11-1322 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
BUILDING. PERMIT
Application Number:
x11-0000'13'27
Property Address:
5158701, - "I'K HTL
APN:
775-231-026- - -
Application description:
MECHANICAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
6000
Architect•or Engineer:
ata.
i CO RACTOR'S DECLARATION
I hereby affirm under penalty of perjury3Katlam Lc ed'under provisions of Chapter 9 (comm agrovifh--
Section 70 0) of Division 3 of.the Bus'6ess'and ofessionals Code, and my. Licen' ' ' force and effect..
License
lCl ns:- C20 License.No.• 3
ate..I ` 1" • 1( ontractor:
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 Ism 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 provisionsof. 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'Is500).:
I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
the structure isnot 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 of
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 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions, Code: The, Contractois',State_License Law,does not apply town -.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:
MCALLISTER THOMAS/BARBARA
19301 CALADERO ST
TARZANA, CA 91356
Contractor:
AIR EXPERTS .AIR
PO BOX 94..
VOICE (760) 777-7012
FAX.(760) 777-7011
INSPECTIONS (760) 777-7153
Date: 12/12/11
CONDITIONG-
LA QUINTA, CA 92247
(760)777-1724.
'LiC. No.: 725283
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.
V,I have and will maintain workers' compensation insurance, as.requiredby Section 3700 of the Labor
Code, for the performance of the work for which this permit is issued. My workers' compensation
insurancecarrievand policy number are:
Carrier GUARD INS GROUP Poli PAWC226751
I certify that, in the. performance c e work for w ch this permit is issued, I shall not employ any
person in any manner so as become sub' to the workers', compensation lawsof California,
and agree that, if should ecome sub' to the workers' compensation provisions of Section
00 of the Labor Code, shall fo ith comply with those provisions.
16ate;
WARNIN : F ILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL; AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND- .
DOLLARS ($100,006)• 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 fonh'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, orfollowing 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 ofissuance of se , or ce tion of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that thve infor ton is correct. I agree to comply with all .
city and county ordinances and state laws relating to bur�dingconst tion, and hereby authorize representatives
of this count Nolen er upon the above-mentioned property fror i ction purposes.
DaSE �6/ /�Si re (Applicant -or Agent): 1
Application Number . . . . . 11-00001322
Permit . .
. MECHANICAL
Additional desc .
.
Permit Fee . . .
. 40.50
Plan Check Fee
10.13
Issue Date . . .
.
Valuation
0
Expiration Date
6/09/12
Qty Unit Charge Per
Extension
BASE
FEE
15.00
1.00 9.0000 EA MECH
FURNACE <=100K
9.00
1.00 16.5000 EA MECH
B/C >3-15HP/>100K-500KBTU
16:50
----------------------------------------------------------------------------
Special Notes and
Comments
REPLACE (1) 4 TON
PACKAGE SYSTEM.
2010
CODES.
----------------------------------------------------------------------------
Other Fees .. . .
. . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary
-----------------
Charged
--------------------
Paid Credited
--------------------
Due
Permit Fee Total
40.50
.00 .00
40.50
Plan Check 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 Alterations CF-iR-ALT-HVAC
Climate Zones -10 - 15
Site Address:
Enforcement Agency:
Date:
Permit #:
55-801 Oakhill La Quinta, CA 92253
City of La Quinta
Dec 12, 2011
Duct insulation
Conditioned Floor
Equipment Type1
List Minimum Efficiency2
requirement
Area
Thermostat
V Package Unit
Furnace
Indoor Coil
v AFUE 80%
V SEER 15.0
COP
HSPF
R 6 (CZ 10-13)
Served sf system
V Setback
If not already present, must be
Condensing Unit
EER
Resistance
R 8 (CZ i4-15)
1600
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, 78010 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 CF -6R shall also be on site for final inspection.
1. HVAC Changeout
Required Forms:
. All HVAC Equipment
CF -611 forms: MECH-04, MECH-2I-HERS ,Fid (for split ......t,.ms) 04EGH 2544EA
replaced
CF -4R forms: MECH-21 and (for splili systems) PilriGH L&
. Condenser Coil and /or
CF -6R forms: MECH-04, MECH-2I-HERS and (�er split ,-,,,-t,.ms) 04EGN 25 14ERS
. Indoor Coil and /or
CF -411 forms: MECH-21 and (fa- split ..,,..t,,ms) NEGH_2
. Furnace
For Packaged Units: Duct leakage < 15 percent
Exempted from duct leakage testin'g.if:
1. Duct system was documented to have been previously sealed and confirmed through HERS verification, or
2. Duct systems with less than 40 linear feet in unconditioned space, or
3. Existing duct systems are 'constructed, insulated or sealed with asbestos
4. The.systiem-,will not be Ducted'(ie.+Ductless�,Mim=S lit.System)-(Also Exempt sfromzRefrigetari! Charge)
e s.,--. P - k-,..
2. New HVAC System
Required Forms: f.+ ,^� `i' _"•. �'
. Cut in4or Changeout withi •
new ducts: (all new
"' ' ; sr
CF 6R forms MECH-04, MECH=20 HERS, and (for split systems) MECH=22-HERS, and
ducting and all new
MECH125!HER5 t^ - *'-•
CF -4R forms-.- MECH 20, and (for splrtsystems) MECH=22, MECH-25
equipment)
and
il
U0
For Split Systems: Duct leakage'<'.6 percent;, RC,` CCA 2:350., CFM/to.n,"FWD; TMAH;"SIMS, and either HSPP or PSPP.
For Packaged Units: Duct leakage< 6'percent
3. New Ducts with/or without"
Required Forms:
Replacement
. Includes replacing or installing all new
ducting and/or outdoor condensing unit
CF -611 forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS
and/or indoor coil and/or furnace. No or some
CF -411 forms: MECH-20 and (for split systems) MECH-25
equipment changed.
For Split Systems: Duct leakage < 6 percent; RC, CCA >_ 300 CFM/ton, TMAH
For Packaged Units: Dud leakage < 6 percent
4. New Ducting over 40 feet
Required Forms:
. Includes adding or replacing more than 40
CF -61k forms: MECH-04, MECH-2I-HERS
linear feet of dud in unconditioned space.
CF -411 forms: MECH-21
For split system or packaged units: Dud 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: Paul Van Vlymen Signature: Paul Van Vlymen
Company: AIR EXPERTS AIR CONDITIONING -HEATING Date: Dec 12, 2011
Address: PO BOX 94 License: 725283
City/State/Zip: LA QUINTA / CA / 92247-0094 Phone: (760) 777-1724
Reg: 211-AO06427OA-00000000-0000 Registration Date/Time: 2011/12/12 11:53:39 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms July 2010
Bin #
City O� Q[lifl ta
ti ..
Building 8r Safety. Divislon
P.O. Box 1504, 76-495-Calle Tampico
La Qulnfa, CA 92253 - (760) 777-70:12
Bu►Iding Petmlt Application: and -Tracking Sheet
Permit #'
lt' 13
Project Address: l 66k l
-Owner's Name: 42U7.S /
A. P. Number:
Address: S _ QA
Legal Description:
Contractor. � E�C� . ..
City, ST, Zip: Q.�f,n�`i14 �ZZJ
Telephone:
Address:. F6 ZdX
Project Description:
n
City, ST, Zip: zk 97-Zy- 7
�i4 G ON3 C. 7Z ,J.
Telephone: -760 -7%7 % Z
City Lic` #:
State Lic. # : Z
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:3s5>s
<. >': s' , :
scr<'>•``i>�
:,::;<:t<:.r.:t�.:•
Construction Type: Occupancy:
State Lic: #:
roJ type(circle one) New Add'n Alter Repair Demo
Name of Contact Person:
.Sq. Ft. / G.orj
#'Stories:
# Units.
Telephone # of Contact Person:.
Estimated Value of Project: Odd
APPLICANT: DO NOT WRITE,BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Checksubmitted;
Item Amount
Structural Calcs.
Reviewed,•ready for cormetions
Plan Check Deposit
Truss Calcs.
`'CalledContact Person
Plan Check Balance
Title 24 Calcs.
Plans picked aP :• . •
Coastraction
Flood plain plan
Plans resubmitted..
Mechanical
Grading plan
2"' Review, ready for correctionstiissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked.up
S.M.I.
HOA. Approval
s
Plans resubmitted
Grading
IN HOUSE:-
''' Review, ready for correctionsrmue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees