08-1512 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 08=000.01512".
Property Address: 52090 EISENHOWER DR
APN: 773-231-005-18 -000000-
Application description: PLUMBING
,Property Zoning: COVE RESIDENTIAL
Application valuation: 500
T4ht 4 4 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: C36 License No.: 828264
q
Date:
ontractor: I V
OWNE-BUILDE XCIARATION
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).:
(_) 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.).
( ) 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:
MAZUR JOSEPH LEE
52090 EISENHOWER
LA QUINTA, CA 92253
(
Contractor: I D
FOY, SCOTT A.-
43579
. 43579 MAIN STREET
INDIO, CA 92201
(760)775-9405
Lic. No.: 828264
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/03/08
0 4 200 a4
SEP
Olr LA Qt,lIWA
r� Yn T,QT
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 ACE INC Policy Number C45040239
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
X31700 of the Labor Code, II shall forthwith comply withthoseprovisions.
t Date. ''V ,.Applicant:
WARNING: FAILURE TO SECURE WORKERS'COON OVERAGE 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 commence
within 180 days from date of issuance of such permit, or cessation of work for 180 days wil ubject
permit to cancellation. `
I'certify that I have read this application and state that the above information is correct. I agree to co ly with all
city and county ordinances and state laws relating to building construction, and hereby authorize re sentativas
of this county to enter upon the above-mentioned property for inspecti n purpo s.
Date:' Signature (Applicant or Agent):
Application Number
. . . . . 08-00001512
Permit . .
. PLUMBING
Additional desc .
Permit Fee . . .
. 22.50
Plan Check
Fee
5.63
Issue Date . . .
.
Valuation
. . .
.
0
Expiration Date ..
3/02/09
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.40 GALLON
ELECTRIC WATER
HEATER
Fee summary
-----------------
Charged
--------------------
Paid Credited
--------------------
Due
Permit Fee Total
_ 2.2.50
.00
.00
22.50
Plan Check Total
5.63.
.00
.00
5.63
Grand Total
28.13
.00
.00
28.13
LQPEEMIT
CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 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
0 Alternative to Sealed Ducts and Refrigerant Charge fTXVs (See Package D Alternative Package Features for
Project Climate Zone in the RM Appendix B Table IS I -C, Footnotes 7-14.
OR
For additions and alterations, duct systems that are not documented to have been previously
0 sealed as confirmed through field verification and diagnostic testing in accordance with procedures in the
Residential ACM Manual and duct systems with more tan h 40 linear feet in unconditioned
spaces shall meet the requirements of Section 150(m) and duct insulation requirements of Package D.
WATER HEATING SYSTEMS
V
Distribution
Type
13
Sealed Ducts all climate zones(Installer testing and certification and HERS rater field verificationrequired.)
11
TXVs, readily accessible (climate zones 2 and 8-15 only)
(Installer testing and certification and HERS Rater field verificationrequired.)
0
Refrigerant Charge (climate zones 2 and 8-15 only) (Installer testing and certification and HERS Rater field
verificationrequired.)
OR
0 Alternative to Sealed Ducts and Refrigerant Charge fTXVs (See Package D Alternative Package Features for
Project Climate Zone in the RM Appendix B Table IS I -C, Footnotes 7-14.
OR
For additions and alterations, duct systems that are not documented to have been previously
0 sealed as confirmed through field verification and diagnostic testing in accordance with procedures in the
Residential ACM Manual and duct systems with more tan h 40 linear feet in unconditioned
spaces shall meet the requirements of Section 150(m) and duct insulation requirements of Package D.
WATER HEATING SYSTEMS
V
Distribution
Type
Number
in System
Check box if system meets criteria of a "Standard" system. Standard system is one gas-fired water heater per
Tank
Capacity
ions
dwelling unit. If the water heater is a storage type, 50 gallons is the maximum capacity and recirculation system is
Standby
Loss %
not allowed.
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
Alternative Water Heating table. In this case, the Performance Method must be used and must be included in the
submittal.
C3
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
TypefFuel Type
Distribution
Type
Number
in System
Rated
Input'
(kw or
Btu/hr)
Tank
Capacity
ions
Energy
Factor or
Thermal
Efficiency
Standby
Loss %
Tank
External
Insulation
R -Value
System serving multiple dwelling units
Water Heater
Type
Distribution"
Type
Number
in System
Rated
Input'
(kW or
Btuty)
Tank
Tank
Capacity
(gAltons)
Energy
Factor or
Thermal
Efficiency
Standby
Loss %
Tank
External
Insulation
R -Value
1. For small gas storage water heaters (rated inputs of less than or equal to 75,000 BuAr), electric resistance, and heat
pump water heaters, list Energy Factor. For large gas storage water heaters (tested 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 3/a
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
F0'r - 10/12/2004 TUE 9:53 FAX 760 777 7112 Bldg & Saftev
@001/001
Total Permit Fees
Bin #
City of La Quints
Building gr Safety Division
Permit #P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application, and Tracking Sheet
Project Address: . 6d09z)--C—/ Owner's Name:.
A. P. Number: Addre:.-:
Legal Description: City, ST, Zip:
ContracUir: Telephone: !
Address:ZCIO" Project Description: L-�Z�2 ee (M-11? L,9
City, ST, Zip: ane)
Telephone:
R
State Lic, 9: City -Li..
Arch., Ergr., Designer:
Address:
City, ST, Zip:
Telephone:
Stale Lie.
Construction Type: Occupancy:
Project typt (circle one)- New Add'n Alter Repair Demo
Nallic, of Contact Pc"on: Sq. Ft.:
# Stories:
4 Unit::
Telephone# of Contact Person: Estimated Value of Project Mt9- cc
APPLICANT DO NOT WRITE BELOW THIS LINE
fi Submittal Req -d Reed TRACKING PEPUN1117 r FEES
Plan Sets
Plan Check submitted
Item
Amouns.
Stractural Cates.
Reviewed, ready for corrections
Plan Check Deposit
Tress Cates.
Called Contact Person
Plan Check Balance
Tide 24 Coles.
Plans picked up
Construction
Mood plain plan
Plans resubmitted
Mechanical
Grading plan
22' Review, ready ror correctionvissue
Electrical
Sullcontactor List
Calltd Contact Person
Plumbing
GranrDeed
Plans Picked up
S. M. 1.
II.O.A. Approval
Plans resubmitted
Grading
HOUSE;-
Review, ready for correcdonstissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees