09-1212 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
09-00001212
Property Address:
52720 AVENIDA DIAZ
APN:
773-282-011-13 -000000-
Application description:
PLUMBING
Property Zoning:
COVE RESIDENTIAL
Application valuation:
720
T-iitt 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
DAN AMPIE
52720 AVENIDA DIAZ
LA QUINTA, CA 92253
Contractor:
Applicant: Architect or Engineer: CALIFORNIA DELTA MECHNI
6052 E. BASELINE RD, #1
MESA, AZ 85206
/� (480) 898-0007
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/24/09
D
L INcDEC 01 2UD9
5
CITYUF LA QUINTA
F-WA?I- !rrPT.
L1c. NO.: 811114
-
-----------------------------------------------------------------------------------------
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.
Licen ass: nB-C10-1236 LicenseNo,:: 811114
Date/ Z ""ntractor:
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).:
(_ 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.).
(_) 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 r r
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:
LQPERni1T
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.
1 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 1697823
_ 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
J�7000 of the Labor Code, spall forthwith comp) with those provisions.
�l /`/' Ap nt: �%Vf%
WARNING: FAIL ECURE 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 Quints, ils ufficers, 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.
1 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 hereby authorize representatives
of this couint to enQter upon the above-mentioned property rr inspectn purp!)s.
Q3te:;o ;J Si cure (Applicant or Agent):
Application Number . . . . .
Permit . . . PLUMBING
Additional desc .
Permit Fee 22.50
Issue Date . . . .
Expiration'Date . . 5/23/10
09-00001212
Plan Check Fee . . 5.63
Valuation . . . . 0
Qty Unit Charge Per
Extension
BASE
FEE
15.00
1.00 7.5000 EA PLB WATER HEATER/VENT
7.50
----------------------------------------------------------------------------
Special Notes and
Comments
REPLACE 50 GALLON
ELECTRIC WATER
HEATER.
2007 CODES.
-------------------------------------------------7--------------------------
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
LQPERAIIT
Nov, 24. 2009 11:21AM STEVE No. 65^04 P. 9
CERTIFICATE OF COMPLIANCE: RESIDENTIAL, (Page 3 of 4) CF -IR
Project Title
SEALED DUCTS and TXVs for Alternative Measures)
A signed CF -4R Form must be provided to the building department for each home for which the following. are
required.
I ❑ I Alternative to Sealed Ducts and Refrigerant Charge CMs (See Package D AItemative Package Features for
Project Climate Zone in the RM Appendix 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
spaces shall meet the requirements of Section 150(m) and duct insulation requirements of Package D.
WA,'A'g!Z 1 EXULNG SYSTI('+ MS
ve
Rated Energy
Input` Tank Factor' or1
Distribution Number (kw or Capacity Thermal
Type in System Bron) (gallons) Eff cies
yens o. 16
❑
Sealed Ducts all climate zones nstaller testing and certification and HERS rater field verification required)
❑
TXVs, readily accessible (climate zones 2 and 8-15 only)
(Installer testing and certification and HERS Rater field verification required.)
11
Refrigerant Charge (climate zones 2 and 8-15 only) (Installer testing and certification and HERS Rater field
verification
I ❑ I Alternative to Sealed Ducts and Refrigerant Charge CMs (See Package D AItemative Package Features for
Project Climate Zone in the RM Appendix 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
spaces shall meet the requirements of Section 150(m) and duct insulation requirements of Package D.
WA,'A'g!Z 1 EXULNG SYSTI('+ MS
ve
Rated Energy
Input` Tank Factor' or1
Distribution Number (kw or Capacity Thermal
Type in System Bron) (gallons) Eff cies
yens o. 16
Standby
Loss %
Check box if system meets criteria of a "Standard" system. Standard system is one gas-fired water heater per
,, E 1Y4A�,'cG►rl 9/ect.
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 Altemativo Water Heating table, Table 5-4 in Chapter 5 in the Residential
Manual. No water beating 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
0
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 for a system serving multiple
units
Systems servinsin a dwelling units
TYPWater Heater
eJFuel
Rated Energy
Input` Tank Factor' or1
Distribution Number (kw or Capacity Thermal
Type in System Bron) (gallons) Eff cies
yens o. 16
Standby
Loss %
. Tank
External
Insulation
R -Value
,, E 1Y4A�,'cG►rl 9/ect.
4 -1
System serving multiple dwelling units
Water Heater Distribution
Type TVIX
n�� Tank
Number (kW or Capacity
in System Bew/iu(gallons)
Ener+ Tank
Factor or External
Thermal Standby' Insulation
Efficiency Loss % 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
Brv/hr), list Rated Jnput, 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 %
inches or greater is diameter shall be thermally insulated as specified by Section 150 (j) 2 A or 150 0) 2 B.
Residential Compliance Forms March 2005
Nov.24. 2009 11:26AM STEVE No.6584 P. 8
8
0
Bre #
CIT Of Ia QuInta
BuUng 8r Safety DWIon
pe g # P.O. Box 1504, 76-495 Calle Tampico
(� 1 La Ql>inta, CA 92233 - (760) 777-7012
Bdlding Permit ,Application and Tracking Sheet
Project Address: �Z T�7f V gvij Z Owncr's Name:
A. P. Number Address: —2- Zo 4-ile 'lA•
T otj Qj,0:?4
Legal Dcscri tion: City, ST, Zip: 1.0 Qu4rLtg,c 4 7 s Z.,3
Contractor. lel �D (tkooq Od to Telephone: % %
Address: 056 iv— 9d 1515— Project Description: lace, 5 D
City. ST. Zlp: Msa Az- ?5206 'c, w 4AAr-.
Telephone: 6 4q' --7-3
IM", MState
Lie, # : Lie. M /0 �0� y
Arch., Engz., Designer:
Address.
City, ST, Zip:
Telephone: Construction Type: 0=paocy:
State Lie. #: PrnjeO type (circle one): New Add'n Altcr Repair Demo
Name of Contact Person: Sq. Ft.: # Stories: # Uaits:
Telephone # of Contact person: Estimated value of Pmject Sq Z 0'.
APPLICANT: DO NOY WRITE BELOW THIS LINE
# Submittal Req'd [teed TRACING PERMff FE,.FS
Plan Sete Pian Check submitted Item Amount
MraMaral Calms• Reviewed, ready for corrections Plan Check Deposit
Truss Cafes. Called Contact Person Pian Check Balance
Title 34 Calcs. Plana picked up Construction
Flood plat i plan Plans rceubmitted Mechanical
Grading plan 3" Review, ready for eorrectionslissue Mectrical
Subcostactor List galled ContactPeraon Plumbing
e.mnr ox� —r o 9.1.
TLO.A. Approval Plans resubmitted Grading
INHOUSE;- ' Review, ready for eorreetioc ssae Developer Impact Fee
PiamAiog Approval Called Contact person A.I.P.P.
Pub. Wks. Appr Date of permit Issue
Scho61 Fees
Toil Permit Fees
8
0