09-0301 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 09-00000301'
Property Address: 79180 CANTERRA CIR
APN: 604-263-003-28 -23913 -
Application description: PLUMBING
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 500
Tiht
�W
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
CONOWAY BILL RAY
79180 CANTERRA CIRCLE
UNKNOWN, CA 99999
1
Contractor:
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/02/09
Applicant: Architect or Engineer: FOY, SCOTT A.
43579 MAIN STREETr
INDIO, CA 92201 .P o� Z gg I
I(760) 775-9405 CITyQF
Lic. No.: 828264 FILgl�?l3lfyrq
=f ' gP7'
-------------------------------------------------------------------------------------------------
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.
License Class: C36 icenseNo.: 828264
G ,
te: tractor:
OWN E-BUILDE ECLARATION
I hereby affirm under penalty of perjury that I am exempt from t e 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 1$500).:
1 _ 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 _ I 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:
LQPERMIT
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 FIRST COMP INS Policy Number WS1004457
I certify that, in the performance of the work for which this permit is issued, I shalt 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 shall forthwith comply with those provisions.
r
(fate: lit: )
WARNING: FAILVETOSECURE WORKERS' COM NSATION OVERAGE 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.
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 uthorize representatives
of thi county to enter upon the above-mentioned property for inspect' n p poses.
aJ?I t�gnature (Applicant or Agent):
9
Application Number . . . . . 09-00000301
Permit . .
. PLUMBING
Additional desc .
Permit Fee . . .
. 22.50
Plan Check
Fee
5.63
Issue Date . . .
.
Valuation
. . .
. 0
Expiration Date
9/29/09
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 7.5000
EA PLB WATER
HEATER/VENT
7.50
----------------------------------------------------------------------------
Special Notes and
Comments
REMOVE & REPLACE
50 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
CERTIFICATE OF COMPLUNCE_: RESIDENTIAL (Page 3 of 4) CF -IR
Project Title Date
SEALED DUCTS and TXVs (or Alternative Measures)
A signed CF -4R Form must be provided to tate building department for each home for which the following. are
required.
OR
Alternative to Sealed Ducts and Refrigerant Charge /TXVs (See Package D Alternative Package Features for
Project Climate Zone in the RM Appendix B Table 15 i -C, Footnotes 7-14.
OR
For additions and alterations, duct systems that are not documented to have been previously
❑ sealed as confirmed through field verification and diagnostic testing in accordance with procedures in t e
Residential ACM Manual and duct systems with more than 40 linear feet in unconditioned
spaces shall meet the requirements uirements of Section 150(m) and duct insulation requirements of Package D. ,
WATER HEATING SYSTEMS
✓
t
Number
in System
Check box if system meets criteria of a "Standard" system. Standard system is one gas-fired water heater per
❑ .
Sealed Ducts all climate zones Installer testing and certification and HERS rater field verification re aired.
Standby:
Loss %
❑
TXVs, readily accessible (climate zones 2 and 8-15 only) I
Installer testing and certification and HERS Rater field verification required.)
Check box when using Preapproved Alternative Water Heating table, Table 54 in Chapter 5 in the Residential
❑ '
Refrigerant Charge (climate zones 2 and 8-15 only) (Installer testing and certification and HERS Rater field
verification uired.
OR
Alternative to Sealed Ducts and Refrigerant Charge /TXVs (See Package D Alternative Package Features for
Project Climate Zone in the RM Appendix B Table 15 i -C, Footnotes 7-14.
OR
For additions and alterations, duct systems that are not documented to have been previously
❑ sealed as confirmed through field verification and diagnostic testing in accordance with procedures in t e
Residential ACM Manual and duct systems with more than 40 linear feet in unconditioned
spaces shall meet the requirements uirements of Section 150(m) and duct insulation requirements of Package D. ,
WATER HEATING SYSTEMS
✓
t
Number
in System
Check box if system meets criteria of a "Standard" system. Standard system is one gas-fired water heater per
Tank
Capacity
(gallons)
dwelling unit. If the water heater is a storage type, 50 gallons is the maximum capacity and recirculation system is
Standby:
Loss %
not allowed. i
c
CC!
Check box when using Preapproved Alternative Water Heating table, Table 54 in Chapter 5 in the Residential
Manual. No water hewing calculations are required, uired, and the system complies automatically. i
Check box if system does not meet criteria of"Standard" system, and does not comply with the Preapproved
❑
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 ±
Svstems serving single dweitine units
Water Heater
Type/Fuel Type
Distribution
Type
Number
in System
Rated
(w or
Bwft)
Tank
Capacity
(gallons)
Enemy
Factor or
Thermal
Efficiency
Standby:
Loss %
Tank
External
Insulation
R -Value
c
CC!
7U
'c7
Cvctem serving multiple dwelling units
Water Heater
Type
Distribution
Type
Number
in System
Rated
(kW or
y1LvV(gallons)
Tank
Capacity
Energy
Factor' or
Thermal
Efficiency
Standby'
Loss %
Tank
External
Insulation
R -Value
!1. For small gas storage. water heaters (rated inputs of -less than or equal to i:),vvv otwnr/, dean; resuiar+cx, arw nnaL
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 INWation (kitchen Idles > 3/4 inches) All hot water pipes from the heating source to the kitchen fixtures that are '14
inches or greater in diameter;shall be thermally insulated as specified by Section 150 0) 2 A or 150 0) 2 B.
Residential Compliance Forms
March 2005
�r
f
Bin #
City of La Quinta
Building &r Safety Division
P.O. Box 1504, 78-495 Cape Tampico
la Quanta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
PerMt # O
. 3
PmJW Address:
Owner's Name: r
A. P. Number:
Address: C6
Legal Description.
City, ST, Zip:
Contractor: S C C r C)i
Address: q 3l:� 79 0.
Telephone:
Project Description:P, k R..5 o 110
City, ST, Zip: = n c; O C F} 22 01
Telephone: 7(pA I.7 7'5-- 09 11
State Lia 2 (p q L!ES-
City. #; � -7 g
Arch., Eng., Designer.
Address:
City., ST, Zip:
Telephone:
State Lic. #:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project: o , x
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'.d
TRACKING
PERMIT FEES
Pian Sets
Plan Check submitted
Item
Amount
Structural Calfa.
Rtviewed, ready for corrections
Plan Check Deposit
Tans Cale.
Called Contact Person
Plan Check Balance.
Title 24 Caics.
Plans picked up
Constrncdon I
Flood plain plan
Plans resubmitted
Mechanical
Grading pian
Z" Review, ready for corrections&uue
Electrical
Subeontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked tip
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
Review, ready for correctionsAssue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
t
Total Permit Fees
Notice:
Document Cannot Be Duplicated
Date 3/13/96
No. 14244
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Owner Name Roger Snellenberger & Associates
No. 79180 Street Canterra Ct.
Jurisdiction
APN # 604-263-003
La Quinta
Permit #
Log #
City La Quinta Zip 92253 Study Area 223
Tract # 23913 Lot # 28 Square Footage 2149
Type of Development Single Family Residence No. of Units 1
Comments
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports,
covered patios/walkways, residential additions under 500 square feet, detached accessory structures or
replacement mobilehomes. It has been determined the above-named owner is exempt from paying
school fees at this time due to the following reason:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080
in the amount of 1.72 X 2,149 or $3,696.28
the property listed above and that building permits and/or Certificates of Occupancy for
this square footage in this proposed project may now be issued. r"
Fees Paid By Roger Snellenberger & Associates Telephone' -=-.777-7766
Name on the check -
By Dolores A. Ballesteros
Superintendent
Fee collected /exempted by Pauline Pearson
Signature �lli , Q e nes �SL�I� n ,Oil
Payment Received
Check No. 11437
$3,696.28
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting