing
Grant Dad
Plan pidwd up
S.M.I.
H.OA. Approval
Plans reuemttted
(trading
IN ROLIM--
' 1 Review, ready for eor =ODMAS ac
Developer Impact Fee
planning Approval
CaAed Contact Person
A.I.P.P.
Pub. Wks. Appy
Date of permit lame
Sdwol Fees
Total Permit Fees