06-1491 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
06-00001491
Property Address:
78985 DEL MONTE
APN:
770-050-007-6
Application description:
PLUMBING
Property Zoning:
MEDIUM DENSITY
Application valuation:
500
c&ht 4 4 a"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
CT
-25389 -,
RES
Applicant: Architect or Engineer:
--------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm under penalty of perjury that 1 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.
Licen. seclas C36 wens No.: 828264
/ate Cntraaor:
o
-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).:
(_ 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 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.).
1 _ 1 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: i
Lender's Address:
LQPERMIT
Owner:
MORTENSEN CLIFFORD
78985 DEL MONTE CT
LA QUINTA, CA 92253
Contractor:
FOY, SCOTT A.
43579 MAIN STREET
INDIO, CA 92201
(760)775-9405
Lic. No.:. 828264
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/12/06
-----------------------------------------------
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 STATE FUND Policy Number 1576840
_ 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 hajyIor�wit comply with those provisions.
yace��7��A 'ant: CJ
WARNING: FAILURE TO SECURE WORKE S' PENSATIO14 COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PE ALTIES 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 ouinta, 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 by authorize representatives
of this count to enter upon th move -mentioned property for insp ctio urp ses.
Date: Si ture (Applicant or Agent):
LQPERMIT
Application Number . . . . . 06-00001491 .
Permit . . . PLUMBING
Additional desc .
Permit Fee 22.50
Plan Check
Fee
5.63
Issue Date . . . .
Valuation
. . .
.
0
Expiration Date 10/09/06
Qty Unit Charge Per
Extension
BASE FEE
15.00
7_5000-EA PLB WATER-HEATER/VENT-----------------7_50.-
----- --1_00-----------------------------
Special Notes and Comments
REMOVE & REPLACE NATURAL GAS WATER
HEATER.CF1-R APPROVED.
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
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La Oubna, CA 92253 - (760) M-7012
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CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 1 of 4) CF -1R
Project Title 7G 9�S �G-t-
Project Address o
Documentation Author Telephone
Compliance Method (Prescriptive)
Climate Zone
3 -15 �-- o�
Date
Building Permit #
Plan Check / Date
Field Check / Date
Enforcement Agency Use Only
✓ CI 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 -111 page 3)
For Package D Alternative see Appendix B Table 151-0 Footnotes 7-14
GENERAL INFORMATION
Total Conditioned Floor Area (CFA) fl Average Ceiling Height ft
Maximum Allowed West Facing Fenestration Products Per Table 151-B or 151-0 — (5% X CFA) ft
Maximum Allowed Total Fenestration Products Per Table 151-B or 151-0 _ (20% X CFA) ft
✓ O Building Type: (check one or more) Single Family MultifamilyAddition Alteration
(If adding fenestration fill out WS -411, Fenestration Maximum Allowed Area Worksheet and see Section 8.3.2
for Additions and 8.3.3 for Alterations.)
Number of Stories: Number of Dwelling Units:
Floor Construction Type: Slab/Raised Floor, (circle one or both)
Front Orientation: North / South / East / West / All Orientations (input front orientation in degrees from True
North and circle one).
✓ 0 RADIANT BARRIER (required in climate zones 2.4.8-15)
OPAQUE SURFACES INCLUDING OPAQUE DOORS
Component
Type (Wall,
Roof, Floor,
Slab Edge,
Dom)or
Frame
Type
(Wood
Metal
Cavity Continuous
Insulation Insulation
R Value R Value
Assembly U -
factor (for
wood, metal `
frame and mass
assemblies t
Joint
Appendix
IV
Reference
Roof Radiant
Barrier Location/Comments
Installed (attic, garage,
Yes or No ' ical etc.
1) See Joint Appendix IV in Section IV.2, IV.3 and IVA, which is the basis for the U -factor criterion. U -factors can not
exceed prescriptive value to show equivalence to R -values.
Residential Compliance Forms
March 2005
CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 3 of 4) CF -IR
3 —? D,,.
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
required.
Ve
Distribution
Type
.0
Sealed Ducts all climate zones taller testingand certification and HERS rater field verification uired
f_f
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 only) (Installer testing and certification and HERS Rater field
verification ' ' fired
0 I Alternative to Sealed Ducts and Refrigerant Charge lr"s (See Package D Alternative Package Features for I
Proiect Climate Zone in the RM Aonendix B Table 151-0. Footnotes 7-14.
OR
For additions and alterations, duct systems that are not documented to have been previously
0 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
aces shall meet the requirements of Section 15 m and duct insulation requirements of Package D.
WATER HEATING SYSTEMS
Systems serving single dwelling units
Water Heater
Type/Fuel Type
Distribution
Type
r
Check box if system meets criteria of a "Standard" system. Standard system is one gas -feed water heater per
f_f
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 Mquirod, and the system complies automatically.
Check box if system does not meet criteria of "Standard" system, and does not comply with the Preapproved
0
Alternative Water Heating table. In this can, the Performance Method must be used and must be included in the
submittal.
0
Check box to verify that a time control is required for a recirculating system pump fora system serving multiple
units
Systems serving single dwelling units
Water Heater
Type/Fuel Type
Distribution
Type
En
Rated Tank Factor' or
Number (kw or Capacity Thermal
in System Bw/hr) (galoos Efficien
Standby'
Loss /o
Tank
External
Insulation
R Value
—R
System ser An ,multile dunits
`t Rated
Input'
Water Heater Distribution Number (kw or
Type Type in System Bwlhr)
Energy
Tank Factor' or
Capacity Thermal
wimy Efficiency
Standby
Loss %
Tank
External
Insulation
-Value
—R
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 1/4
inches or greater in diameter shall be thermally insulated as.specified by Section 150 6) 2 A or 150 6) 2 B.
Residential Compliance Forms
March 2005
CERTIFICATE OYCOWLIANCE: RESIDENTIAL (Page 4 of 4) CF -1R
Project Title Date
SPECIAL FEATURES NOT REQUIRING HERS VERIFICATION (add extra sheets if necessary)
Indicate which special'features are part of this project. The list below only represents special features relevant to the
nrncerm ivP mrthnd
+�
Feature
Reauked Forms if applicable)
Description
❑
Metal Framed Walls
CF -1R
4 of 12
❑
Radiant Barriers
CF -IR
5 of 12
❑
Exterior Shades
WS -411
part 6 of 12
N/A; Attach CRRC Label to
❑
Cool Roof
Forms.
13
Dedicated Hydronic Heating
Performance Calculation
System
Required; Attach Run to Fomes.
Performance Calculation
❑
Combined Hydronic System
R u' - Attach Run to Forms.
❑
Gas Cooling
Performance Calculation
Required,
❑
Buried Ducts
N/ • Indicate on building fans.
❑
Kitchen Pipe Insulation
See Section 5.6.2 Distribution
Systems in Residential Manual.
Multiple Water Heaters Per
See Table 5-13 or use
❑
Performance Calculation and
Dwelling Unit
attach Run to Forms.
❑
Central Water Heating System
Performance Calculation and
Serving Multiple Dwellings
attach Run to Fors.
❑
Non-NAECA Large Water
CF -1R
Heater
See Table 5-13 or use
❑
Indirect Water Heater
Performance Calculation and
attach Rtm to Fors
See Table 5-13 or use
❑
Instantaneous Gas Water Heater
Performance Calculation and
attach Run to Fors
See Table 5-13 or use
❑
Solar Water Heating System
Performance Calculation and
attach Run to Forms
❑
1 Wood Stove Boiler
Performance Calculation and
attach Run to Forms
SPECIAL FEATURES REOUIRING HERS RATER VERIFICATION
Tadd ext g sheets if necessary) Indicate to the HERS Rater which credits are part of this project and need
verification.
✓
Feature
Required
Forms if applicable) Description
Duct SealingCF-6R
4 of 12
❑
1❑
Refrigerant Charge
CF -6R
5 of 12
❑
Thermostatic Expansion Valve
CF -6R
part 6 of 12
Residential Compliance Forms
March 2005