10-0817 (MECH)T iht 4 4- - Q, ",-
Applicant: Architect r Engineer:
04-
BUILDING & SAFETY DEPARTMENT .
BUILDING PERMIT
Owner:
OSBORN GARY
54374 OAK TREE
LA.QUINTA, CA 92253
(310),880=5353
Contractor:
PALM DESERT AIR:COND
42081 BEACON HILL
PALM'DESERT, CA 92211
(760)346=0677
Lic."No.:.374937 .
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/30/10
AUG 3 0 201D I l l
--------------------------------
-_--------------------
"LICENSED CONTRACTOR'S DECLARATION ".
------
WORKER'S COMPENSATION DECLARATION
P.O. BOX 1504
I hereby affirm under�penalty.of.perjury one of the following:declarations -
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:10"=00;00,0817
for by Section 3700 of the Labor. Code, for the performance of the work for which this permit is "
-
Property Address:
"54374 OAK TREE
APN:
775 -081 -028 -
Application description:
MECHANICAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
8124
T iht 4 4- - Q, ",-
Applicant: Architect r Engineer:
04-
BUILDING & SAFETY DEPARTMENT .
BUILDING PERMIT
Owner:
OSBORN GARY
54374 OAK TREE
LA.QUINTA, CA 92253
(310),880=5353
Contractor:
PALM DESERT AIR:COND
42081 BEACON HILL
PALM'DESERT, CA 92211
(760)346=0677
Lic."No.:.374937 .
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/30/10
AUG 3 0 201D I l l
--------------------------------
-_--------------------
"LICENSED CONTRACTOR'S DECLARATION ".
------
WORKER'S COMPENSATION DECLARATION
Ihereby affirm under penalty of perjury that I am licensed'und.wprovisions of:Chapter 9 (commencing. with
I hereby affirm under�penalty.of.perjury one of the following:declarations -
Sectiom700o) of Division,3 of the Business and Professionals Code, and my License is in full force and.effect.
_ I have and,will maintain a certificate bf:consent to self -insure for workers' compensation, as provided
License Class: C20 License No.: 374937
for by Section 3700 of the Labor. Code, for the performance of the work for which this permit is "
-
��V
issued.-
insurance, by Section 3700 the Labor
r-
1R
Date:"v Contractor:g
I have and will maintain workers' compensation as required of
— i"
Code, for the performance of the work for which this permit is issued. My workers"compensation
OWNER -BUILDER DECLARATION
insurance carrier and policy number are:
' Ihereby affirm under penaltyof perjury that am exempt from the Contractor's State License ;Law for the
Carrier SOUTHERR .INS Policy Number .WSIO03802-01•.
following reason (Sec. 7031.5,Business and Professions Code: Any city or county-that'requires apermit to -
for
_ I certify that,.in the$erformance'of the work for which this permit is issued, I shall not employ any
in,any manner, so as to become subject to the workers' compensation laws of: California,
construct, alter,. improve, demolish, or repair any structure, prior to its issuance, also requires the applicant the
permit to file a sign ed' statement that he or she is licensed pursuant to theprovisions of the Contractor's State
person
and agree that: if -I should becomesubject to the workers' compensation provisions of Section -
License Law (Chapter 9lcommencing withSecuon^70001-ofDivision 3.of.the Business and Professions Code) or
3700 of the Cabot Code, I shall forthwith co y with those provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any'violationof-Section 7031.5 by
penalty. not more than five hundred dollars (5500).: -
,�.�;
`?Date L 3a LI"-CApp1. c a -
any applicant for a permit subjects the applicant to a civil of
(_) I, as owner of the property, or my employees with we their sole compensation, will do the work, and
__.
=" "
-
the structure is not intended or offered for sale (Sec:.7044, Business and Professions Code: The.
WARNING: FAILURE TO SECUREWORKERS' COMPENSATION COVERAGE IS'UNLAWFUL, AND SHALL
Contractors'.State License Law does.not apply -to -an owner of property who builds or improves thereon,
SUBJECT AN. EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP:T.O ONE HUNDRED THOUSAND
and"who does the work 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
improvementrare not intended or offered for sale. If; however, the building or improvement is sold within
SECTION'37Q6 OFTHELABOR 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 - - - - -APPLICANT. ACKNOWLEDGEMENT..
1 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 contractors) 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,
( I 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
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.
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 cancellation.
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 this application and 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 ordinances and state laws relating to building construction, and hereby authorize representatives
-
of this county to enter upon the above-mentioned property for inspection pur/
Lender's Name:
-: / t 1` t -car 'rte. ` `
ZZ -e,- e- Signature lApplicant:or.Agent
Lender's Address:
LQPERMIT
LQPERMIT
Application Number . . . . . 10-00000817
Permit MECHANICAL
Additional desc .
Permit Fee . . . . 49.50
Plan Check Fee
12.38
Issue Date . .
Valuation . . . .
0
Expiration Date 2/26/11
Qty Unit Charge Per
Extension
BASE.
FEE
15.00
1.00 9.0000 EA MECH
FURNACE <=10.OK
9.00
1.00 9.0000:EA MECH
APPL REP'/ALT/ADD.
9:.00
1.00 16.5000. EA MECH
B/C >3-15HP./>100K--500KBTU
1'66.50
-----Special Notes'. and Comments
.l' REPLACE (1,) 4. TON.SPLIT.SYSTEM:&
INDOOR.
"COIL:: 18. SEER. 2007. "CODES.. ..
Other -Fees :,: BLDG, STD§; ADMIN- :(SB14.73)
1.00
' Fee-ksummary- Charged"
----------
Paid. Credited—
---
Due .. - .
------------------------
Permit Fee Total 49.50
..00 .00
:49.5.0
Plan=Check: .Total: 12 .,38' .
: 0.0' 00
12, 38;
. . .
Other Fee.;;Total ' T .,00:
?00: .00. -
1 00
Grand Total '., j "62..88;
00.00.,
LQPERMIT
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVACAIterations CF -IR -ALT -HVAC
Climate Zones 10 to 15
Site Address: 54-374 OAK TREE, LA QUINTA 92253.
Enforcement Agency:
Date: 08/30/2010
Permit #:
Conditioned Floor
Equipment T e'
List Minimum Efficiency 2
Duct insulation requirement
Area
Thermostat
❑ Packaged Unit
• Furnace
O AFUE eo.00%
❑ COP
Over 40 ft of ducts added -or
I7 Setback
• Indoor Coil
EISEER moo
❑ HSPF
replaced in unconditioned space
Served by system
(If not already
17 Condensing Unit
(i] EER 13.00
❑ Resistance
❑ R 6 (CZ 10-13)
sf
present, must be
❑ Other
❑ R 8 (CZ 14-15)
installed)
1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -1 R -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 wasin fact the work completed by the
installer. The inspector also verifies that each appropriate CF -6R 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 -1R and CF4R shall also be on site for final inspection.
1. HVAC Changeout
Required Forms:
• All HVAC Equipment replaced
CF -6R forms: MECH-04, MECH-21-HERS and (for split systems) MECH- 25 -HERS
CF -4R forms: MECH- 21 and fors lits stems MECH-25
• Condenser Coil and/or
• Indoor Coil and /or
CF -6R forms: MECH-2I-HERS and (for split systems) MECH- 25 -HERS
CF -4R forms: MECH- 21 and (for split systems) MECH-25
• Furnace
For Split Systems: Duct leakage < 15 percent; RC, CCA > 300 UNI/ton(Minimum Air Flow Requirement), TMAH
For Packaged Units: Duct leakage < 15 percent
Exempted from duct leakage testing 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. Existingduct systems are constructed, insulated or sealed with asbestos
❑ 2. New HVAC System
Required Forms:
• Cut in or Changeout with new
ducts: (all new ducting and all
CF =6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-HERS
CF -4R forms: MECH'20-, and (for split systems)MECH-22, and MECH 25
new equipment)
For Split Systems: Duct leakage < 6 percent; RC,.CCA >_ 350 CFM/ton, FWD, TMAH, SIMS, and either HSPP or PSPP.
For Packaged Units: Duct leakage < 6 percent
❑ 3. New Ducts with/or without Replacement Required Forms:
• Includes replacing or installing all new ducting CF-611,forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-25-HERS
and/or outdoor condensingunit and/or indoor coil CF -4R 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 2:300 CFM/ton, TMAH
For Packaged Units: Duct leakage < 6 percent
❑ 4. New Ducting over 40 feet
Forms:
'Required
• Includes adding or replacing more than 40
linear feet of duct in unconditioned space.
CF -6R forms: MECH-04, MECH-2I-HERS CF -4R forms: MECH-21
For split system or packaged units: Duct leakage < 15 percent
❑ EXCEPTION: Existing ducts stems 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 I and 6 of the Cal ifomia Code of Regulations.
• The design features identified on this Certificate of Compliance are consistent with the information docume o o plicable compliance forms, worksheets,
calculations plans and specifications submitted to the enforcement agency for approval with the perlii icat'
Name: KARL BROWN
Signature:
Company: PALM DESERT AIR CONDITIONING & HEATING COMPANY
Dat 08/30/2010
Address: 42-081 BEACON HILL
License: 374937
City/State/Zip: PALM DESERT, CA 92211
Phone: (760) 346-0677
2008 Residential Compliance Forms March 2010
91
Bin #
.
Qty of La Quinta
Building &r Safety.` Division
P.O. Box 1504, 78-49.5- 'lie Tampico
La Quinta, CA 92253'= (760) ,777-70,12,
Building, Permit Application and Tracking Sheet
Permit #
Project Address: 54-374 OAK TREE
Owner's Name:' OSBORN, GARY'
A. P. Number:
Address: 54-374 OAK TREE
Legal Description:
City, ST, Zip:. LA Q.UINTA, CA 92253
Contractor: Palm Desert Air Conditioning & Heating.Company,`:
telephone': 310-880=5353
Address: 42081 Beacon Hill
Project Description:
City, ST, Zip: Palm.Desert, CA 92211
PLACE ON E 1 4.0 TON SPLIT
Telephone (760)346-0677
..:::....... .::.__100886�:.,��j:=.,
:SYSTEM.
State Lic. # City.Lic. M. 374937
:
Arch., Engr., Designer:
.
Address:
City., ST, Zip:
�:`> `:•`:•^>< iii;;:;# ��<`'%
Telephone ":.::::>;'>:.:::.:;:<,. ::.:....:.:,::::.::;i
<.•::<:>.ss::'<::;::;;;:>::::<>::>::: >:
.Y:;f:�ji�:i5ii'i:::::;rr.!•', `: �!:Y }:'<;.
State Llc. # :5:>,,,<.><::<;;;:::;»>55>;s:: •::::•:::•: <>.::<:L;.
::..{::;;.:;.;;;;;;:.;,<•;::«,:<.::.i;::.;:::.::.•
Construction -e:
YP Occupancy:
._J.t'. . 1. ..
, Project a circle One
J type ( ). New Add'n Alter Repair Demo
Name of Contact Person: KARL BROWNSq.:Ft.:
# Stories:
# Units:
Telephone # of Contact Person: (760) 34670677.1.
Estimated Value of Project: 8124
APPLICANT: DO':NOT WRITE BELOW THISiINE_y.
#
Submittal
Req'd,,.:
Recd
TRACKING
PERMIT FEES
Plan Sets
.-
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready.,foi,corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
.Plan Check Balance
Tide 24 Calcs.
.-Plans. picked up
;Construction
Flood plain plan
`Plans resubmitted
Mechanical
Grading plan
2-d. Review, ready, corrections/issue
Electrical
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+
Pub. Wks. Appr
Date of permit issue
School Fees
Total PermifFees