08-0475 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA;: CALIFORNIA 92253 '
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
4
Application Number:
08-00000475
Property Address:
54380 AVENIDA VALLEJO
APN:
.774-245-007-18 -000000-
Application description:
PLUMBING
Property Zoning:
COVE RESIDENTIAL
Application valuation:
400
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: 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 ISec. 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 (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and. Professions Code) or _-
tl h r she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by '
any plicant.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 ISec. 7044, Business and Professions Code: The
Contractors' State License Law does not apply to an ownerof 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 contracting with licensed contractors to construct the project ISec.
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 a emptunder Sec. , B.&P.0 's reason
Date: / D 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.I.
Lender's Name:
Lender's Address: ,
LQPERA11T
Owner:
.CARLA JOHANSEN
54380 AVENIDA VALLEJO.
LA QUINTA, CA 92253
(760)771-9509
Contractor:
Owner
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/19/08
Da
MAK 0 1008
-7---------------------------------------------
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 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
33700 of the
/ L d<e/, `1 /sh II
a forth comply with those proviso
Date: Applic
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). 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 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 t building construction, and hereby authorize representatives
of thisWto-ponthe above-mentioned ro Arty f r nspection p s.
Date:nature (Applicant or Ag t
Application.Number . . . . 08-000.00475
Permit - PLUMBING
Additional desc .
Permit Fee 22.50
Plan Check
Fee
5.63
Issue -.,Date -..r
Valuation
0
Expiration Date .. 9/15/08
_
Qty Unit Charge. Per
Extension
BASE
FEE
.15..00
1.00 7.5000 EA PLB
WATER HEATER/VENT
7.50
-------------------------------------------------------------
Special Notes and Comments
WATER HEATER CHANGE OUT ./ 50
GALLON
UNIT
Fee summary.*- Charged
Paid' Credited
Due
-----------
Permit Fee 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 -
Bin #
City of La Quinta
Building 4 Safety Division
Permit # P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Project Address:' 1 C J v Owner's Name
A. P. Number: Address•
Legal Description: City, ST, Zip: U G
Contractor:
Address: Project Description:
City, ST, Zip:
Telephone:
1'
State Lic. # : City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone: 1
l Construction Type: Occupancy:
State Lic. #: Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: Sq. Ft.: #Stories: #Units:
Telephone # of Contact Person: Estimated Value of Project -Tv V
APPLICANT: DO NOT WRITE BELOW THIS LINE
# Submittal Req'd Recd TRACKING . PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Truss Calcs.
Reviewed, ready for corrections
Called Contact Person
Plan Check Deposit
Plan Check Balance
Energy Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading, plan
2°" Review, ready for correctionsfissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
S.M.I.
Grant Deed
Plans picked up
H.O.A. Approval
Plans resubmitted
Grading
Impact Fee
A.I.P.P.
IN HOUSE:-
'"' Review, ready for corrections/issueDeveloper
Planning Approval
Called Contact Person
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
CERTIFICATE OF COP
CE: RESID
ge-I of 4) C&IR
Date
Pio ect A res(��- Building Permit it
1ET�
Do en on AuM Telepho Plan Check /Dace
Field Check / Date
Compliance Meth( ptive) Climate Zone
(Prescri
Enforcement Agency Use Only
✓ •0. Alternative Component Package Method: (check one) C D �D (Alternative)
Package C and Package D choices require HERS rater field Verification and/or diagnostic testing (see CF -IR page 3)
For Package D Alternative see Appendix B Table 151-C Footnotes 7-14
GENERAL INFORMATION
Total Conditioned Floor Area (CFA) flz Average Ceiling Height: fl
Maximum Allowed West Facing Fenestration Products Per Table 151-B or 151-C ---- (5% X CFA)
Maximum Allowed Total Fenestration Products Per Table 151-B or 151-C � (20% X CFA) ft
❑ Building Type: (check one or more) Single Family ° Multifamily - Addition Alteration .
(If adding fenestration fill out WS4R, Fenestration Maximum Allowed Area Worksheet and see Section 8.3 2
for.Additions and 8.3.3 for Alterations.)
Number of Stories: Number f
Floor. Constructione
TyP •
o we mg Units. .
SIab/Raised Floor (circle- one or both)
Front Orientation::
North and circle one)..
North 1 South / East / West j All Orientations (input front orientation in
degrees from True
RADIANTBARRIER (required in climate zones 2,4,8-15)
OPAQUE SURFACES INCLUDING OPAQUE DOORS
Component .
Assembly Q-
-Type (Wall,
Roof, Floor,
Frame.
Type
factor (for -
Cavity Continuous wood, metal
Joint Roof Radiant.
Appendix Barrier.
Slab Edge,
Doors
(Wood
Insulation 'Insulation frame and mass
IV Installed
Location/Comments
(attic, garage,
or Metal
R -Value R -Value assemblies t
Reference Yes or No
tvninal_ etc 1
l) See Joint Appendix IV in Section IV.2, IV.3 and IV.4, which is the basis for the U -factor criterion. U-factorscan not
exceed prescriptive Value to show equivalence to. R -values: .
CERTIFICATE OF COMPLIANCE: RESIDENTIAL. (Page 2 of4)
C&IR
Project Title Date
FENESTRATION PRODUCTS — U -FACTOR AND SHGC
✓. ❑ FENESTRATION MAXIMUM ALLOWED AREA WORKSHEET
WS-4R—must be included
Additions and Alterations.
for New Construction,
Fenestration
'
#/TypeJPos.
.
ft' Orien-
(Rear
Exterior �
Ri ght, talion, Area U -factor SHGC
Skylight) 14, S, E, W� ff U-factor2
Shading/Ls6• 7
✓box iis
Source' 'SHGC° Sources
inc
❑
13
❑.
1) Skylights are now included in West -facing fenestratibn area if the, skylights are.tilted to the
west or tilted
when the pitch is less than 1:12. See'§151(f)3C and in Section 3.2.3 ofthe Residential Manual
in any direction
2) Enter values in this column are 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 NFRC or from Standards Default -Table 116B or adjusted SHGC from WS -3R
5) Indicate source either from. NMC- or Table 116B.
6) Shading Devices are defined in Table 3-3 in the.Residential Manual and see WS -3R to calculate Exterior Shading devices.
7) See Section 32A in the Residential -Manual.
HVAC SYSTEMS .
Heating Equipment Minimum . • Distri ution
Type and Capacity Efficiency_ Type and. Location Duct or Piping Thermostat
furnace heat boder, etc. APL1E or HSP ducts ata etc. ' R -Value
C Paration
lit or e
ht or
4
Cooling Equipment Minimum
Type and Capacity. Efficiency Duct Location Dud Thermostat
A/C beat u eva . cooli SEER or EER attic etc. R -Value
Configuration
(split or package)
i
• 1
Residential Compliance Forms
Maich 2005
4
CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page3 of4) C&IR
Project Title Date
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
uired.
K3Scaled Ducts all climate zones Installer testin and certification and HERS rater field verification uired:
❑TXVs,.readily. accessible (climate zones 2 and 8-15 only)
(Installer testingand certification and HERS Rater field verificationrequired.).
E3 Refrigerant Charge (climate zones 2 and 8-15 only).(Installer testing and certification and=RSRater::::d
verification required.
OR
t7 Alternative to Sealed Ducts and Refrigerant
Charge /I'XVs. (Seg Package D Alternative Package Features for
Proiect Climate Zone in the RMAppendix B Table 151-C, Footnotes 7-14.
OR
Hj.saces
dditions and alterations, dud systems that are not documented to. have been previously
d as confirmed through field verification and diagnostic testing in accordance with procedures in the
dential ACM Manual and duct systems withmore than 40 linear feet in unconditioned
shall meet the r uirements of Section 150 m and dud insulation i unconditioned
WATER HEATING SYSTEMS
Check box if system meets criteria of a "Standard" system. Standard system is one gas-fired water heater per
dwelling unit. If the water heater is a storage type, 50•gallons is the maximum capacity and recirculation system is
fiOAItemative
ot allowed.
heck box when using Preapproved Alternative Water Heating tableTable 5-4 in.Chapter 5 in the Residential
anual.No water heatin calculations ane uired, and the stem com lies automaticall.
heck box if system does not meet criteria of "Standard" system_and does not complywith the Preapproved
WaterHeating table. In this case, theTerformanceMethod must be used and must be included in the
bmittal.
13 heck box to verify that a time control isra recirculating system um for anits pump system serving multiple .
Systems serving single dwellin . units
Rated Energy Tank
Inpue Tank Factor or E�r�
Water Heater Distribution Number (kW or Capacity Th�� Standby' Insulation
Type/Fu a in.S stem BaVt,r tons . Efficien Loss % IR Val
.Sri
seem servin multi le dwellin units
Rated E►ergy Tank
Water Heater Distribution Number Input Tanik
Factor' or External
(kW.or aci Thermal Standby' Insulation
Type e in :stem -Biu/hr Gatto)ty Efficien Loss. % R -Value
I. .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 ofgreater 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/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
CERTIFICATE OF COMPLIANCE° RESIDENTIAL (Page 3 of4) CF -1R
Project Title Date
SEALEDDUCTS and TXVs (or Alternative Measures)
A signed CF -4R Form must be
required. provided to the building department for each home for which the following. are
U Sealed Ducts all climate zones Installer testing and certification and HERS rater field verification requirei
17 TXVs, readily accessible (climate zones 2 and 8-15 only)
(Installer testing and certification and HERS Rater field verificationrequired.).
Refrigerant Charge (climate zones 2 and 8-15 onl
verification r uired. y) (Installer testing and certification and HERS Rater field
OR
Alternative to Sealed Ducts and Refrigerant Charge .
/TXVs(See Package D Alternative Package Features for
Pro'ect Climate Zone in the RMA ndix B Table AT 151, Footnotes 7-14.
FBI
O
1]
❑�
For additions and alterations, duct systems that are not documented tohave been previously
sealed as confirmed through field verification and diagnostic testing in accordance with procedures in the
Residential ACM Manual and duct systems withmore than 40 linear feet in unconditioned
spa. ces shall meet the r uirements of Section 150 m and duct insulation requirements of Package D.
III A TTTI VT1 amr�ti-...—....�__ __.
Check box if system meets criteria of a "Standard" system. Standard system is one gas-fired water heater per
dwelling unit. If the water heater is a storage type, SO'gallons is the maximum capacity
not allowed. and recirculation system is
Check box when using Preapproved Alternative Water Heating table, Table 54 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, theTerformance Method must be used and must be included in the
submittal.
Check box to verify thata time control is req
units uired for a recirculating system pump for a system serving multiple
.
ns serving single dwelling. units
Water Heater
Distribution 1. Number
e in S sten
..RVctPm cPrvina miss finln d..,ell......:a.. _
Water Heater
Type
Energy
Tank
Input'
Tank Factor or
External
(kW or
Capacity Thermal
Standby' Insulation
Bwft
(gallons). Efi'icien
Loss % R -Value
..RVctPm cPrvina miss finln d..,ell......:a.. _
Water Heater
Type
Rated
Input'
Distribution Number (kw or
e in :stem Bu,/hr
'Tank
Capacity
aeons
Energy
Factor' or
Thermal Standby'
Efficiency Loss %
Tank
External
Insulation
R -Value
�UUJ V. cyu41 w 10,wu rsiwnr/, electric resistance, and heat
pump water heaters, list Energy Factor. For large gas storage water heaters (rated input of greater than 75,000
Bhou), 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'/e
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
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.
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.
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 thar 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 Federal Government 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 -hese obligations, and these risks are especially serious with
respect to worker's compensation insurance.
For more specific information about your obligations under Federal Law, 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 wh3 are not licensed contracts 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
OWNER'S S NATURE/DATE
3R.
�� i LEA
PROPERTY ADDRESS
PERMIT NUMBER(S)