12-0512 (MECH)P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QU`INTA, CALIFORNIA 92253 BUILDING &.SAFETY DEPARTMENT INSPECTIONS (760) 7.77-7153
BUILDING PERMIT
Date: 5/08/12•
Application Number: 12-00000512 Owner:
Property. Address: 54.157 OAK HILL '" CHERRYL SUMMAR
APN: 775-061-020- - - 54157 OAK HILL D
Application description: MECHANICAL LA.QUINTA,. CA 92253
Property Zoning: LOW••DENSITY, RESIDENTIAL ppi�pp
Application valuation: 600.0 l'lii 0 8 1011
-� Contractor: CITY OFCA
Engineer: PALOMA AIR CONDITIONING QUINTA
Applicant: Architect or En
9 FINANCE DEPT
P 'O. BOX 3501
PALM,.DESERT,• CA ..92261
z -(760) 347.-1212
IdC..:No.: 619091
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• \ CISED CONTRACTOR'S DECLA ION~ WORKER'S COMPENSATION DECLARATION
Iherebyaffirm under,penalt of perjury3hat I am licensed undeG-provisi .Chapter 9 (commencing with I hereby affirm under penalty of perjury one of -the following declarations -
Section 7000) of Divis%pn.3 f the Business and Professionals Co , nd my,License-is in full force and effect. _ I have and will maintain a certifica4e:of consent to self -insure -for workers compensation, as provided
'Lice Class: - - - �'�' ' nse No.:. 619091 • t•- for by Seaion3700'of.the Labor Code, for the performance of the work for which.thispermif is
3.}, 4 f• .. �.:F .. Issued. <
ate Y tractor: IL I have and will maintain workers'compensation insurance; as required by.Section 3700'of the Laboi'
Code forthe performance of "the work'for which thispermrt is issued. My workers' compensation
„`� K •' OWNER:BUILDER DECLARATION r .insurance.carrier and-policynumber are: -
I.
her affirm under penalty of_ perjury that I amexemptfromtheContractor's State LicenseLaw.for the • - Carrier EVEREST NATL. - Policy*Number' " 7600007550111
following reason'ISec,7031.5i BusinessandProfessions Code:Any'city or.county that requires a permit to _ I certify that,io-the performance of the work for which this permit is'issued, (shall`not employ any ..
co r6 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 workers'-compensation'lawsof California,
permit to file a signed statement that he'or she is,licensed pursuant to the•provisions-of'tlie Contractor's State - antl agree th „ 4'sfiould-become subject'to the workers'.compensation-provisions of;Section `
License'Law (Chat t6,4 (commencing with•Section 7000) of Division 3 of th6'Business and Professions Code) or . 37 ythe�abor Code, 1 shall forfhwith'com rovisions:
that he or she isexempt.theiefroin and:the ltiasis for the.alleged exemption.'v Any'AcIation'of Section 7031.5 by '
. ..
•any applicant fora permit subjectsthe.applicant io a civil penalty "of not, than five hundred dollars"(5500)•: te: A cant:
f _ 1 I,. as owner. of:theproperty,-or my employees. with wages astheir sole compensation; will do the work, and - - i • • :
_ • the structure is not intended oroffered,for,sale (S66'7044, Business and Professions -Code: The WARNING:. FAILpJpE TO SECURE WORKERS'. COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractoys' State License Law doesnof apply to an owner oipropeity who,liuilds or•improves thereon, SUBJECT AN EMPLOYER "TO CRIMINAL•PENALiIES AND:CIVIL FINES UP TO ONE HUNDRED THOUSAND
4:.
and 'who does thework 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 notbuild or
improve forthe purpose of'sale.lAPPLICANT 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 restrictiory*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 performe8-under or pursuant to any permit issued as a result of this application,
(_ 1 I am exempt under Sec.,B.&P.C. for this reason the owner, and the applicant, each agrees to, and shall defend, indemnity andhold harmless the City
y
of La Quinta, its officers, agents and employees for anact or omission related to the work being
. - performed under or following:issuance of.thispermit.
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 cancellatio ••�� "
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify that I have read �h. i pp�catteaand state that the above information is correct. I agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.). _ city and county ordinFes and state laws relating to building construction, and hereby authorize representativ ,.....
of this cot pori the above-mentioned property for inspection purpose
Lender's Name:
e: S' atwe (Applicant or Age
Lender's Address: -
16 PC
LQPERMIT
Application Number . . . 12-00000512
Permit . . . MECHANICAL
Additional desc .
Permit Fee 40.50 Plan Check Fee 10.13
Issue Date . . Valuation . . . . 0
Expiration Date 11/04/12
Qty Unit Charge Per Extension
BASE.,FEE 15.00
1.00 9.0000' EA. MECH'FORNACE <=100K. 9.00
1.00. 16.5000.EA MECH 13/C,>3-15HP/>100K=500KBTU 16.50
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`Special. Notes d -an'Comments
HVAC. ;GRANGE=OUT..'REPLACE'.' SPLIT 'SYSTEM,
FURNACE -,,COIL, CONDENSER. 2010' CODES:,
-9- - - - - - - - - ----------- -
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Otfier:Fees =BLDG STDS;ADMIN (SB1473) 1.0.0
Fee summary_ :Charged -.Paid Credited Due
Permit - Fee .Total 4,0.50 ".'0 0 00 40..50
-vi=:n'rl,of� -ti 1 1n'1'a no nn in,1-4'
LQPERMIT
•r
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-IR-ALT-HVAC
Climate Zones 10 - 15
Site Address:
Enforcement Agency:
Date:
Permit #:
54-157 OAKHILL La Quinta, CA 92253
City of La Quint'
Apr 19, 2012
Duct insulation
Conditioned Floor
Equipment Typel
List Minimum Efficiency2
requirement
Area
Thermostat
❑ Package Unit
p Furnace
Indoor Coil.
10 AFUE 78%
SEER
❑ COP
HSPF
❑ R 6 (CZ 10-13)
Served by system
® Setback
p
13 13.0
❑
R g CZ 14-15)EER
(
1900 sf
If not already present, must be
0 Condensing Unit
[I EER
❑ Resistance
installed)
❑ Other
1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF-IR-ALT-HVAC for each system.
Z. Minimum Equipment Efficiencies: 13 SEER, 78% AFUE, Z7HSPF for typical residential systems.
HERS VERIFICATION SUMMARY Listed below are FOUR HVAC alteration Options. The installer decides what work is being done
and picks one of the appropriate Options. Each Option lists the HERS measures that must be conducted. A copy of the forms shall
be left on site for final inspection and a copy given to the homeowner. At final, the inspector verifies that the work listed on this
form was in fact the work completed by the installer. The inspector also verifies that each appropriate CF-611 and registered CF-4R
forms (no hand. filled CF-4Rs allowed) are filled out and signed.Beginning October 1, 2010, a registered copy of the CF-1111
and CF-6111 shall also be on site for final inspection.
D 1. HVAC Changeout
Required Forms:
. All HVAC Equipment
CF-611 forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS
replaced
CF-411 forms: MECH-21 and (for split systems) MECH-25
. Condenser Coil and /or
. Indoor Coil and /or
CF-611 forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS
. Furnace
CF=4. forms: MECH-21 and (for split systems) MECH-25
For Split Systems: Duct leakage.,< 01:5:1 percent; RC, CCA 5 300 CFM/ton (Minimum Air Flow Requirement), TMAH
^
For- Packaged I In"
Exempte.d:from,.duct.leakagertest :
ng if`:
1 Duct sy... ...as documented Io have been previously sealed and confirmed through HERS verification, or
❑ 2 Duet systems With: ess tha0linear feet in unconditioned space, or
p 3 Existing duct systems are constructed,. insulated or sealed with asbestos
4 The ystem will not be Ducted (ie uuctlessxMini-S 'l' Sys tem)-(AlsogExempt from,Refrigerant Charge)
-. ...�3Ws:RY.t. .. vi: i..f L9dX` "'".XVfY2PxiLPKY ....
❑ 2.:N
Requi're"d Forms �Il� x
. Cut in'oRChan eout with
Mr 9
new ducts (all new
, :
CF6R forms 'MECH 04 MECH 20 HERS, and or spilt systems) MECH-2HERS, and
ME(H 25 HERS.
ductingMall new. w
-,2
eCF 4R forms MMM11 20 and (for split systems) MECH 22 and MECH Ni:i:i:i:�i:'��.—.
',
equipment)
.
c's �; .; • _3.3?i:
WIR
For S lit 5 stems Duct leak'
P ywxr g
Duct
e z96" ercent RC CCA,; 5 JCFM/ton, FWD TMAH SIMS and either HSPP or-PSFP:'m ""k
�gp ham' xmaxv3 .:,� ..
leakage 6
For Packaged Urnts
< asp,. percent ..
❑ 3 New Ducts',with/or without`
Required Forms:
Repla ement „ % :.
.Includes r.:eplacing or installing all�new
ducting and/or outdoor condensing unit
CF-6R forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS
and/or indoor coil and/or;fyrnaceN'o or some
CF-4R forms: MECH-20 and (for split systems) MECH-25
equipment changed. c':;;::
For Split Systems: Duct leakage':z>6' percent; RC, CCA >_ 300 CFM/ton, TMAH
For Packaged Units: Duct leakage < 6 percent
❑ 4. New Ducting over 40 feet
Required Forms:
. Includes adding or replacing more than 40
CF-6R forms: MECH-04, MECH-21-HERS
linear feet of duct in unconditioned space.
CF-4R forms: MECH-21
For split system or packaged units: Duct leakage < 15 percent
❑ EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos.
Contractor (Documentation Author's /Responsible Designer's Declaration Statement)
• I certify that this Certificate of Compliance documentation is accurate and complete.
• I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this Certificate of
Compliance.
• I certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the
requirements of Title 24, Parts 1 and 6 of the California Code of Regulations.
• The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable compliance
forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with the permit application.
Name: Herman Paredes Signature: Hermnn Paredes
Company: PALOMA AIR CONDITIONING Date: Apr 19, 2012
Address: P 0 BOX 3501 License: 619091
City/State/Zip: PALM DESERT/ CA/ 92261 Phone: (760) 347-1212
Reg: 212-A0019499A-00000000-0000 Registration Date/Time: 2012/04/19 14:51:47 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms July 2010
Bin. #
'
..
Cry! of La Qurnta�,
., Btitlding 8t Safety Division .
P.O r6tix' 1504; :78-495 Cai(e Tampico .
La::Quinta; (A-92210 (760} 777-7012
Building Per1nrt:Applicatron-and Tracking.5heet
Permit # �`
1�
Project Address:�. G_ / ''.:
Ownu'siName . "` (rl `P. Y V ; ' l S c/ U4144,
A. P. Number.
'Address: 1 ��
Legal Description:
,City, ST, Zip: L .
Contractor. U 1 pp W A A /
Telephone: 76`0
Address: ®. ,.Q
ProjectDescriptiorir/^��
City, ST, Zip: P /
U.
Telephone:
U V Q kA.Le.1
State Lie. #: ( city Lic !E;
Arcs., Engr., Designer
Address:
City., ST, Zip:
Telephone: 7
State Lic. #: ;. ^�.,:
. �i sa`r6
Construction Type., Occupancy:
,Project type (cirele•one): kNew Add'n Alter. Repair. Demo
."Sq.. Et: #Stories:' # Unity
, „r
Name of Contact Person:
.Telephone # of Contact Person:
��Estimated Value of,Projeet: 6 000
APPLICANT: DO:NOT;WR[TE:BELOW THIS UNE `
#
Submittal
R.
P-ed.:' .
TRACKING ::.
PERMIT FEES
Plan Sets
Plan Check submitted
Item, Amount
Structural Coles
Reviewed, ready for corrections
Plan Check Deposit, .
Truss Coles.
Called Contact Person
Play Check Bal aace _
Title 24 Cates.Plans
picked up
Cons"cdou
Hood plata plan
Plans resub n[tied"
Mectuiriica[:
Grading plan
.2n 'Revlew; ready for correcGonitissue
Electrical
Subcoutactofllst
Called Contact Person
Plus bang
Grant Deed
Plans picked up
ILOA. Approval
Plaais resubmitted-
Gradiug
IN iiOUSE:-.
Review; ready for eorrectionsfissue '•..
Developei.lmpact Fee
Planning Approval "
Cal[4 Contact Person
AJ P.P. '.
Pub: Wks. Appr
'Date of permit Issue .
School Fees
Total Permit Fees