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09-0076 (PLBG){ P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application description Property Zoning: Application valuation: Applicant: 09-00000076- 55728 OAK TREE 775 -231 -004 - PLUMBING _ LOW DENSITY RESIDENTIAL 900 c&tv144Q" Architect or Engineer: P140 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 1/30/09 Owner: MATSKO BRIGGS 55728 OAK TREE n LA QUINTA, CA 92253 /�A`\' D JAN 3 0 2009 Contractor: CALIFORNIA DELTA MECHANI L CITY OFLAQUINTA 6052 E. BASELINE RD, #155 FINAN1 EOEPT. MESA, AZ 85206 (48'0) 898-0007 tic. No.: 811114 --------------------------------------------------------------------------- LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION 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 70001 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: B -1210-C36 License No.: 811114 for by Section 3700 of the Labor Code, for the performance of, the work for which this permit is issued. ate.( 3Offi_ R 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 -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).: (_ 11, 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 1, 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—) I am exempt under Sec. BAP.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 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 370000.. of the Labor Code, `I�s�hhall forth/with comply with those provisions. WARNING: FAILRE TO SECURE 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 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 1.80 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 building construction, and hereby authorize representatives of this county to enter upon the above-mentioned property for inspection p rposes. te:; Sature (Applicant or Agent): Application Number . . . . . 09-00000076 Permit . . . PLUMBING Additional desc . Permit Fee . . . . 22.50 Plan Check Fee 5.63 Issue Date . . . . Valuation . . . . 0 Expiration Date 7/29,/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 REPLACE 50 GALLON GAS WATER HEATER WITH LIKE UNIT ---------------------------------------------------------------------------- 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 Jan.30, 2009 11:35AM STEVE CERTIFICATE OF COMPLIANCE: RESIDENTIAL .;�E No. 3869 P. 7 3 of 4) CF -1R rroject Title Date SEI AIDED DUCTS and TXVs(i Alternative Measures) A signed CF -4R Form must be provided to the building department for each home for which the following, are TXVs, readily accessible (climate zones 2 and 6-15 Installer testing and certification and HERS Rater: ❑ Refrigerant Charge (climate zones 2 and 8-15 only) HERS rater field verification Rater Alternative to Sealed Ducts and Refrigerant Charge /TXVs (See Package D Alternative Package Features Pro'ect Climate Zone in the RM Appendix B Table 151-C Footnotes 7-14 OR For additions and alterations, duct systems that are not documented to have been previously O 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. WATER FIRATTNG RVORTIRM.R Water Heater Type Distribution Type Rated Input' Number (kw or in System ©tAr(gallons heck box if system meets criteria of a "Standard" system. Standard system is one gas-fired water heater per Enerp Factor or Thermal Standby' Efficiency Loss % 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 Alternative Water Heating table, Table 5-4 In Chapter 5 in the Residential Manual. No water heating calculations are required, and the system complies automaticall • 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 fora recirculating system pump for a system serving multiple units Systems serving single dwe ling units ' Rated Enerp�y Tank Water Heater Distribution Number input' Tank (kw or Capacity Factor or Thermal Standby' External Insulation T e/Fuel Type Type in System iitAr(gallons) Efficienc Loss % . R-Valuo Water Heater Type Distribution Type Rated Input' Number (kw or in System ©tAr(gallons Tank Capacity Enerp Factor or Thermal Standby' Efficiency Loss % Tank External Insulation R -Value b 5- ---o k,awu ,upu,a w ,ess uian or equal to. ic,uuu tsiuwtnr), electric resistance, and heat 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 Ins 1 tion (kitchen lines �: 3/4 inches) All hot water pipes from the heating source to the kitchen fixtures that are 1/4 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 California Delta Mechanical Inc. f 1235 Grand Ave, Spring Vallev,CA 91977 Phone 619-307-0032 Fax 480-844-8844 Affidavit. that Power of Attorney is in. Full Force f STATE OF CA, 1, TONY KITCHUKOV, President of California Delta Mechanical Inc being duly sworn, depose and say: 5. The Principal within did, in writing, appoint me as the Principal's t"rue=and lawful' ATTORNEY -MI -FACT in the -within Power of Attorney. 6. 1 make this affidavit for the purpose of inducing : Svetoslav Evgeniev Pavlov to pull and process the permits in the state of California r OFFICIAL SEAL SWORN before me this 1� day 0",LYNN A. L AWTON �^ NOTARY PUBLIC - State o1 Arizona .� C;o � MARICOPA COUNTY My Comm. Expires May 24, 2011 ) A NotaVy Public ) ) ) Jan, 30. 2009 11:35AM STEVE No, 3869 P. 6 Stn N City of Lj uinta BulldlnB at Safety Wslon Permit # P.O. Box 1504, 78-495 Came r'amplco La Qulnta, CA 92255 - (760) 777.7012 Building Permit Application and Tracking Sheet Project Address:e� Owner's Name: ` A. P. Number. Addresst.�! al Deacri Aon: City, ST, Zip:aJ Contractee 1, Yr . Telephone: I .P 1000 Address: �2- }� Project ascription: b 7-r4/P/2, City, ST, Zip: �'� c /✓` (..oto Telephone-& 02 State Lia #; Ci ti Arch., Bngr., Designer, Address: City, ST, Zip: Telephone: Conawction Type: Occupancy: State Lic. #: project type (circle one): Now Add'n Altar Repair Demo Name of Contact Person; Sq. Ft.; # 3torles: #Unita: clophone # of Contact Person: $stimated Value of PNeer. . 00 APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal lieq'd Ytee'dWOMEN 'TRACKING PERMIT FEES Plan 8e6 Plan Cheek submitted Item Amount Straet" Coles, Reviewed, ready for corrections Plan CbecliMposlt Trues Cala. Called Contact Person Plan Check Balance Title 2dCala. flans picked upZ Coastructlon Flood plain plan Plans resubmt tied Mechonlcal Grading plan 2" Review, ready for carrectlond4sue Electrical Subtantactor Litt Called Contact Person Plumbing , Grant Deed Plans picked up S,M,I, H.OA Approval Plana resubmitted Grading IN HOUSE:. "' Review, ready for eorrectlomAssug Developer Impact Fee Plan" Approval Called Contact Person AIP,P, 6. Pub. Wks. Appr Date of permit [Mae School Fees Total Permit Fees