13-0698 (PLBG)P.O BOX 1104 .; " 4 "VOICE (760) 777-7012
78-495 CALLE TAMPICO ' + . FAX (760) 777-7011
LA QUINTA_.CALIFORNIA 92253. ".. _ BUILDING & SAFETY DEPARTMENT, INSPECTIONS (760) 777-7153
F BUILDING PERMIT
' Date: 6/04/13.
r Application Number: 13-00000698 Owner:
Property Address: 55587 WINGED FOOT' ' ROB QUINN ,.
APN: 775-182-005- - 55587 WINGED FOOT
Application description: PLUMBING LA QUINTA, CA 92253
Property Zoning: LOW DENSITY, RESIDENTIAL-. w (408) 710-6069 PFIN09491 Appljaatien '�oluationl 8.64
Contractor:Applicant: Architect or Engineer: ALVAREZ, JORGE A.P-O- BOX_984 THERMAL, CA 92274
(760)777-3613 a '
Lic.'No.- 880103
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that 1 am licensed under provisions of Chapter -9 (commencing with I hereby affirm under penalty of perjury one of the following declarations: -
'Section 7000) of Division 3 of the Business and Professionals Code; and my License is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: C36 license No.: 880103 for by Section 3700 of the Labor Code, for the performance of the work for which'[his permit is
issued.
Date Contractor: 40P - + _ 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 +
WNER-BUILDER DECLARATION ` - insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the - Carrier EXEMPT Policy Number EXEMPT -
following reason (Sec. 7031 .5, Business and Professions Code: "Any city or county that requires a permit_to eW-I Certify that, in the performance of the work for which this permit is issued, 1, shall not employ any _
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner so as to become subject to the workers' compensatin laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I should become subject to the workers' compensation provisions of Section -
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3700 of the Labor Cod I shall forthwith comply with those provisions.
- 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).: Dahl —�I' 13 Applicanf� -
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 WARNING: FAILURE TO SECURE WO KERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL -
Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the DOLLARS ($100,000): IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. _
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.). • - APPLICANT ACKNOWLEDGEMENT -
(_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the -
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application.
property who builds or improves thereon, and who contracts for the projects with a'contractor(s) licensed 1 . .Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License Law.). whose benefit work is performed under or pursuant to any permit issued as a result of this application,
lam exempt under Sec. " , B.&P.C. for this reason - - . 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 ac[ or omission related to the work being - --
- r performed under or following issuance of this permit.
Date: Owner: _ 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
^ • CONSTRUCTION LENDING AGENCY permit to cancellation.
I hereby affirm under penalty of perjury that there is aconstructiorr lending.agency.for the performance of the 1 certify that I have read this application and state that the above information is correct. Iagree to comply with all
work for which this permit is issued (Sec. 3097, Civ, C.). city and county ordinances and state laws relating to building construction; and hereby authorize representatives -
of this county to enter upon the above-mentioned property for i pe ion purposes.
Lender's Name: - -7 - -
Da[e _C{_(3 Signature (Applicant or Agent):
Lender's ..--
Address:
LQPER1N11T
. Application Number . . . . ._ 13-00000698
Permit-PLUMBING`2013
Additional desc•
Permit..Fee 11.92 Plan Check
.00
-Fee
_ Issue -Date Valuation
0
Expiration Date 12/01/13
Qty Unit Charge Per`"
Extension
.1.00 11.9200 EA PLBG•WATER HEATER/VENT
11.,92,
Special Notes and'Comments
WATER HEATER-CHANGE•OUT - 40GALLUN/UAS
[2008 ENERGY] CARBON MONOXIDE ALARM(S)
' TO BE INSTALLED PRIOR TO FINAL
INSPECTION. 2010 CALIFORNIA BUILDING
CODES.
.
------------------- --
Other Fees . . . . . . BLDG STDS ADMIN (SB1473)
1.00
PERMIT ISSUANCE M/P/E
90.57
PLAN_CHECK, PLUMBING
7.15
Fee summary Charged Paid Credited
Due
Permit Fee Total 11.92 .00 .00
11.92
Plan Check Total .00 .00 .00
.00
Other Fee Total. 98.72 .00 .00
98.72.
Grand Total 110.64 .00 .00
110..64
LOPFRMIT
B1n # ...
City of La QuInta
Building a Safety Division
P.O. Box 1504, 78-495 Calle TaMPICo
La Quinta, CA 92253 - (760) 777-7012-
77-70t2Building Permit Application and Tracking Sheet
Building
Permit #
Project Address: JS W (� �\ F F- Owner's Name: p V k ll
A. P. Number: a" i t1 �-c C Pc Address:�Sq _,U3Legal
Description: �� Q v t (1 City, ST, Zip: La- U l n 225.3
Contractor: `:4Lc, -e--z Telephone: ' D2) --110- o
Address: Project Description:
City, ST, Zip: C`Ce_ A
pp
Telephone: 0 .-(p �J g6l7S
t
� ( cl,-e i2
State Lic. 9:
City. Lia #:105
Arch., Engr., Designer:
Address:
City, ST, Zip: _
Telephone: Construction Type: Occupancy:
State Lic. #: Project type (circle one): New Add'n Alter Repair Demo .
Name of Contact Person: Sq. FL:
# Stories:
# Units:
Telephone # of Contact Person: Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING PERMIT FEES
Plan Sets
Plan Check submitted Itcm Amount
Structural Cales.
Reviewed, ready for corrections Plan Check Deposit
Truss Calca.
Called Contact Person Plan Check Balance.
Title 24 Cales. .
Plans picked up Coastruetion
Flood plain plan
Plans resubmitted Mechanical
Grading plan
2"' Review, ready for correctionvAssue MAIrical
Subcontactor List
Called Contact Person Plsmbing
Grant Deed
L
Plans picked up SALL
H.O.A. Approval
Plans resubmitted trading
IN HOUSE:-
'`' Review, ready for correcdonsAnne Developer Impact Fee
Planning Approval
Called Contact Person A.i.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
otal Permit Fees
CF-W-MECH411i
INSTALLATION
_ STt
INSTALLATION 'CERTIFICATE
AtEF0MestiCHoCWatei(DAW)
�
,C
-:7;-
'(P#geTof2
Site Address: Enf6rcement Agency: It Number
5S.e
1. WA1LK
HLA 11lN%v0101%V,1V1a: . '
.. .. " , : j
.. 4 01 4
CEC
Distribution
Type
If
#,Of,
, : .
Rated
Input.(kW
jank
Standby
L"
Heater
Certified Mir Name & Model,
(Std, Point -of-
Recirculation,
Identical
'Systems'
or
Btu/hr)
V.lu-ne
Efficiency
(EF, RE).
T
Number
Use ,'cic),
�l T
i
(gallons)
T -
,V,
�A
-
..-LAO
Note 1: For small gas storage (rated input less than or equal to 75,000 Btu/hr), electric resistance and /teat pump water heaters, list
Energy Factor (EF). For large gas storage water heaters (rated input of greater than 75,000 Blulhr), list Recovery Efficiency (RE).
Thermal Efficiency. Standby Loss and Rated Input. For instantaneous gas water heaters, &I the 771ermal Efficiency and Rated Input.
2. Mandatory Measures
TO COMPLY - ALL BOXES MUST BE CHECKED
E3 § 11*0-§ 1 - 13: Water heaters, showerhead and faucets are certified by the California Energy Commission.
§ 1506): Water System Pipe and Tank Insulation. And Cooling Line Insulation
L,,,.,Storage.tank insulation.
El A..Storage gas water heaters rated with an Energy Factor -no greater than the federal minimal standard are
externally wrapped with insulatiow having an installed thermal resistance of R- 12. or greater; and
El - B., Unfitid storage tanks or other indirect hot Water tanks have R-12 •external insulation or R- 16, internal
insulation
ulatioh whieitthe intimalinsulationR-viluie is indicated on thi exterior: of the tank.
2. Water 'piping and 'cool iinig'gystem line insulation thickneii�and conductivity",
-jifheater link systems, and elittre
��ater-
El First 5 feet of hot and cold water pipes closest to non -recirculating srA
'�Siandards Table 150-131; an
len of recircu atin sections of hot.w insulated d"•'
gth I ater pipes are
g
Pipe insulation for steam.hydronic heating systems or hot water systems, >15 psi, -meets the requirements of
'Standards Table 123-A.
13 Insulation. is protected from dam..age including that due to sunlight, moisiure, equipment maintenance, and
wind.
0- §'151(f)8D' if indicated on the CF;. I 1?, -all hot water piping that runs from the hot water source to the kitchen fixtures is
insulated per Standards Table
2008 Residential Compliance Forms Au.
�,t,2009
N
INSTALLATION CERTIFICATE CF-6R-MECH-0I
Domestic Hot Water (DHW) (Pa e 2 of 2
Site Address: Enforcement Agency: Permit Number.
3. Central Water Heating In Buildings with Multiple Dwelling Units (required for prescriptive)
TO COMPLY - ALL BOXES MUST BE CHECKED
❑ All hot water piping in main circulating loop is insulated to requirements of §15CQ
❑ Central hot water systems serving six or fewer dwelling units which have (1) less than 25' of distribution piping
outdoors; (2) zero distribution piping underground; (3) no recirculation pump; and (4) insulation on distribution
piping that meets the requirements of Section 1506)
❑ Central hot water systems serving more than 6 dwelling units - presence of either a time control or a
time/temperature control
DECLARATION STATEMENT
• 1 certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct.
• 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized
representative of the person responsible for construction (responsible person).
• I certify that the installed features, materials, components, or manufactured devices identified on this certificate (the installation)
conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the
enforcement agency.
• 1 reviewed a copy of the Certificate of Compliance (CF -I R) form approved by the enforcement agency that identifiesthe specific
requirements for the installation. 1 certify that the requirements detailed on the CF -1 R that apply to the installation have been met.
• 1 will ensure that a completed, signed copy of this Installation Certificate shall be posted, or [Wade available with the building
permit(s) Issued for the building, and made available to the enforcement agency for all applicable Inspections. I understand
that a signed copy of this Installation Certificate Is required to be Included with the documentation the builder provides to
the building owner at occupancy.
Company Name: (installing Subcontractor or General Contractor or Builder/Owner)
as \ U ry-\ i (A
Responsible Person's Name:
Responsible on's Signature:
CSLB License:
Date Signed:
Position With mpany (Title):
8d i 03
C0 - LA - I 3
r '
2008 Residential Compliance Forms August 2009
M