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07-2727 (PLBG)VOICE (760) 777-7012 , FAX (760).777-7011 INSPECTIONS (760) 777-7153 Date: 10/09/07 LICENSED CONTRACTOR'S DECLARATION ------------------ - WORKER'S COMPENSATION DECLARATION - I hereby affirm under penalty of perjury that I ani licensed under provisions of Chapter 9 (commencing with P.O. BOX 1504 I hereby affirm under penalty of perjury one of the following declarations: Section 7000) of Division 3 of the Busine_ ss 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 78-495 CALLE TAMPICO _ for by Section 3700 of the Labor Code, for the performance of the work for which this permit is J ate:/ C ractor: "' X LA QUINTA, CALIFORNIA 92253 BUILDING &. SAFETY DEPARTMENT Code, for the performance of the work for which this permit is issued. My workers' compensation BUILDING PERMIT Application Number:4.07-0000_2727 hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier ENDR INS Policy Number WEN060882301 Owner.: Property Address: 78470 CALLS ORENSE construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the ROLAPP THOMAS CROSS APN: 646-192-006- - - and agree that, if. I should become subject to the workers' compensation provisions of Section - 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 78470 CALLE ORENSE Application description: PLUMBING ate' [� �4/pplicant: LA QUINTA, ,CA 92253 Property Zoning: LOW DENSITY RESIDENTIAL . the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The WARNING: FAILURE TO SECURE WORKERS' COMPENSATIO OVERAGE IS UNLAWFUL, AND SHALL Application valuation: 500 SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND and who does the work himself or herself through his orherown employees, provided that the DOLLARS 1$100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN improvements are not intended or offered for sale: If, however, the building or improvement is sold within _ SECTION 3706 OF THE LABOR CODE; INTEREST, AND ATTORNEY'S FEES. ' Contractor: Applicant:- Architect or Engineer improve for the purpose of sale.). - FOY, SCOTT A. _ 'APPLICANT ACKNOWLEDGEMENT - (_) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the 43579 MAIN STREET conditions and restrictions set forth on this application. property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed INDIO, CA 92201 - pursuant.to the Contractors' State License Law.). - - - _ whose benefit work is performed under or pursuant to any permit issued as a result of this application, 1 _ 1 I am exempt under Sec. , B.&P.C. for this reason - (760)775-9405 Lic. No.: 828264 " theowner, 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 - VOICE (760) 777-7012 , FAX (760).777-7011 INSPECTIONS (760) 777-7153 Date: 10/09/07 LICENSED CONTRACTOR'S DECLARATION ------------------ - WORKER'S COMPENSATION DECLARATION - I hereby affirm under penalty of perjury that I ani licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations: Section 7000) of Division 3 of the Busine_ ss 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: �C36. License No.: '828264 _ for by Section 3700 of the Labor Code, for the performance of the work for which this permit is J ate:/ C ractor: "' �,/ 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 OWN •BUIL R DECLARATION insurance carrier and policy number are: hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier ENDR INS Policy Number WEN060882301 following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to - _ I certify that, in the performance of the work for which this permit is issued, I shall not employ any - construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner so as to become subject to the workers' compensation laws of California, permit to file asigned statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if. I should become subject to the workers' compensation provisions of Section - 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 3700 of the edbor Code, I shall forthwith comply those provisions. any applicant for apermit subjects the applicant to a civil penalty of not more than five hundred dollars (5500).: ate' [� �4/pplicant: (_ 1 r, as owner of the property, or -my employees withwages 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 WARNING: FAILURE TO SECURE WORKERS' COMPENSATIO OVERAGE IS UNLAWFUL, AND SHALL _ Contractors' State License Law does not apply to an owner of property who builds or improves thereon, _ SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND and who does the work himself or herself through his orherown employees, provided that the DOLLARS 1$100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN improvements are not intended or offered for sale: If, however, the building or improvement is sold within _ SECTION 3706 OF THE LABOR CODE; INTEREST, AND ATTORNEY'S FEES. ' . 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.). - _ 'APPLICANT ACKNOWLEDGEMENT - (_) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the - 7044, Business and Professions Code: The. Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application. property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed 1 . Each person upon whose behalf this application is made, each person at whose request and for - pursuant.to the Contractors' State License Law.). - - - _ whose benefit work is performed under or pursuant to any permit issued as a result of this application, 1 _ 1 I am exempt under Sec. , B.&P.C. for this reason - theowner, 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. - Date: Owner. 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. • - CONSTRUCTION LENDING AGENCY permit to cancellation. .. I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the - I certify that 1 have read this application and state that the above information is correct. I agree to.comply with all t - work for which this permit is issued ISec. 3097, Civ: C.1. .. - city a county' ordinances and state laws relating to building construction, and hereby authorize representatives ' Lender's Name: - - - - • - of is county to enter upo the above-mentioned property for insp tion purposes. —/ °�• Date.. gnature (Applicant or Agent): Lender's c; , LQPERA11T - - Application Number 07-00002727 Permit PLUMBING Additional desc . Permit Fee 22.50 Plan Check Fee 5.63 Issue Date :.. Valuation 0 Expiration Date 4/06/08 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 WATER HEATER WITH NEW 40 GALLON NATURAL GAS UNIT Fee summary Charged Paid Credited Due. Permit Fee Total 22.50 --------- ---------- .00 ---------- .00 22.50 Plan Check Total 5.63 .00 .00 5.63 Grand Total 28.13 .00 .00 2.8.13 LQPERA4IT ' , - Din # City of La Quints BuRding 8r Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quints, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # Project Address: Owner's Name: -ThDMO,_S ?Z)L_apP A. P. Number- Address: --T8Lj—+c) Cc),Ike, O�ejr)�C Legal Description: City, ST, Zip: lo�m� CA4 Contractor. Amb 1 Addmss: ff)CL ly-) TeIephonc:q(AD—— O—JRC4 Project Description: City. ST, Zip; �06 (ro C)P, -( -k eAI oqX , N0x15 JT uS g gWIN Slow JAG- City Lic. Aruk. Ew.. Dvoigner, Addrew City., %T, Zip: M 0 :-M 1. Slitic^ir xa Wanto of Contact Porann-Sq. Construction Type- Occupancy: Project type (circle one): New Add'n Alter Repair Demo FL: # Stories: # Units: Telephone N of Con= Person- '6'U q- Estimated Value of Pmject 4 rno- 0, 00 APPLICANT: DO NOT WRITE BELOW THIS LINE 0 Nallt"Ittal Rt4-'d Rte.d TRACIMG PERMIT FEES Final 9943 Plan Check submitted Item Amount Atractural Calm Reviewed, ready for corrections Plan Check Deposit Truss calcs. Called Contact Person Plan Check Balance Mile 34 Calix. Plans picked up Construction Flood Plain Plan Plans resubmitted Mechanical GrMft plan 2" Review, ready for correctiondissue Electrical Subt6litfitfor List Called Contact Person Plumbing Grant Dead Plans picked up SJKL H.U-A. Approval Plans resubmitted Grading IN HOUSE, Jid Review, ready for correctionslissue Developer Impact Fee Plaaabig Approval Called Conteet Person A.I.P.P. Pub- Wks. Appr Date of permit issue Sdml Fta Total Permit Fees CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 3 of 4) CF -11R Project Title Cate SEALED DUCTS and TXVs (or Alternative Measures) A signed CF -411 Form must be provided to the building department for each home for -which the following. are required. V/ Distribution Type ❑ Sealed Ducts all climate zones installer testing and certification and.HERS rater field verification required.) 0 TXVs, readily accessible (climate zones 2 and 8-15 only) Installer testing and certification and HERS.Rater field verificationrequired.) ❑ Refrigerant Charge (climate zones 2 and 8-15 only) (Installer testing and certification. and HERS Rater field verification required.) OR ❑ 1 Alternative to Scaled Ducts and Refrigerant Charge rrXVs (See Package D Alternative Package Features for Nr Ject Climate Zone in the RM Appendix B Table 151-C, Footnotes 7-14. OR Fur additions and alterations, duct systems that are not documented to have been previously sealed as cunfirrned through field verification and diagnostic testing in accordance wih 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 reauitements of Package D. WATER HEATING SYSTEMS J Distribution Type Number in System Check box if system meets criteria of a "Standard" system. Standard system is one gas-fired water heater per 0 dwelling unit. If the water heater is a storage type, 50 gallons is the maximum capacity and recirculation system is Standby' Loss % nut alluwed. 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 automat.call . Check box if system does not meet criteria of "Standard" system, and does not comply with the Preapproved O Altrrnativr Water Heating table. In this case, the Performance Method must be used and must be included in the Gle �_ subiuiltal. 13 Cheek 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 Wntcr I1Gnter TYPC/l'-'uClTYPC Distribution Type Number in System Rated Input (kW or Btu/hr) Tank Capacity (gallons) Enemy Factor orExternal Thermal Efficiency Standby' Loss % Tank Insulation R -Value Gle �_ C >�-S V LJO �. System serving multiple d efte units Water 1-lcatcr Type .Distribution fYoe Number in System Rated Input' (kW or Btu/hr) Tank Capacity (- Ions) Energy Factor or Thermal Efficient Standby Loss %) Tank External Insulation R -Value I _ I-,nr smnll gns storage water heaters (rated inputs of less than or equal to 75,000 Btu/Fr), 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 treaters, list Rated Input and Thermal Efficiencies. Pine Insulation (kitchen lines > 3/4 inches) All hot water pipes from the heating source to the kitchen fixtures that are '14 inches or greater in diameter shall he thermally insulated as specified by Section 150 6) 2 A or 150 0) 2 B. Residential Compliance Forms March 2005