12-0841 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 12-00000841
Property Address: 47675 VIA MONTESSA
APN: 643-120-014-242 -26152
Application description: PLUMBING
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 1200
Td�v 4 e(P4"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
ROSKER BENJAMIN,H
47675 VIA MONTESSA
LA QUINTA, CA 92253
VOICE (760) 777-7012 .
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/30/12
`r Alt
n trantnr•
Applicant: Architect or Engineer: It J V ?OtZ VAREZ, JORGE A.
C / .O. BOX 984
F QF(� HERMAL, CA 92274
(760) 777-3613
.\ T Lic. No.: 880103
-
-----------------------------------------------------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION I WORKER'S COMPENSATION DECLARATION //
1 hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the 8usine and Professionals Code, and my License is in full force and effect.
License Class: C36 License No.: 880103
Ir:ate:�'ll
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 70001.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.).
(_ 1 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.).
(_ 1 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:
Lender's Address: I '
LQPERMIT
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
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 shout ecom subject to the workers'.compensation provisions of Section
3700 of the Labor Code, I shat orthwith comply with those provisions.
aU te: lo� plicant:
WARNING: FAIL RE TO SECURE WOR ERS' 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 buildin construction, and hereby authorize representatives
of thi couunt^y'to enter upon he above-mentioned property f r 'nsp coon purposes.
ate? , 0 /Z 'nature (Applicant or Agent):
Application Number . . . . . 12-00000841
Permit
PLUMBING
Additional desc .
Permit Fee . . . .
30.00
Plan Check Fee
7.50
Issue Date . . . .
Valuation . . .
. 0
Expiration Date
1/26/13
Qty. Unit Charge
Per
Extension
BASE FEE
15.00
2.00 7.5000
EA PLB
WATER HEATER/VENT
15.00
----------------------------------------------------------------------------
Special Notes and Comments
REPLACE (2) 50 GALLON
GAS WATER
HEATERS.
2010 CODES.
----------------------------------------------------------------------------
Other Fees . . . . .
. . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged
Paid Credited
Due
---------------------------
Permit Fee Total
---=------
30.00
--------------------
.00 .00
30.00
Plan Check Total
7.50
.00 .00
7.50
Other Fee Total
1.00
.00 .00
1.00
Grand Total
38.50
.00 .00
38.50
LQPERMIT
Prescriptive Certificate of Compliance: Residential CF-IR-ALT-DHW
Residential Alterations Page I of 2
Project Name: T Climate Zone: Permit #:
General Information
Site Address: G t1
Enforcement Agency: Ci'(NA-c-- Date: -
Building Type: Wingle Family 0 Multi Family
Project T e: a lacement or Change Out of Water Heater
WATER HEATING
List newtv installed stater Treaters and boilers for both domestic hot nater heaters (DWH) and hvdronic space heating. Newly installed
D IVH !seaters and !milers must be xas. propane, or use the e.vistinithel type.
Distribution Type Number In Tank Energy Factor at
Watts Heater . (Standanl,
Eztcmat Tank
Insulation
Type/Fttel Type lteciuculatin System Capacity (gal) Thermal Efficiency
R-Vatue'
2
1. indicate Tspe (Storage Gas, Heat Pump. Instantaneous, etc.)
2. Recirculating systems serving multiple dwelling units shall uteet the recirculation regr�irements of §I50(n).
T/te Prescriptive
requirements do not allow the installation of a recirculating water heating system for single du4etling units.
.1. The er►ernal water heating tank and i es shall be insulated to meet the requirements of §1500.
Contractor or Homeowner (Documentation Author's/Responsibte Building Designer's Declaration Statement)
• i certify that this Certificate of Compliance documentation is accurate and complete.
• i am eligible under 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 id--ntifted on this Certificate of Compliance
conform to the requirements of Title 24. Part t and 5 of the California Code of Regulations.
a 'flit bu: i(ding 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. puns and specifications submitted to the
enforcetre»t agency Fetr approval vrith this building permit a lication. _ _ _ _ __...__ ..._ -
Name: Signatu
o t^g P A \V
eatnpa;,y:
T - _ _ License:
Address: _ _ _�___ ._..
$9010_
City/State/Zip: Phone:
(&Anril Mit)
1. Per Section ibu(I) oT ine Guuo r-l+dlyy cnw,viwr .,•W......-..-•
Anril 2010
2009 Appliance EffIddricy Aegulatioris for Smell Water Heaters
Small Water Heater Is defined as:
Type
Input
Gas Storage
75,000 Btu/hr or less
Oil Storage
105,0 Btu/hr or less
Electric Storage
12 kW or less
Gas Instant
200,000 Btu/hr or less
Oil Instant
210,000 Btu/hr or less
Electric Instant
12 kW or less
Heat Pump
24 amps or less
1. Per Section ibu(I) oT ine Guuo r-l+dlyy cnw,viwr .,•W......-..-•
Anril 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 T
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
0.59 — (0.0019 x V)
0.533
0.514
0.495
Oil -fired water heaters
(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
062 — (0-0019 x V)
0.563
0.544
0.525
Gas-fired Instantaneous water
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 allons
1. Per Section ibu(I) oT ine Guuo r-l+dlyy cnw,viwr .,•W......-..-•
Anril 2010
"n #
Permit # � ,1
Project Address: A-1
A. P. Number:
Legal Description:
Contractor: p f -
Address:
City, ST, Zip:^ er
VTelephone: k0l
Designer
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person:
Telephone # of Contact Person:
: City of La Qulnta
Building 8i: Safety Mislon
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Owner's Name: Y\ \SOS
Address: t cl_ t1ko�_2 S
City. ST, Zip: `(\ mss-
Telephone: -
Project Description:
CUL -7 y CnAl
City Lic. #c \05336
M
Submittal
Req'd
Rec'd
TRACKING PERMIT REFS
Plan Sets
Plan Cheek submitted item Amount
Structural Coles.
Reviewed, ready for corrections flan Check Deposit .
Truss Cala.
Called Contact Person Plan Check Balance.
Title 24 Coles.' .
Plans picked up Construction
Flood plain plan
Plans resubmitted Mechanical
Grading plan
2" Review, ready for correctiondissue Electrical
Subcontactor List
Called Contact Person Plumbing
Grant Deed
Plans picked up SMI.
H.O.A. Approval
Plans resubmitted Grading
IN HOUSE:-
''� Rcview, ready for cormctionsftae Developer Impact Fee
Planning Approval
Called Contact Person A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees