09-0075 (PLBG). -2
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
09-00000075
Property Address:
53167 AVENIDA DIAZ
APN:
774-041-02'0-10 -000000-
Application description:
PLUMBING
Property Zoning:
COVE RESIDENTIAL
Application valuation:
900
Tiht44.0"
Applicant: Architect or Engineer:
lop �lA-
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 -C10-1236 LicenseNo.: 811114
ate: Il tractor:
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.).
(_ 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.).
( 1 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:
PEALE C GEORGE
53167 AVENIDA DIAZ
LA QUINTA, CA 92253
Contractor:
CALIFORNIA DELTA
6052 E. BASELINE
MESA, AZ 85206
(480)898-0007
Lic. No.: 811114
ME
RD
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/30/09
------------------
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
1 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
3700 of the Labor Co I shall forthw' h comply with those provisions.
ate:1 r90 plicant:
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 coup y to enter upon th bove-mentioned propertylir inspection purposes.
////
' nature (Applicant or Agent):'L/ .
Application Number . . . . . 09-00000075
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
ELECTRIC WATER
HEATER
----------------------------------------------------------------------------
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 11:34AM - STEVE
CERTIFICATE OF COMPLIANCE: RESIDENTIAL
No, 3869 P, 5
3 of 4) C&IR
SEAM DUCTS and TXVs or Alternative asures
A signed CF -4R Form must be provided to the building department for each home for which the following. are
❑ I Sealed Ducts all climate zones Installer testing and certification and HERS rater field verification required.)
❑ TXVs, readily. accessible (climate zones 2 and 8-15 only)
Installer testing and certification and HERS Rater field verification required.)
13Refrigerant Charge (climate zones 2 and 8-15 only) (Installer testing and certification and HERS Rater field
OR
❑ Alternative to Sealed Ducts and Refrigerant Charge /TXVs (See Package D Alternative Package Features for
Pro eet 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
❑ 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,
Check box if system meets criteria of a "Standard" system. Standard system is one gas-fired water heater per
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 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 dwe linz units
Water Heater
Tyve/Fuel Type
Distribution
Type
Rated
input'
Number (kW or
In System et4r.
Enemy
Tank Factor or
Capacity Thermal
(gallons) Efficiency
Standby
Loss N
Tank
External
Insulation
R -Value
��OOw
System serving maltiole dwelling units
Water Hester Distribution
Tvpe Type
Number
in System
Rated
In ut' Tank
(kw or Capacity
BhAr(gallons
Enemy
Factor or
Thermal Standby'
Efficiency Loss M
Tank
External
Insulation
R -Value
I. For smau gas storage water heaters (rated inputs of less than or.equal to 75,000 Btu/hr), 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 Q) 2 B.
Residential Compliance Forms March 2005
California Delta Mechanical Inc.
1235 Grand Ave, Spring Valley,CA 91977
Phone 619-307-0032 Fax 480-844-8844
Affidavit that Power of Attorney is in Full Force
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'iFrue; and.lawful
ATTORNEY-IN-FACT in the within Power of Attorney.
6. I 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 of LYNN A. k.AWTON
NOTARY PUBLIC • State of Arizona
A/., ��/ MARICOPA COUNTY
1 ) My Comm. Expires May 24, 2011
)
A NotaVy Public )
)
Jan,30. 2009 11:34AM STEVE
Bin N
No. 3869 P. 4•
Qty OF La. Quinta
Building er Safety MOM
Pertrrlt (� P.O. Sox 1504, 78.495 Calle Tampico
00V La Qulnta, CA 92253 - (760) 777-7012
BLdIdlnp Permit Appiicatlon and Tracking Sheet
Project Addrass; J 3 �'�L�l A o, 77 Owner's Nance; GUY Cie,
A. P. Number. Address: 531 61 hYtn• (�
Legal Description: Cis, ST, Zip. 1
Contractor; 04l l
F. nia. qxj; 6- Tei hone: � �
Address;
� #155 • Project Description:
Cons metion "type:
Occupancy:
State Lie N:
project typo (circle one):
New Add'n Alter Repair Demo
Name of Contact Person 1(
Sq. Pt.:
0 Stories
q Units:
Tel hone q of Contact Porion:
Estimated Value of Uact,
APPLICANT:
DO NOT WRITE BELOW THIS LINE
N
Submittal
Ra 'd
Read
TRACMG
pRRMiT FEE$
Pian Bets
Plan Check nubmitted
Item
Amount
Structural Cala.
Reviewed, ready for correction
Plan deck Deposit
Trust Celts,
Caped Contact Person
Plan Cheek balance.
Tltie 24 Cases.
Pians picked up
Construction
Flood p1110 plait
plana resubmitted
Mechanical
Grading pica
V Review, ready for eorrectionallssue
I
Electrical
Subeoulactor Llat
Called Contact person
Plumbing
Grant Deed
Plans picked up
HAA Approval
Plena resubmitted
Grading
IN HOUSM.
ai Review, ready for oorrectiouslissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of perrAlt issue
$0001 Fee.
Total Permit Few