11-0811 (PLBG)4 P.O' BOX 1504 VOICE (760) 777-7012
78-495 CALLS TAMPICO FAX (760),777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS '(760) 777-7153
BUILDING PERMIT
8/11
Application Number: '- "; 11-00000811--!:> Owner: D p
Property Address: 44070 E' SUNDOWN CREST DR WAYMAN ROBERT N
APN: 604-100-002-02 -19903 - 44,070 EAST SUNDOWN CRES -
Application description: PLUMBING LA QUINTA, CA 92253 . r JUL
? 2�,�
Property Zoning: LOW DENSITY RESIDENTIAL U
Application valuation: 750
CITY OF LA 61UINYA
Contractor: FI`CE;,rE
Applicant: Architect or Engineer: ALVAREZ, JORGE A.
P.O. BOX 984
THERMAL, CA 92274
(760)777-3613
fI Lic. No.: 880103.
------------------
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 B s' ass and Professionals Code, and, my License is in full force and effect.
License Class: C36 License No.: 880103
ate: ontractor:
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 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: - I
/�.
Lerider's Address: to
!'r
LQPERMIT
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 EXEMPT Policy Number EXEMPT
('certify that, in the performance of the work for which this permit is issued, I shall not employ any
c=at,
any manner so as to become subject to the workers' compensation laws of Califoinia, .
and agree that, if I sl� uld become subject to the workers' compensation provisions of Section
3700 off the Labor Cod i shall forthwith comply with those provisions.
Qate�6—Plican • _
/WARNING: FA URE TO SECURE WORK RS' 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 to qNding construction, and hereby authorize representatives'
of this county to enter upon the above•mentioned pro rrttsp ction purposes.'
Date:%�f� nature (Applicant or Agen '
Application Number
11-00000811
Permit . . . PLUMING
Additional desc .
Permit Fee . . 22.50
Plan Check Fee
5.63
Issue Date...
Valuation . . .
. 0
Expiration Date 1/24/12
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 50 GALLOW GAS WATER
HEATER.
2010 CODES.
-----------------_-----------------------------------
Other.Fees . .
---------------------
BLDG STDS ADMIN (SB1473)
-
1.00 -
Fee summary Charged
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
LQPERMIT
Prescriptive Certificate of Compliance: Residential CF-IR-ALT-DHW
Residential Alterations Page I of 2
Project [Mame: Climate Zone: Permit #:
General Information
Site Address: d E .&QrOU,jn tart
Enforcement Agency: &-W e\t f, Date:---l&-ll
Building T e: in le Family D Multi Family Project Typc W Re lacement or Change Out of Water Heater
WATER HEATING
List newly installed water heaters and boilers for both domestic hot water heaters (D WH) and hydronic space heating. Newly installed
DWH heaters and boilers must be gas. propane, or use the existingfueI type.
Water Heater
Distribution Type Number In Tank
(Standard,
Energy Factor or
External Tank
Insulation
Type/Fuel Types.
= System Capacity (gal)
Recirculatin)
Thermal Efficiency
R -Value
1150
2
2-12
le;
7- 2.&-�
Address:
License:
g00103
City/State/Zip:
Phone:
7 (00- 7 77-3 (o 12
1. Indicate Type (Storage Gas, Heat Pump, Instantaneous, etc.)
2. Recirculating systems serving multiple dwelling units shall meet the recirculation requirements of §150(n). The Prescriptive
". requirements 'do not allow the installation of a recirculating water heating system for single dwelling -units.,
.3. The external water heating tank and pipes shall be insulated to meet the requirements of §150 ').
Contractor or Homeowner (Documentation Author's/Responsible Building Designer's Declaration Statement)
• I certify that this Certificate of Compliance documentation is accurate and complete. I
•'1 am eligible tinder Division 3 of the California Business and Professions Code to accept responsibility for the building design
identified on this Certificate of Compliance.
• 1 certify that the energy features and performance specifications for the building design identified on this Certificate of Compliance.
conform to the requirements of Title 24. Part I and 6 of the California Code of Regulations..
• The building design features identified on this Certificate of Compliance are consistent with the information provided to document this
building design on the other applicable compliance forms, .worksheets, calculations, plans and specifications submitted to the
enforcement agency for approval with this building permit application.
Name:
Signature:
Company:
Date:
le;
7- 2.&-�
Address:
License:
g00103
City/State/Zip:
Phone:
7 (00- 7 77-3 (o 12
GArwril 71) If
Storage Water Heater Is defined as:
Max Btu/hr per Gallon 30 Gallon 40 Gallon 50 Gallon
200,000
A nnn 120.000 160,000
1. Per Section 1500) of the 2008 Energy Efficiency Standards.
QAnril 2010
If rated Energy Factor does not EXCEED minimum
Federal Minimum
Values Below, an External Insulating Blanket (R-12,
Energy Factor
minimum) shall be Installed'
Water Heater Fuel Type
Effective Jan 20 2004
30 Gallon 40 Gallon 50 Gallon
Gas-fired storage -type water
0.62 — (0.0019 x V)
0.563
0.544
0.525 -
heaters
Oil -fired water heaters
0.59 — (0.0019 x V)
0.533
0.514
0.495
(storage and instantaneous
Electric storage water heaters
(excluding tabletop water
0.93 — (0.00132 x V)
0.890
0.877
0.864
heaters
Electric tabletop water
0.93 — (0.00132 x V)
0.890
0.877
0.864
heaters
Gas-fired instantaneous water
0.62 — (0.0019 x V)
0.563
0.544
0.525
heaters
Electric instantaneous water
heaters (excluding tabletop
0.93 — (0.00132 x V)
0.890
:0.877:0.864
water heaters
Heat um water heaters
0.93 — 0.00132 x
0.890
0.877
0.864
V = rated volume in gallons
1. Per Section 1500) of the 2008 Energy Efficiency Standards.
QAnril 2010
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Building; m Safety Division
F'ennii # P.O. Box 1504, 78-495. elle Tampico
I..a Quinti, CA 41225:3 - (760; 777-7017
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