12-0049 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: =127=V60_0004 -9_N
Property Address:
79815 LIGA
APN:
772 -230 -047 -
Application description:
PLUMBING
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
1082
T,it!t 4 4 Q" -
Applicant: Architect or Engineer:
------------------
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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.
LicenseClass: C10 C20 C3 License No.: 811114
XI Date: 1 Contractor:
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 ($5001•:
(_ 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, 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. , 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
Owner:
ZIEMBA THOMAS SARKIS
79815 LIGA
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/17/12
Contractor:
CALIFORNIA DELTA
'��
MECHNICA11 C
�r,,
6052 E. BASELINE
AZ 85206
RD,#155!
J12
.ilMESA, `
(866) 692-5273
Lic. No.. 811114
--.,
Gl'1�y f --NIA
-----------------------------------------------
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 STATE FUND Policy Number 1697823-11
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
j�qq0 of the Labor Code, I shall wi h c ply with those provisions.
Date: I ' /aL Applicant:
WARNING: FAILURE 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 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 building construction, and hereby authorize representatives
of this/c my t e�nJter upon the above-mentioned propertyf trio Durposes.
Date: ` I /� Signature (Applicant or Agent):
1
LQPERMIT
Application Number . . . . . 12-00000049 .
Permit PLUMBING
`
Additional desc .
Permit -Fee . . . 22.50 Plan Check Fee
5.63.
Issue Date . . . . Valuation
0
Expiration Date 7/15/12
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 7.5000 EA PLB WATER HEATER/VENT
7.50
-----------------------------------------------------------------------------
Special Notes and Comments
WATER HEATER CHANGE OUT - 50GAL/GAS
[2008 ENERGY] 2010 CALIFORNIA BUILDING
CODES.
January 17, 2012 5:16:31 PM AORTEGA
-
-----------------_-_-------------------------------------------------
Other.Fees . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
Due
J 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
1
LQPERMIT
Prescri txVe Certificate o>`'
General Information
Site Addreea:
NOTA; This fpr,lt L4 oatu rr.oeA f ..�.
ance; Residential W�tpr
Climata Zone:
eating CF-lkt-ALT-U'g
Date:
WATM MA�'AYG
List water heaters and botlers for bot%i domesllc hot water
heaters must be g ll or propane Bred, and may not exceed 0 gultons�r Hot water pipsVtnsulation fromndhqdual ths DhIW heQteg � t�
kitchen s) and an all emd find hot watarp ss is r tred to all com onset a
p in all clltnors sones.
water Heatar e / Energy Factor or
Fue a Distnbutian T+pe Ntunber of Tank Capacity
Standard S stem almoie ei g
� � �areal Tank
Standard /f7,,. ).,/ 1. IICy �lafionR-Values
b
_ 20,
1.lnpficats Type (SYarage Qbs, $eatPinnp, Irratar+tanseus, eta)
2• RdCf 1dat<ng 4MOM eervh,g MUI*le dwalli
ng n t7 the s p o a a e ahal9 >rreerta the rectrnulatton rsgutrsmerrts of 150(n). s P crtettva rsa .e
3. The water hsattng tank andr ►++ to de
PtP� sholl be Msulded to meat *a requtrsmsnts af150A).
..onaactor (Documentation Author's /Re anstble Designer's Dedaratinn Sf$teaxeat
• I cartt#y that this Corti$cata of Complianca dom=entdtian Is aoctuate and complate.
• I am el A16 nndw 111viaim 3 of the Cdlitbtaie Huaincaa and Pzufeaslons Cado to accept roapoy�
this Centi.hazts of Compliance, bility £or the bur7dlrrg design IdenflSad on
• I certify that tlu anergy fhatores and erfo
to rho mQul este of'I'lae 14, Parts I aqd B o f the ca ft the bmldigg drslga IdantWed on this CerdBaete of Compliance contbrm
• The btuTdiag dealgn fbeivres idaed an thfs� Code of Regulations
bufdmg design on eae other hcable co C�th for of Compiience aro aortsietaat with the iaforMatioa provided to document aria
a 2r a toval WM this ba mpllan li forms, wo�hecta, calculaeco; plane and speelficAtIOw eubmittad the Wbreement
N.�• e I 'ter lication,
�D�„� awk �ignat�.
Compal.. Calif0mla Ufa Me
/Z
Add resB:6056 E. Beaellne.'Rd., #156 Data:
License;811114
Ctty/5taeo/z,p.Me88, AZ 85206
• PhoneL866-892-5273
'2008 Raide,11101
Afarch 20
L 'd �SE''ON3A31S' Wd95 lIOZ 9l •u'2�
;RinQty
of L.a Quinta 3oy�7 ('Building
tar Safety DNIslon pp #
lt #
P,O, Box 1504, 78-495 Calle Tampico 3 �
-
'OL, -tA
La Qidn'ta, CA 92251- (760) 777.701 ?10" �
Building Permit Application and Tracking Sheet
ProjeotAddress;
1 a
A. P. Number
Owner's Name:
Address: /� 1
Logal Description: pj tz
IA
City, 9T, zip: 14
Contractor:'1
'!'elephone: ��
Address: 6ojr'6 �� An ID
i1A ,5..� Yrgject Aoseription; '
city, ST, zip: Z
p,5245)6
Telephone:
' �� �V(.Ij1�L
( '
6 .��2 •_ Jr2�'3 �,�r$-
City Lie. #, /0q00 r
Arch., Engr., Deaigner:
'
Address:
N
City,, 3T, Zip:
N
Rt
Telephone:
stela Lie, #.-e:
Construction *P Occupancy.,
Name of Contact person:
N0et type (chole ons): New Add'n ter ' ~epair Demo
Sq, Ft:
Telephone # of Contact person: �6 b�6 q Z �— �Z� 3
# sDoriee;. its'
$sthakd Value ofPrgjec: 477
APPLICANT: DO NOT WRITE 0ELpW PHIS LINE
iM
Bubmlttel
lie 'd
Rec14
TRACK NG
Plan sets
PERS` B1Y,R8
Plan Check submitted
structural Calce,
Reviewed, ready for corrections
Amount
- xrusaC¢Iee.
t?hLftCheekjDE)eposIt
�Caked Contact Prryon
Titre 24 Calca,
Plane ple6d up
Flood plain plan
ConetructlonPlana resubmitted
Grading plan
2 ne Mechanical
, Rcview, ready for corrcellonossue
3ubcontactnr I,fat
ElecMcai
Called Contact Person
Grant Deed
Plumbing
Plana picked up
•
H2O.A. ApproYal
Plane resubmitted
IPI HOUBEt•
Grading
Review, ready fbr corracllous/Iseue
Planglrrg Approval
Developer impact Fee
Called Contact Person
Pub. Wiry, Appr
A.LP,P.
Date otpermit Issue
School Bees
Total Permit Fees
9 d tiS6E--'°N ..
]AhS MS:.E ZlR '9l 'UPr .._.
Presci•i
-JLrYC-ermicate of Compliance: Resiriantiat w.+e,- T -T, -."-
General Information
Site Address: A
!VOTE: This forrn is o
Climate Zone:
used or alteration or addition of water heatina.cv.
Date: /
CF -1R -ALT -WH
Contractor
certif(Documentation Author's /Responsible Designer's Declaration Statement)
• I y 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 respon
this Certificate of Compsibility for the budding design identified on
liance.
• I certify that the energy features and performance specifications for the building design identified on this Certificate of Co
to the requirements of Title 24, Parts 1 and 6 of the California Code of Regulations. mpliance conform
The building design features identified on this Certificate of Compliance are consistent with the infoffiation provided to document this
building design on the other applicable compliance forms, worksheets, calculations, plans and specifications submitted to the enforcement
age far a royal with this building emut a Iication.
rramt. Die
dlil% Signature:
Company:California Delta Me anical
Date:
Address:6056 E. BaselineRd., #155 /
City/State/Zip:Mesa, AZ 85206
2008 Residential Cornpiiance Foi ..s
License:811114
Phone:866-692-5273
kfar-ch 2010
a
INSTALLATION CERTIFICATE CF-6I2-1YlECH-01
DomesticHot Water (IDIIW) • (Pane 1 of 2)
Site Address: Enforcer ent Agency: Permit Number:
((JJ U'U) yl�
1. WA'A'RR ItW-ATVN-cwcirvmQ.
CEC
Heater Certified Mfr Name & Model
Type Number
Distribution
Type
(Std, Point -of-
Use, etc)
If
Recirculation,
Control Type
# of
Identical
Systems
Rated
Input (kW
or
Btu/hr)t
Tank
Volume
allons
Efficiency
(EF, RE)'
Standby
Loss
..ute 1. rur srrrau gas storage (rated input less than or equal to 75, 000 Btwhr), electric resistance and heat pump water heaters, list
Energy Factor (EF). For large gas storage water heaters (rated input of greater than 75, 000 BtuAr), list Recovery Efficiency (RE),
Thermal Efficiency, Standby Loss and Rated Input. For instantaneous gas water heaters, list the Thermal Efficiency and Rated Input.
2. Mandatory Measures
TO COMPLY - ALL BOXES MUST BE CHECKED
94110-§ 113: Water heaters, showerhead and faucets are certified by the California Energy Commission.
§ 1500): Water System Pipe and Tank Insulation. And Cooling Line Insulation
1. Storage tank insulation
A. Storage gas water heaters rated with an Energy Factor no greater than the federal minimal standard are
externally wrapped with insulation having an installed thermal resistance of R-12 or greater; and
B. Unfired storage tanks or other indirect hot water tanks have R-12 external insulation or R-16 internal
insulation where the internal insulation R -value is indicated on the exterior of the tank.
2. Water piping and. cooling system line insulation thickness and conductivity
First 5 feet of hot and cold water pipes closest to water heater tank, non -recirculating systems, and entire
length of recirculating sections of hot water pipes are insulated per Standards Table 150-B; and
Pipe insulation for steam hydropic heating systems or hot water systems >15 psi, meets the requirements of
Standards Table 123-A.
Insulation is protected from damage, including that due to sunlight, moisture, equipment maintenance, and
wind.
§ 151(f)8D: If indicated on the CF -1R, all hot water piping that runs from the hot water source to the kitchen fixtures is
insulated per Standards Table 150-B.
2008 Residential Compliance Forms August 2009
�7
s
INSTALLATION CERTIFICATE
Domestic Rot Water EEM CF-6R-MMCR-01
Site Address: (Pa e 2 of 21
7ja I I Enf cement Agency: Permit Number:
3. Central Water Heating in ]Buildings with Multiple Dwelling Units (required for prescriptive)
® COMPLY - ALL BOXES MUST BE CHECKED
All hot water piping in main circ
Central hot water systems ulating loop is insulated to requirements of § 150(j)
outdoors; (2) zero serving six or fewer dwelling units which have (1) less than 25' of distribution piping
distribution piping underground; (3) no recirculation pump; and (4) insulation on distribution
Piping that meets the requirements of Section 1500)
Central hot water systems -serving more than 6 dwelling units
timeltemperature control _presence of either a time control or a
DECLARATION STATEMENT
I certify
under• penalty of perjury, under the laws of the- State -of Califomia, the information provided on this form is true and correct.
I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized
,,lam
representative of the person responsible fnr constnrction (responsible person).
o 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
enforcement agency, and specifications approved by the
a I reviewed a copy of the Certificate of Compliance (CF -1R) form approved by the enforcement agency that identifies the specific
requirements for the installation. I certify that the requirements detailed on the CF -1R that apply to the installation have been met.
I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made 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 docuriientation the builder provides to
the building owner at occupancy,
--—x—.y tiusminng Jllbcon actor or General Contractor or Builder/Owner)
Responsible
F non's N
���� Responsible P i,�•
CSI.B License. �te ed Position With Co
f /
7 -e -
j �_itllp —
2008 Residential Compliance Forms
August 2009