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11-0372 (MECH)
P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: L1.1-00"0-00372 Property Address: 55457 OAK HILL APN: 7757161-025- - - Application description: MECHANICAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 4000 Applicant: Architect or Engineer: LICENSED CONTRACTOR'S DECLARATION BUILDING & SAFETY DEPARTMENT BUILDING PERMIT I hereby affirm under penalty of perjurythat `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:C6is': -C20 ' ' � "-' License No.-.- 619091 DaleY� Contractor: ' " '- OWNER -BUILDER DECLARATION. I hereby affirm.under.penalty of perjury that I am exempt -from ihe�Contractor's.State LicenseLaw•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 pursuahtto,the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section,7000),of Division 3.of the.Busmess and Professions Code) or that he or she -is exempt therefrom and the basis forthe alleged. exemption. Any violation oFSection 7031.5 by any applicant for a permit subjects the applicant to a civil.penalty of not more than five hundred. dollars ($500).: 1 _ 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, Businessand.Profesiions"Code: The _.Contractors' State License'Law does not apply.to an owner, of property wsho builds or improvethereon, and who does the work himself ortierself through his or her own-employees,'provided that the' improvements arenofintended or0ffered for sale. If, however, the building or-improvemehtis 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 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.). (_ 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: GARY DOLENGA 55457 OAK HILL LA QUINTA, CA 92253 (760)564-4794 Contractor: PALOMA AIR COND PO BOX 35.01 PALM DESERT., CA (760)347-1212 .,Lic. No.: 6190.911 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 l101�T�db. Date: 4/13/11 . 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 oy°Section 3700 of the Labor Code, for the performance of. the work for which this permit is issued s *, - - _ I have and Will 'maintain workers' compensation msuiance,:as required by Section 3700 of the Labor Code; for !he performance of the work for which this permit is issued.*- My workers' compensation' insurance carrier and policy number are: - Carrier SOUTHERN INS CO Policy Number WSIO02303402 _.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 agiee that, if I should become subject to the workers' compensation provisions of Section 377000 of1 Labor Code, I shall forthwith comply. with those'provisions. _ Da e: til ✓-.canter#. WARNING: FAILURETOSECURE 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 onthisapplication. 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 �6r 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 county toeer upon above-mentioned prop for in ion purposes _ 71 - Application Number . . . . . 11-00000372 Permit . . . MECHANICAL Additional desc . Permit Fee . . . . 40.50 Plan Check Fee 10.13 Issue Date Valuation . . . . 0 " Expiration Date 10/10/11 Qty Unit Charge Per Extension BASE FEE. 15.00 1.0.0 9.0000 EA MECH:FURNACE <=100K 9.00 1.00 16.5000 EA MECH.B/C >.3-15HP/5100K-560KBTU "16.50-:•, --_ --- ------------------------------------------------------------------- z Special_Notes and:Comments REPLACE,HVAC A/C UNIT 4 TON. 17 SEER.'. . ---------------- ----------- ----------------- -------- ' ------ Other Fees . . . . BLDG STDS ADMIN (S131473) 1.00. 'Fee -summary Charged Paid.:. Credited Due �. --------- - ----------_--.------------ ------------------------------ Permit-, Fee Total '40.50 .00 00 40.50 Plan,. Clzeck- Total 10.13 .00 .00 10.13 Other Fee,.Total. .1':00 .00- 00 . 1_-00 Grand Total 51:.63 .00.. .00 51.:63 LQPERMIT Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC CF-lR-ALT-HVAC Alterations Climate Zones 10 - 15 Site Address: Enforcement Agency: Date: Permit #: 55-457 Oakhill La Quinta, CA 92253 City of La Quinta Apr 12, 2011 Duct insulation Conditioned Floor Equipment Type1 List Minimum Efficiency2 requirement Area Thermostat ❑ Package Unit p Furnace p Indoor Coil R AFUE 78% 0 SEER 16.0 ❑ COP ❑ HSPFIf ❑ R 6 PCZ 10-13) R 8 Served by system 1600 sf © Setback not already present, p Condensing Unit [:1 EER ❑ Resistance [I (CZ 14-15) must be installed) ❑ Other 1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF-IR-ALT-HVAC for each system. 2. Minimum Equipment Efficiencies: 13 SEER, 78% AFUE, 7.7HSPF 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-111 and C0411Z shall also be on site for final inspection. 8 1. HVAC Changeout Required Forms: . All HVAC Equipment CF-6R 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 CF-.6.Rforms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS • Indoor Coil and /or CF-4R forms: MECH-21 and (for split systems) MECH-25 • Furnace For Split Systems: Ductaeakage;<15 percent; RC, CCA <_ 300 CFM/ton (Minimum Air Flow Requirement), TMAH For„Packaged Units Duct leakage <Wg 15 percent Exempted from duet leagag6 testing p 1 Duct system was: documented to: have been previously sealed and confirmed through HERS verification, or 2 Duct systems witFi less than40 linear feet in unconditioned space, or c,.t�$1systems are on uedinsulated-orsealed _wit�asliestos ' 3 Existing9 "ducstret .:. ::`%.CN. 441?:r ❑ 2 New HVAC ''k System Regwredtfd� -1,� s ” •Cut in or Changeout� .� with new ducts all ' ;°� (- (�,�- CF 6RYforms MECH 04, MECH 20-HERS and (for"split systems) MECH 22 HERS, and Q E ' > ' MECH 25 HERS ;: 3 Mfg! ' new ducting call GF 4R forms a M 20,xand (for, split systems) MECH 22, and MECH 25 new a ui „meat � § For Split Systems Duct leakage W6�percent tRC; CCA z 350 CFM%ton; FWD; TMAH, STMS; and `either: HSPP or PSPP. For Packaged Units Duct lea kage;x 6 percent Q 3 NewDucts with/nor without NU Required Forms: Replacement , . Includes replacing or insta.l..ling ally . new ducting and/or outdoors �s1;: CF-6R forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS condensing unit and/or indoor coil; CF-411 forms: MECH-20 and (for split systems) MECH-25 and/or furnace. No or some ::.<..: equipment changed. For Split Systems: Duct leakage < 6 percent; RC, CCA a 300 CFM/ton, TMAH For Packaged Units: Duct leakage < 6 percent ❑ 4. New Ducting over`40 feet Required Forms: . Includes adding or replacing more CF-611 forms: MECH-04, MECH-2I-HERS than 40 linear feet of duct in CF-4R forms: MECH-21 unconditioned ,space. For split system or packaged units: Duct leakage < 15 percent E] 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: Herman Paredes Company: PALOMA AIR CONDITIONING Date: Apr 12, 2011 Address: P 0 BOX 3501 License: 619091 City/State/Zip: PALM DESERT / CA / 92261 Phone: (760) 347-1212 .91 Reg: 211-A0018192A-00000000-0000 Registration Date/Time: 2011/04/12 19:54:24 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms July 2010 Bin #' 0ty of La - Qu►n ta. Buildtng8i Sa%ty; Ufvfslon P.O. Box 1,504; 78-495 Calle Tampico' 0 Ouinta, CA 92253- (760).777-;7012 Buildin ;PermitTricking g ._ Appkcatlon and . Sheet { Permit # 3'w �1 Project Address: �� r I : ,, Owner's Name: A. P. Number: Address: S Q t Legal Description: .City, ST, Zip: Contractor: :,Telephone: 4 �j. / <;«;;..<?::?;:.?:<:?.::::...•?::,:::::;::k:: :r.;4z:<:>:>:<-:' Address: Project Description: City, ST, Zip: 1. S State.Lic. # :City.Lic. #< Arch., Engr., Designer: Address: City, ST, Zip: Telephone: ;v;?�>;w::;. .;:. ::� w;�•?:>:;:<.:. �;::..a.::•::«t`�.4:.,.h.�•;.? 'ry`A�tc.•4 State Lic. #: v;'>'?::._:.:;,:.•`.;^<}.�i%n}< `:r%yY•S:?.,, s,,.. Name of Contact Person; ConstructionrType: Occupancy• ' s I Project type (circle, one): New. Add'n . Alt Repair Demo Sq' Ft.: #Stories:. #Units: Telephone # of Contact Person: Estimated Value of Project: APPLICANT; DO';NOT WRITE BELOW THIS LINE. . # Submittal Req'd Rec'd., TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready-tor corrections' Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Title 24 Calcs. Plans picked up . •Construction Flood plain plan Plans resubmitted Mechanical Grading plan tad Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person, Plpmbing Grant Deed Plans picked up S.M.I. H.O.A. Approval :Plans resubmitted :Grading. IN HOUSE:- ''a Review, ready for correctionsAssue Developer Impact Fee Planning Approval Called Contact.Person Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees