09-1150 (PLBG)P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT -
Date: 10/30/09
Application Number. 09-00001150 Owner:
Property Address: - +47295VIA KORON GARRY GIBBS
APN: 643-100-012-191 -26152 - 47295 VIA KORON
Application description: PLUMBING LA QUINTA, CA 92253
Property Zoning:` LOW DENSITY RESIDENTIAL "'
Application valuation: 250
Contractor: 0 T U 2009
Applicant: Architect or Engineer: PACIFIC EXPRESS INS LL SVC INC
P.O. BOX 2590 CITYOFLAQUINTA
` CARLSBAD rCA 92018-1599 .
nFpT.
~ _j�7 •
(76 0) 720-1613
r LiC. No.: 878921
------------------------------------------
• LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
•` t I.hereby affirm under penalty of perjury that I 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 CI ss: C36 nse No.: 21 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is '
- issued. -
ate; ntractor: 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
OWNER-BUILDE ECLA TION insurance carrier and policy number are: ..
I hereby affirm under penalty of perjury that I am exempt from e o ctor's State License Law for the - Carrier TOWER SELECT Policy Number WD9-3310353 -09
following reason (Sec. 7031.5, Business and Professions Code: city or county that requires a permit to - I certify that, in the performance of the work for which this permit is issued, I 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' compensation 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 Code, I shall forthwithAimply with t rovisions.
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).: ate: GO C%A scant:
( 1 1, 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: FAIL RE TO SECURE WORKERS' COMPENSAT N COVER E 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 VIL FINE P 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 C MPEN ION, 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, ANDA EY'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 licensedcontractorsto 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 buildsorimproves thereon, and whn 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 applivatiun,
(_ 1 I am 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 act or omission related to the work being
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 AGENCYpermit to cancellation.
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the. - I certify that 1 have read this applicationand state that the above information is correct. I agree 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, a hereby au a representatives
of this court to ores upo the above-menti tion pu oses.
Lender's Name: -
,• - Dater gnature. (Applicant or Agent): -
Lender's Address:. • -
LQPERMIT - - - -
Application Number• . . . . . 09-00001150
Permit PLUMBING
Additional desc .
Permit Fee 22.50 Plan Check Fee
5.63
Issue Date . . . Valuation .
. 0
Expiration Date 4/28/10
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 -40 GALLON GAS WATER HEATER
----------------------------------------------------
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
r
CkATIFIC
.TE. OF COMPLIANCE: :RESIDENTIAL .(Page 3 -of 4). :: CF=1R
Date
UCTS and TX -Vs- (or Alternative Measures)
R Form must -be provided 16. We building department for each homefor which the following. are .
OR*
FAltematiye to Sealed Ducts and Refrige1.rant Charge /T- Vs (See Package D Alternative Package Fe4ures -for
olProject Climate Zone in.the RKA endix B Table 151-C Footnotes 7-14:
OR.
for.'additions- and alterations, duct systems that are.not documented to'. have been previously
sealed as confirmed through, field'veiification and diagnostic testing in accordance with procedures in the .
Residential ACM Manual.and duct systems with more than 40 linear feet in unconditioned
:sp aces shall meet there uirements of Section 150(m) and'duct insulation requirements of Packa e,D.
\I7 A TLD: aPA TT1�T!? CVCTTi 1ViC
uu,w.
Distribution
Type
'E3 '
Sealed Ducts all climate: zones staller testin .and certification and HERS rater field verification required.)
Tank :
Capacityy°
aeons
TXVs'-readiN accessible (cl.imate''zones2 and 8-15 only)
Stancb t
Loss %
staller testing and certification and HERS Rater field verification required.)
Refrigerant• Charge (climate zones 2 and 8-15 only) (Installer testing and certification and HERS kz-ter field
verification re uired:)"
OR*
FAltematiye to Sealed Ducts and Refrige1.rant Charge /T- Vs (See Package D Alternative Package Fe4ures -for
olProject Climate Zone in.the RKA endix B Table 151-C Footnotes 7-14:
OR.
for.'additions- and alterations, duct systems that are.not documented to'. have been previously
sealed as confirmed through, field'veiification and diagnostic testing in accordance with procedures in the .
Residential ACM Manual.and duct systems with more than 40 linear feet in unconditioned
:sp aces shall meet there uirements of Section 150(m) and'duct insulation requirements of Packa e,D.
\I7 A TLD: aPA TT1�T!? CVCTTi 1ViC
-) .stems Serving single Uwe ,un
• Water Heater .
T . e/Fuel Type . "
uu,w.
Distribution
Type
Number
in.S stem ,
heck box if system meets criteria of a "Standard"'system: Standard system is one`gas=fired water ieater per'
Tank :
Capacityy°
aeons
dwelling unit. If the water heater is a storag'e:type, 50'gal10ins is.the. maximum: capacity and recirculation system is .
Stancb t
Loss %
not allowed.
Check:box whenusing Preapproved Alternative Water Heating table, Table 5-4 in Chapter 5 in the Residential
Manual. No water heating calculations are required, and the system complies automatically.
Tank
'Check boz if'system does not meetcriteria:of "Standard" system, and -does not comply with. the Preipproved
0:
Altem' ative Wate 41eating table. lsi this case, the Performance Method must be used and. must be included in the:
�
Water Heater
.submittal. � . ' ...
Number'
Check -box to verify' that. a time control is,required for a recirculating system'putnp fora, system seriing'triultiple
Capacity
units
-) .stems Serving single Uwe ,un
• Water Heater .
T . e/Fuel Type . "
uu,w.
Distribution
Type
Number
in.S stem ,
Rated .
Input
(kw or
stu/t0
Tank :
Capacityy°
aeons
Ener
..Factor�or
Thermal ..
Efficienc .
Stancb t
Loss %
Tank
External
'Insulation'..
R -Value .
Rated .
Tank
Factor' or
External
Water Heater
Distribution..
Number'
(kw or
Capacity
Thermal
Standby'
Insulation.
T e .
T e
in S stem.
Btu/hr
aeons •
Efficienc .
'Loss %
R -Value .
J SLG„�JG'Yiu lu unl 1G 4�t
Vl1lL - YluW.
.
_ '
Energy
Tank..
Rated .
Tank
Factor' or
External
Water Heater
Distribution..
Number'
(kw or
Capacity
Thermal
Standby'
Insulation.
T e .
T e
in S stem.
Btu/hr
aeons •
Efficienc .
'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 75,0.00
Btu/hr), list Rated Input,.Recovery Efficiency, Thermal Efficiency and Standby Loss: For instantaieous.gas water
heaters, list Rated. Input and Thermal. Efficiencies.. .
Pirie Insulation (kitchen. lines. > 3/4 inches)'All.hot water pipes from the heating source to the kitchen -5xtdres that are
inches or greater in diameter shall be thermally insulated: asspecified by'Section 150 (j) 2 A'or.'150 (j) 2 &
. Residential Compliance Forms March 2005
Bin #
..
City of La Quinta
Building u Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address:03_7q�_V
vN0
Owner's Name: G V y 1
A. P. Number: 7 ZqS
Address: R -
Legal Description:
Contractor:
S
City, ST, Zip:
Telephone:
ZZS�
Address: PoBac ZS [o
City, ST, Zip: &v 1 cjK
Project Description:
Telephone: hone: � v 7 Z0 b
a f
.
State Lic. # :
Arch., Engr., Designer:
p
City Lie. #; O C O
Address:
City, ST, Zip:
Telephone: hone:
State L ic. #
Name of Contact Person:
Construction T Occupancy:
Type: e• P Y•
Project type (circle one): New Add'n Alter Repair air De mo
Sq. Ft.: # Stories: # Units:
Telephone # of Contact Person
Estimated Value of Project: 2 �6
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cates.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cales.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2"a Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person,
Plumbing .
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
Jrd Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees