09-0928 (PLBG)P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA,,CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Application Number: 09-00000928
Property Address: 78845 SUNBROOK LN
APN: 604-292-007-28 -23995 -
Application description: PLUMBING
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 840
-_.Li
Owner:
PAUL MUSLOVSKI
78845 SUNBROOK LANE
LA QUINTA, CA 92253
Date: 9/01/09
Contractor: — C
Applicant: Architect or Engineer: CALIFORNIA DELTA ME CAL I
6052 E. BASELINE , 55 �1
MESA, AZ 85206
\ (480) 898-0007 /jy 0
LiC. No.: 811114
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATI
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 7000) 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' c pensation, as provided
License Class: B -C10- License No.: 811114 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
ae�/O/ Contractor:
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 insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier STATE FUND Policy Number 1697823
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 personin any manner so as to become subject to the workers' compensation laws of California,
permit to filea signed 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 ' 3,700 of the Labor Code, I shall forthwith comply with those provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by* /%� Q
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars IS500I.: ate:r''" �v pplicant:
(_) 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 WARNING: FAI URE TO SECURE WORKERS' COMPENSATION COVERAGE 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 or her own employees, provided that the DOLLARS ($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.).
(_) 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: A '
Lender's Address: 1
LQPERMIT
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
conditionsand 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 ano county ordinances and state laws relating to building construction, and hereby authorize representatives
of �c%ount too a ter upon he above-mentioned property for inspection purposes.
Da" 1Rv nature (Applicant or Agentl: l� �NT/ �lTt//�
LQPERMIT
Application Number
09-00000928
Permit . . . PLUMBING
_
Additional desc .
Permit Fee . . . . 22.50
Plan Check Fee
5.63
Issue Date . . . .
Valuation . . .
. 0
Expiration Date 2/28/10
Qty Unit Charge Per
Extension
BASE
FEE
15.00
1.00 1.5000 EA PLB
WATER HEATER/VENT
7.50
----------------------------------------------------------------------------,
Special Notes and Comments
INSTALL NEW 40 GALLON GAS WATER
HEATER.
2007 CODES.
---------------------------------------------------------------
OtherFees . . . . . . .
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
Sep, 1. 2009 3:12PM STEVE ' No, 3615 P. 3
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CERTIFICATE OF COMPLIANCE: RESIDENTIAL e 3 of 4 CF -1R
Project Title Date
SEALED DUCTS and TXVs (or Alternative Measures
A signed CF -4R Form must be provided to the building department for each home for which the following. are
required.
OR
Altc-mativc to Ecalcd ThmU and Rcfrigcrcuit Chargo /'MVV (3.c rackagc D Alttauativc I`acl.agc ,Pcatwca .fv�
Project Climate Zone in the RM ADDendix B Table 151-0, Footnotes 7-14.
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
s aces shall meet the requirements of Section 150(m) and duct insulation requirements of Package D.
WATER HEATING SYSTEMS
Distribution
e
❑
Sealed Ducts all climate zones Installer testinA and certification and HERS rater field verification required.)
13
TXVs, readily accessible (climate zones 2 and 8-15 only)
Installer testing and certification and HERS Rater field verification required.)
E3Refrigerant
Charge (climate zones 2 and 8-15 only) (Installer testing and certification and HERS Rater field
verification required.)__
OR
Altc-mativc to Ecalcd ThmU and Rcfrigcrcuit Chargo /'MVV (3.c rackagc D Alttauativc I`acl.agc ,Pcatwca .fv�
Project Climate Zone in the RM ADDendix B Table 151-0, Footnotes 7-14.
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
s aces shall meet the requirements of Section 150(m) and duct insulation requirements of Package D.
WATER HEATING SYSTEMS
Systems serving single dwelling units
Water Heater
Type/Fuel Type
Distribution
e
Rated
Input'
Number (kw or
in System Bndhr
Check box if system meets criteria of a "Standard" system. Standard system is one gas-fired water heater per
Enemy
Factor or
Thermal
Efficiency
dwelling unit. If the water heater is a storage type, 50 gallons is the maximum capacity and recirculation system is
Tank
External
Insulation
R -Value
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 automatically.
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
Systems serving single dwelling units
Water Heater
Type/Fuel Type
Distribution
e
Rated
Input'
Number (kw or
in System Bndhr
Enemy Tank
Tank Factor or External
Capacity Thermal Standby Insulation
aeons Efficiency Loss % R -Value
Enemy
Factor or
Thermal
Efficiency
Standby
Loss %
Tank
External
Insulation
R -Value
�i4 'rt
5 stem serving multiple d elling units
Water Heater
T'ype----
Distribution
Type
Number
in System
Rated
Input' Tank
(kw or Capacity
Bw/hr) eons
Enemy
Factor or
Thermal
Efficiency
Standby
Loss %
Tank
External
Insulation
R -Value
r. For small gas storage water heaters (rated inputs of less than or equal to 75,000 Bbft), 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 -a 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
Sep, 1. 2009 3:13PM STEVE
No, 3615 P. 4
$`" #
City of La Quinta
Building Bt Safety Division
Permit
P.O. Box 1504, 78-495 Calle Tampico
a q
La Qtdhta, CA 92253 - (760) 777-7012
O
Building Permit Application and Tracking Sheet
Proj6at Address: rT% t L,A S
N't3 Owner's Name: 0 L. 1►� U S
A. P. Numbcr:
Address: r 1,2 g 4
Legal 17escription:
City, ST, Zip: L_A, 1 KC
Contracto
T� JsA'Telephone. Cx
Address:(p�
t 4r Project Description:
City, ST, zip:SAx
State Lie. #:
City Lir.. #;
Arch., Engr., Designer.
Address:
City, ST, Zip:
Telephone:
Construction Type: Occupancy:
State Lie, #: 7M=project
type (oirr.le one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.: # Stories: # Units
4Estimated
Telephone # of Contact Person:
$q Value of Project
APPLICANT: DO NOT WRITE BELOW THIS UNE '
#
Submittal
Req'd
Itec'd
TRACKING
PERMIT FEES
Plan Seta
Plan Check submitted
Item Amount
Structural Calci,
Reviewed, ready for corrections
Plan Check Deposit
Truro Calve.
Called Contact Persia
Plan Check Balance
Title 24 Calm
Pians picked up
Construction
Flood plain plan
plans resubmitted
Mecbanical
Grading plan
2pd Review, ready for torrectlona/issue
Electrical
Subcontactor List
Galled Contact Person
plumbing
Grant Deed
Plans picked up
H.O.A. Approval
P12ns resubmitted
Grading
IN HOUSE:-
'"r Review, ready for eorreetionOssue
Developer Impact Pee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit Issue
School Fees
T*W Permit Fees
p2 3
,* 13S0-),5'9
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