09-1226 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
=0;7-0-9
� i
Application Number: 0` 9=00001226
Property Address: 78975 BAYBERRY LN
APN: 604-304-004-33 -23995 -
Application description: PLUMBING
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 875
T4ht 4 4a Q"
Applicant: _ Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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: /B -C10 -C36 ` LicenseNo.: 811114
Date- � 'C7 Contractor. f /y!1 S��
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).:
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.).
(_) 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 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:
HENNY, JOANNE
78975 BAYBERRY LANE
LA QUINTA, CA 92253
(
Contractor:
CALIFORNIA DELTA MECHNICA
6052 E. BASELINE RD, #155
MESA, AZ 85206
(480)898-0007
LiC. No.: 811114
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 7777153
Date: 12/01/09
OEC 012009 L
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 FLTND 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
�J 37700 of the Labor Code, I shall forthwith comply
with those provisions.
od
Date: �Of; /OJ Applicant: !/ kyr; Ole.* 6�
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 county to
enter upon the above-mentioned property fo inspection purposes
Date: /�� -' Signature JApplicant or Agentl:
c . 'Q
Application Number . . . . . 09-00001226
Permit . . .
PLUMBING
Additional desc . .
Permit Fee . . . .
22.50
Plan Check
Fee
5.63
Issue Date
Valuation
. . .
. 0
Expiration Date
5/30/10
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
1.00 7.5000
EA PLB
WATER HEATER/VENT
7.50
----------------------------------------------------------------------------
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
Dec.' 1. 2009 9:25AM STEVE No. 6765 P. 2
CERTTFICAT E OF COMPLIANCE: RESIDENTIAL (Page 3 of 4) CF -1R
Project Title
SEALED DUCTS and TXVs for Alternative Measures)
A signed CF4R Form must be provided to the building department for each home for which the following. are
required.
O Alternative to Sealed Ducts and Refrigerant Charge fMg (See Package D Alternative Package Features for
Proiect CIimate Zone in the RM Ap=dix 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 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 130(m) and duct insulation requirements of Package D.
WATER HEATING SYSTEMS
✓
Distribution Number
TYUin S stem
❑
Sealed Ducts all climate zones Installer testing and certification and HERS rater field verification required.)
17
TXVs, readily accessible (climate zones 2 and 8-15 only)
(In ler testing and certification and HERS Rater field verification required.)
13
Refrigerant Charge (climate zones 2 and 8-15 only) (Installer testing and certification and HERS Rater field
verification required)
O Alternative to Sealed Ducts and Refrigerant Charge fMg (See Package D Alternative Package Features for
Proiect CIimate Zone in the RM Ap=dix 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 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 130(m) and duct insulation requirements of Package D.
WATER HEATING SYSTEMS
✓
Distribution Number
TYUin S stem
innpput' Tank
(kw or Capacity
BtAr) (aeons
Check box if system meets criteria of a "Standard" system. Standard system is one gas-fired water heater per
'tank
Insulation
R -Value
dwelling unit. If the water heater is a storage type, 50 gallons is the maximum capacity and recirculation system is
3'6 3 7
not allowed.
13
Check box when using Preapproved Alternative Water Heating table, Table 54 in Chapter 5 in the Residential
Manual. No water heating calculations are required, and the system complies automatically.
Check box if system does not meet criteria of"Standard" system, and does not comply with the Preapproved
O
Altemative Water Heating table. In this case, the Performance Method must be used and must be included in the
submittal.
0
Check box to verify that a time control is required for a recirculating system pump for a system serving multiple
units
Systems serving single dwelling units
Water.Heater
Typeffluel Type
Distribution Number
TYUin S stem
innpput' Tank
(kw or Capacity
BtAr) (aeons
Energy
Factor orExternal
Thermal Standby'
iciency Loss %
.60
'tank
Insulation
R -Value
9 �Ous S ko►-t
3'6 3 7
System serving muttiple dwelling units
II pu ,
Water Heater Distribution Number Ocw or
Type Type in System BW/hr
Tank
Capacity
eons
Enemy 'tank
Factor or External
Thermal Standby Insulation
Efficien Loss % R -Value
1. For small gas storage water heaters (rated inputs of less than or equal to 75,000 Btu/tu), 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 Insulation, (kitchen lines > 3/4 inches) All hot water pipes from the heating source to the kitchen fixtures that are %
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
Dec.' 1. 2009 9:25AM STEVE No. 6765 P. 1
' #
City of'La Quints
BuUft M Sdfery DilWw
PeM*
P.O. Box 1504, 78495 Cage Tampico
4 Qdnta, CA 92253 - (760) 777-7012
Building Permit Application and Traclang Sheet
Prc0M Address: L t j
Z.& (Nwner's Name: -Ip gyJ1P--
A. P. Nmnber.
Address: L8-'�S-
Legal 'on:
City. ST, Zip: 'Z
C0 ' (.P,4 � T? 4 q
^^
bl? � Telephone:
Address: 6'OS . g
%S15- Project Description: 3 O
K�i�LO
City, n. z'rp: ;?52v 6 w
Telephone. b -Cqz -.
Stene Lie. #!
City Lie. 9,
Arch., LW., Deslgnar:
Addrew,
City, ST, Zip:
Telephone:
COn4QttcROn Type; OCCRMC) :
State LiG #:
Project type (o¢nle one): New Add'n Alter Repair D=o
Name of Contact Pason:p
D Sq. Ft.: # Stori1.es: # Units:
113slimaw
Telephone # of Contact Person: L -
7 — S2 -�3 Value of ujectff
APPLICANT: DO NOT WPJTE BMQW THIS LINE
# ScbmiMl PA40d Reed TRACIMG PERMITFEES
Plan gets
Plan Check submitted
Item
Amount
StrTtetural Cala.
RRvkwed, mdy for corrections
Pian Check Deposit
Tross tales.
tallea Contact Pergm
Plan Check Balance
Tick 14 Coles.
Pians picked up
Construtdon
Flood lWa per►
Plana rembmitted
MwIankal
Grading plan
V Review, ready for eorrectionsAsme
Eleetricd
Subteatactur Leat
galled Contact Person
Plumbing
Groat Dad
Pty Ldd aP
110A. Approval
Plana resubmitted
Cmding
W HOUSE:
Revlew, ready Or correetloatRme
Developer Lmpaet Fee
Platu ft Approval
Called Contact Person
A,LP.P.
Puk Wks, APpr
Date of permit lune
&boot Fees
Tont Permit Few