07-1217 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 922.53
7Application Number: 07-00.0.0.1217
Property Address: 54105 OAK HILL
APN: 775-061-032- - -
App.lication description: _ MECHANICAL
Property Zoning:- LOW DENSITY RESIDENTIAL
Application Valuation: 1600 "
Applicant:
Architect or Engineer:
Jik
,wo
BUILDING & SAFETY DEPARTMENT -
BUILDING. -PERMIT
Owner:
JACOBSON RESIDENCE
54-105 OAK HILL
LA QUINTA, CA 92253
(7;60)564-7353
Contractor:
PALOMA"AIR CONDITIONING
P.O. BOX 3501
PALM DESERT, CA 92261
(760)347-1212
Lit. N&-': .619091'
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760).777-7153
Date: 4/20/07..
� o o
i
APR 2 0 2007
COTY OP LA QUINTA
MANOL:dEIP7 .
•� LICENSED CONTRACTOR'S DECLARATION
- -----------------------—
WORKER'S COMPENSATION DECLARATION
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.
- 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
Licens�e/;s ': C20Licens No.: 6T9091
_
for by Section 3700 of theLabor Code, for,the performance of the work for which this permit is
-
issued.7,pContracto,
_ I have and will maintain workers' compensation insurance, as required,by Section 3700 of the Labor -
Code, for theperformance of the work for which this permit is issued. My workers' compensation
OWNER-BUILDE DECLARATION
insurance carrier and policy number are: -
I hereby affirm under penalty of perjury that I am exempt from the Contractor'sState.License Law for the
Carrier ENDURANCE WRKR . Policy Number WEN000141801
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 a signed statement that.he or sheds 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 (Chap4rr'g (commencing With Section 70001 of -Division 3 of the Business and Professions Code) or
700 of the Labor Code, I shall forthwith comp) with those provisions..',
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 civil "penalty of not more than. five hundred dollars ($500).:.
�".� a—t r Applicant:
1 _ 1 I, as owner of,the property, or my employees with,wages,as theirsole compensation Wali do�the,work, and
,the structure isnot intended or offered for sale(Sec:-7044;:Busi' ss -and Professions Code:.,The
WARN NG: FAILURE TO SECUREWORKERS'pCOMPENSATION'COVERAGE IS UNLAWFUQ!AND SHALL
Contractors' State:License Law does not apply to an owner of property wtio builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND. CIVIL FINES UP TO ONE .HUNDRED THOUSAND
- and: wtio does the:work himself or herself through his or her ow`n employees, provided that the
'DOLLARS (5100,000). IN ADDITION TO.TH .,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
(_ 1 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(sr 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
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
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
of La Ouinta, 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 l 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 to enter upon the above-mentioned property for ' ction purposes.
�,,� �I /r 7, �%
Application Number
Permit . . . MECHANICAL
Additional desc . .
Permit Fee . . . . 33.00
Issue Date . . . .
Expiration Date . . 10/17/07
Qty Unit Charge Per
07-00001217
Plan Check Fee . . 8.25
Valuation . . . . 0
BASE FEE
1.00 9.0000 EA MECH FURNACE <=100K
1.00 9.0000 EA MECH APPL REP/ALT/ADD
Fee summary Charged Paid Credited
-------- - -------- ---------- ---------- ----------
Permit Fee Total 33.00 .00 .00
Plan Check Total 8.25 .00 .00
Grand Total 41.25 .00 .00
LQPERMIT
Extension
15.00
9.00
9.00
Due
33.00
8.25
41.25
• 1 ,' .yes + t
Bi" #
City of U Quihta
Building.ax Safety Division
P:O: 'ox B 1504, 78-495 Calklampico
La Quinta, CA 92253 - (760).:777-7012
�Buiiding Permit Appliption;and Tracking Sheet
,Permit .#
. I�
Project' Address:
Owner's Name: %
A. P. Number:
Address: = p I
Legal Description:
City, ST, Zip: Qc/' �• 6_1 I ZZ
Contractor:
Tele e:
.,phon
Address: — Q 19 K
Project Description:
City, ST, Zip: T1.J �5 2- ZO l
/f
Telephone: 7Co6 3`{7 12(Z
State Lic. # : Q
City Lic'.#:,
�Arch.,.Engr., Designer:
-
Address:
,
City, ST, Zip:
t
_
Telephone:
Construction Type: Occupancy:
State Lic. #:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: �� ! M a ti S ;,
Sq. Ft.:
#Stories: T#
Units:
Telephone # of Contact Person:– (Z j
Estimated Value of Project:t J, 6,Q0,Q
�. .� A4
• -APPLICANT-;DO'NOTrWRITE BELOW'�THIS LINE GCA
#
Submittal;,
-,Req'd .
s: Recd
TRACKING .
PERMIT FEES
Plan Sets no
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
' .
Plan Check Deposit .
Truss Calcs.
Called Contact Person"`:
Plan Check Balance
Energy Calcs.
t
Plans picked up
Construction
Flood plain plan
Plans resubmitted
MIP
Mechanical i/�-
T
Grading plan
2°" Review, ready for correctionsfissue
Electrical
r
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading,
IN HOUSE:-
''" Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A:I.P.P.
Pub. Wks. Appr
Date. of permit issue '
School Fees
Total Permit Fees
CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 1 of 5) CF -1R
Project Title
Date
Building Permit # ` s ::
Roof Radiant
Barrier
Installed
Yes or No
Location
Comments
(attic, garage,
ical etc.
Project Address
La k
Plan Check°;
k
z�
a.a
Documentation Author
Telephone'
67W) �j(oY —7
Field,Check T Date €k �'
-?�-
,,
Compliance Method (Prescriptive)
Climate Zone
Enforcement A enc ,Use Onl rte `
✓ ❑ Alternative Component Package Method: (check one) C D D (Alternative)
Package C and Package D choices require HERS rater field verification and/or diagnostic testing (see CF -1R page 3)
For Package D Alternative see Appendix B Table 151-C Footnotes 7-14
GENERAL INFORMATION
Total Conditioned Floor Area (CFA) ft
Average Ceiling Height: ft
Maximum Allowed West Facing Fenestration Products Per Table 151-B or 151-C ---- (5% X CFA)
Maximum Allowed Total Fenestration Products Per Table 151-B or 151-C ----(20% X CFA)
ftZ
ft
✓ ❑ Building Type: (check one or more) Single Family Multifamily Addition Alteration
(If adding fenestration fill out WS -4R, Fenestration Maximum Allowed Area Worksheet and see Section 8.3.2
for Additions and 8.3.3 for Alterations.)
Number of Stories: Number of Dwelling Units:
Floor Construction Type: Slab/Raised Floor (circle one or both)
Front Orientation: North / South / East / West / All Orientations (input front orientation in degrees from True North
and circle one).
✓ ❑ RADIANT BARRIER (required in climate zones 2, 4, 8-15)
OPAQUE SURFACES INCLUDING OPAQUE DOORS
Component
Type (Wall,
Roof, Floor,
Slab Edge,
Doors)
Frame
Type Cavity
(Wood or Insulation
Metal) R -Value
Assembly U -
factor (for wood,
Continuous metal frame and
Insulation mass
R -Value assemblies)'
Joint
Appendix
IV
Reference
Roof Radiant
Barrier
Installed
Yes or No
Location
Comments
(attic, garage,
ical etc.
1) See Joint Appendix IV in Section IV.2, IV.3 and IVA, which is the basis for the U -factor criterion. U -factors can not exceed
prescriptive value to show equivalence to R -values.
Residential Compliance Forms April 2005
CERTIFICATE -OF COMPLIANCE RESIDENTIAL (Page 2 of 5) CF -1R
Project Title Date
FENESTRATION PRODUCTS — U -FACTOR AND SHGC
✓ ❑ FENESTRATION MAXDAUM ALLOWED AREA WORKSHEET WS -4R —must be included for New
Construction, Additions and Alterations.
Fenestration
#/Type/Pos. Orien-
(Front, Left, tation,
Rear, Right, N, S, E, Area U -factor SHGC
S li t) W'(ft) U-factorz Source' SHGC" Sources
Exterior
Shading/Overhangsb'
✓ box if WS -3R is
included
Duct Thermostat Configuration
R -Value T (split or package)
13
13
I R J
11
13
1) Skylights are now included in West -facing fenestration area if the skylights are tilted to the west or tilted in any
direction when the pitch is less than 1:12. See §151(f)3C and in Section 3.2.3 of the Residential Manual
2) Enter values in this column are either NFRC Rated value or from Standards default Table I I6A.
3) Indicate source either from NFRC or Table I I6A,
4) Enter values in this column from NFRC or from Standards Default Table 116B or adjusted SHGC from WS -3R.
5) Indicate source either from NFRC or Table 116B.
6) Shading Devices are defined in Table 3-3 in the Residential Manual and see WS -311 to calculate Exterior Shading
devices.
7) See Section 3.2.4 in the Residential Manual.
HVAC SYSTEMS
Heating Equipment Minimum Distribution
Type and Capacity Efficiency Type and Location Duct or Piping Thermostat Configuration
furnace heat pump, boiler, etc. AFUE or HSPF ducts, attic etc. R Value Type (T1 or package)
Fa r /l-
Cooling Equipment
Type and Capacity
(A/C, heat pump, evap.
cooling)
Minimum
Efficiency Duct Location
SEER or EER attic, etc.
Duct Thermostat Configuration
R -Value T (split or package)
tC—
I R J
Residential Compliance Forms April 2005
CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 3 of 5) CF -1R
Project Title Date
SEALED DUCTS and TXVs (or Alternative Measures)
A signed CF4R Form must be provided to the building department for each home for which the following. are
required.
❑
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)
Tank
Capacity
ions
Installer testing and certification and HERS Rater field verification required.)
❑
Refrigerant Charge (climate zones 2 and 8-15 only) (Installer testing and certification and HERS Rater field
verification required.)
OR
❑ Alternative to Sealed Ducts and Refrigerant Charge /TXVs (See Package D Alternative Package Features for
Project 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.
WATER HEATING SYSTEMS
FT__—I
Systems serving single dwelling units
Water Heater
Type/Fuel Type
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
Tank
Capacity
ions
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
Type
Number
in System
Rated
Input I
or
Bcu/hr
Tank
Capacity
ions
Energy
Factor' or
Thermal
Efficienc
Standby'
Loss %
Tank
External
Insulation
R -Value
System serving multiple dwelling units
Water Heater
Type
Distribution
Tvne
Number
in System
Rated
utl
(W or
Bwft)
Tank
Capacity
(galIons
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 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 0) 2
B.
Residential Compliance Forms April 2005
CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 4 of 5) CF -1R
Project Title Date
SPECIAL FEATURES NOT REQUIRING HERS VERIFICATION (add extra sheets if necessary)
Indicate which special features are part of this project. The list below represents special features relevant to the Prescriptive
and Performance Method.
✓
Feature
Required Forms if applicable
Descri tion
❑
Metal Framed Walls
CF-IR
CF -6R part 6 of 12
Barriers❑ Radiant Barriers
CF -1R
13
Exterior Shades
WS -4R
N/A; Performance Calculation
❑
Cool Roof
Required. Attach CRRC Label to
Forms.
❑
Dedicated Hydronic Heating
Performance Calculation
System
Required; Attach Run to Forms.
❑
Combined Hydronic System
Performance Calculation
Required; Attach Run to Forms.
❑
Gas Cooling
N/A; Performance Calculation
Required.
❑
1 Buried Ducts
N/A; Indicate on building plans.
❑
Kitchen Pipe Insulation
See Section 5.6.2 Distribution
Systems in Residential Manual.
Multiple Water Heaters Per
See Table 5-13 or use
❑
Dwelling Unit
Performance Calculation and
attach Run to Forms.
❑
Central Water Heating System
Performance Calculation and
Serving Multiple Dwellings
attach Run to Forms.
❑
Non-NAECA Large Water
CF -1R
Heater
See Table 5-13 or use
❑
Indirect Water Heater
Performance Calculation and
attach Run to Forms
See Table 5-13 or use
❑
Instantaneous Gas Water Heater
Performance Calculation and
attach Run to Forms
See Table 5-13 or use
❑
Solar Water Heating System
Performance Calculation and
attach Run to Forms
❑
Wood Stove Boiler
Performance Calculation and
attach Run to Forms
SPECIAL FEATURES REOUHUNG HERS RATER VERIFICATION
(add extra sheets if necessary) Indicate to the HERS Rater which credits are nart of this nroiect and need verification
✓ Feature
R uired'Forms if applicable) Description
❑ Duct Sealing
CF -6R part 4 of 12
❑ Refri Brant Charge
CF -6R part 5 of 12
❑ Thermostatic Expansion Valve
CF -6R part 6 of 12
Residential Compliance Forms September 2005
CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 5 of 5) CF -1R -
Project Title I Date
COMPLIANCE STATEMENT
This certificate of compliance lists the building features and specifications needed to comply with Title
24, Parts 1 and 6 of the California Code of Regulations, and the administrative regulations to implement
them. This certificate has been signed by the individual with overall design responsibility. The
undersigned recognizes that compliance using duct design, duct sealing, verification of refrigerant charge
and TXVs, insulation installation quality, and building envelope sealing require installer testing and
certification and field verification by an approved HERS rater.
Designer or Owner (ner Business and Professions Code) Menmentntinn Author
Name:
Name:
Title/Firm:
Title/Firm:
Address:
Address:
Telephone:
Telephone:
License #:
(signature) (date) I
(signature) (date) 71
Enforcement Agency
Residential Compliance Forms April 2005