10-1086 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 10- 0-0 0 01086* 1
Property Address: 5-4-3-8-6—OAK-1-TREE
APN: 775-081-027-: - -
Application description: MECHANICAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 4025
Applicant: Architect or Engineer:
alp
------------------
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
1 hereby affirm under penalty of perjury that I am,licensed under provisions,of Chapter 9"(commencing with
Section'7000) of Division 3 of the Business and Professionals Code, and my License isin full force and effect. -
Lice eClass. C20 Li/ceerrte3Q'�.No.: 374937 "
Dale: O 0ontractoir'� F
OWNER -BUILDER DECLARATION
I hereby affirm underpenalty, of perjury that I am exempt from the Contractor's State. License Law for the
following. reason (Sec. 70 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 licensedpursuant to !he provisions of the Contractor's State
LicenseLaw (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 exemptions. 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 ($5001.:
1 _ 1 .1, as owner of the. property, or my.employees.with wages as•,their sole'compensation, willdo'the work, and
the structure is notintended'or offered for sale (Sec. 7044, Business and'Professions Code: The
Contractors' State License Law does not .1
an owner of pioperty,who builds or improves thereon,
and who, does the work hirnself.orherself througWhis ocher 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 tfie burden of proving that he or she slid 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 Contrectors' 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.).
I—) 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: ti I
LQPERMIT
Owner:
SUSAN MCRAVEN
54-386 OAK TREE.
LA-QUINTA, CA 92253
Contractor:
PALM DESERT AIR COND_CO
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: 10/21/3:0
O e �-
rC OCT 22,2010
CRY
OF 1.q gUINTq
ern.. r..-_
•------------
{. WORKER'S. COMPENSATION DECLARATION.
I hereby affirm under penalty of perjury one of the -following declarations:
_ I have and'will maintaina. certificate:of consent. to self -insure for workers' compensation, as provided
for by Section 3700 of the'LaborCode,_for the performance of the work46r which this permit is -
�issued.
I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
Code, for the performance of the work for Which this permit is issued. My workers' compensation
insurance carrier and policy number are: -
Carrier SOUTHERN INS ' Policy Number WSIO036802-:01
I certify that, in the performance of the work for which this -permit is issued, I shall not employ any
..person in any manner sous to become subject to the workers' compensation -laws of California,
and agree that, if t should become subject to the workers' compensation provisions of Section
3700 of the Lab Code, Ipshall
ffoorthwiwiithcom with those provisions. -
WARNING: ,FAILURE TO SECURE WORKERS'" COMPENSATION COVERAGE IS UNLAWFUL.AND SHALL
SUBJECT AWEMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED`:THOUSAND'
DOLLARS ($100,006).'INAD6ITION TO.THE COST'OF COMPENSATION, DAMAGES AS`PROVIOED 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 permit subject to the
conditions and restrictions set forth an this'application. }"
1. Each person upon whose behalf this application is made, each person gat whose°rrequest and for
whose benefit work.is performed under or pursuant to any permit issued'as a.result„oYtfiis-application,
the owner, and the applicant,''eacKagrees 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.
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 to enter upon the above-mentioned property for inspection purpo
Date: r �• 0' Sig lure (Applicant or AgenR-�3`f��
LQPERMIT
Application Number . . . . . 10-00001086
Permit . . . MECHANICAL
Additional.desc .
Permit Fee . . . . 24.00 Plan Check Fee
6.00
Issue Date . . . . Valuation
0
Expiration Date 4/19/11
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 9.0000 EA MECH FURNACE <=100K
9.00
Notes: and Comments
,Special
REPLACE FURNACE ONLY. -2007 CODES.
-------------.---------------------------------------------------------
Other Fees . . . ., BLDG SIDS ADMIN (SB1473)
1.00
Fee summary:, Charged Paid Credited
-
Due
---------------- - - - - - - - -- ----------- ..---- - - - - ----
Permit.'Fee:Total 24.00 .00 .0.0
---.- - - --
24.00,
r
Plan Check„::To al 6.00 .00 .00
6.;00
Other -1.0._0 •, .00 .00
Other Fe
1.00
” 'Grand: Total.` 31.,00 00 00
31:00.
G.
LQPERMIT
Sftnpjir10d'M Q- iRkti�,, 0 cei 9 . 6idenfid I(VACAfteedtions CF -M -ALT -HVAC
S010, 2 09 1:
iCrjiinate-zones-46,(6:15:*
MC RAVEN, SUSAN System: #1,,
Site Address:
54=386 OAK TREE, LAQUINTA, CA 92253
En �rcemen�:Aj�ry:
V
C,t
Ci Y 6f'L6 Quinta
'atf
10/21/2010
Permit #:
A10 -
I
iC6ndiijo.nedfloor
u pmentTypel
List Minimu- gffficiency2
Duet, insulation: requirement
Area
Thermostat
0 Pkka' I ged:'Utift
Wumace
0 AFUE 80%
1:1 Cop
Over 40 - ft of ducts added or
0,Setback
11 Indoor'Coil
0 SEER
-
0 HSPF
laced in unconditioned
repcononespace
Served system
by
af not already
• Condensing Unit
11 EER —
0 ResisCa"6Te—
0 R-6 (CZ -10-13)
sf
present, must be
• Other
EIR 8 (CZ 1445)
installed)
I., Eqdipment-,Type: Choose ,the ,eqyipin.6pit.being installed; if more than one system, use dnother CF-1R-AL.T-11VACf.or each system.
2. Minimum: Equipment Efficiencies: 13: SEER, 78% AFUE, 7.,7HSPFfoi-.'typicdl:reviilciztialsystems.
HERS VERIFICATION SUMMA'AY Li§t'ed.,be'low:are . four HV C.alicraticn 6pt ions., The ,insialla decides what work is being.done and
picks one ofthe:appropriate Options. Each Option lists the HERS' measures that niust-156.cdnducted'. A copy., of the,fbrms shall be left on, site for final
ins&ctiori and a.copy given to the homeowfipr. At final, the .insoect6r.xiehfi'es.ttiatthe work, listed on this form was in fact the work completed by the
installer. The,inspectori also verifies, that ach �appropriate CF -.6R. and registered fbrms:(no�hand filled CF-4Rs allowed) are filled out and
I . . - .
signcd ; ' - - J.
Be9innjqg-'.'-OttoWr 1,�2910,.a-text�tered,;�opy..Of.ihe..�tF�lit��,Ld:CF-W�hatl� 7
' also,be�-.onsite forfWaI-ins paction.
MI., HV-Atthan geout
Required Forms;.
11 All HVAC Equipment,replaced
CF;.:6R f6ribs'-..'ME 0421:-RERS-and1fdTWit sy§teihs)-A4.ECH- 25 -HERS
CH.:r,.MEC-.H-
'f6r�split�systemS
C-F4R,'fdnns: MECHl-.,2,1*�and• ) MECK0
0 Condenser-Coll.and./or
0 IndoorCoil-aruf&r
CF-6k-%fonns:t'M:ECii.=2,1-HEkS and "(:for.,split-systems).MECH- 25-RERS
O.Furnace
C-F4R,'f6rmS`. MECH7,.21'larid!(f6rs'plit.,sy'st'-ef'ns)- MECH-25
'Foir-Split Systems: Duct leakage < 15.percdht; RC, CCA _> 300 UM/tort(Mininiiirn Air Flow Requirement), TMAE
For Packaged UnW. Duct leakage <45percent
Exempted ftom:duct teak if,
leakage .:
0 1. Ductsystem was .documented to have, been.previously, spal ed,and confirtned: through HERS verification, or
0 2. Ductsystents.with less�than:40 linearfect ivunconditicinedspacci or
0 3., Existifig,'ductsyst6ths ate? co . Pstructed„ibsulate&,rorsealdd,with,asb6stos
0 2. New HVAC 1,'System
RecidirM, . Forms:
Porms-
0 Cut in or Changeout with new
ducts: (all newducting-and all
CF-6Rforms: MECH-04, MECH-20-HERS,and (for split systems) UECH-22-HERS, and MECH-25-HERS
new,equipment)
CF -4R -:forms: MECH 20-, and (for split systems)MECH-22,:and'MECH 25
For Split Systems; Nct. leakage <6..pqrqent; Ac., CCA2! 356 CFM/ton, MID, TMAH, SIMS, and.either 14SPP,or PSPP.
,for.Pac4age4 Units: Duct:leakage_ < 6 ercent..
0 3. New DtftttftWo �
i,*i*64t-lki iForms;
placimedt Required . .' s.
0 Includes.replacingor iristallin&atl new. ducting CF -6R forms: MEPH10.4,.MECH-20-!ffERS.and.,(for-split%systems) MECH-25-HERS
and/or outd'Qor,6Dn-de&iiig uriii. a.nd/or-ihdoordoil CF-4R-fi5nns: MECA-2.0'and:(forsplit systems) MEC!4=25
and/or furnace. Noor t-chaneed.
.F.or,"Split-Sya6ms:.Dutt.:IeA4ge'<,6rV.erdeiiti.,RCj CCA? 300CFM/t6h,,.TMAH
;For Pifckaatd:'Uhits:DuaJdAkiig6 <'6,pextdnt
114. NewDue koye'r-46'66
geou , fred'y6rm's:
0 Includes adding, or replacing nnore than 40
linear-feetofdo.c-t.;in.unconditioned spaqe.
CF -611 forms: . MECR-04, MECH-21 -HERS CF4kforms: MECH-21
For split system .oir-'*packaged*V units: Duct teakagel-<15-percent;
E3, P
XCtPTION:'Eyisting,,4uct:systpms.otii tcd,,,insulat6d:or scaI!Dd with:asbcstos.
CtintractiDir (Dtittififentatibn Author's /R6,pdn9ibWD6ij.1ter!s D&laratibh- Statement)
1 certify that this Certificate of Compliance documentation is accurate and complete.
I am eligiblemnder Division 3 of the California -business and Professions Code-to;accept responsibility for the design -identified on this Certificate of Compliance.
I certify that theenergyfeatures and perfi5rmancc specifications fbrthc:dcsign-identificdi on tins Certificate of Compliance conform to the requirements of itle 24,
Parts I and 6.of.thc;Califomia Codc;6f Rcgulitions:
The design features identificd-on;this:Ccrtificate of Compliance are consistent with the.infort-nation documented oniothcr applicable compliance forms, worksheets,
calculati6ns,,piiiisAnd'spcci.�cations:subrnittedto,th,cenfoi�geineht.aicnc,,'fo'i�apord.val- dithe4cY641�ji7lica . tion.
Name: KARL BROWN;
.Signature:
4. r
,Company: Palm Desert Air Conditioning & Heating Company
Date: 10/21/2010
Address: 42-081 Beacon Hill
License: 374937
!City/Sta e/Zi
t IP:'Palm Desert, CA 92211
Phone: (760) 346-0677
2008 Residential Compliance Forms March 2010
P.O. Box 1504.78-495 Calle Tampico, • La Quinta, Califbrriia,.92211
Tel - (160): 777-701.2 - Fax: (700) 777-7112
-Q'uinta.Org - Email: B ildinq@1La-Quinfa.Or.(3
We4site: www.La Uc.
1.86� #.
.in .Permft #.10 -toe& J Building Permit Application & Tracking Sheet
Project Address: 54-386 OAK TREE
Owner's Name: MC RAVEN, SUSAN
A.P. Number
Address: 54-386 OAK TREE
Legal Description:
City, State, Zip: LA QUINTA, CA 92253
Contractor: Palm Desert Air Conditioning & Heating Company
Telephone: (435) 645-5335
Address: 42-081 Beacon Hill
Project
tt Description:
City, State,, Zip: Palm Desert, CA
92211
REPLACE ONE (l)
Telephone, No.: (760) 346-0677
State: Lic. M 374937
City Lic. 4: 100886
Ardh./Engr./Designer
Address:
City, State,.Zip:
Telephone No.:
k
Construction Type:
Occupancy:
;State: Lic. M
IN
va
"Project Type: Ell New - 0 Add'n - El Alter - Ell Repair - 0 Demo
Name of Contact Person: KARL BROWN
'Sq. Ft.:
#Stories:
T# Units:
Coritact Telephone No.: (760) 346-0677
Estimated Value of Project: $4,025.00
APPLICANT6.
DO* NOT WRITE
BELOW'THIS1INE
#
Submittal
Req!d
R6c!d
Tracking
Permit Fee's
Plan Sets
Aan Check Submitted
Item
Amount
Structural Cates.
Reviewed, Ready for Corrections
Plan Check Deposit
Truss Cales.
Called -Contact Person
Plan Check Balance
Title 24 CaIcs.
Plains Picked Up
Construction
Flood Plain Plan
Plans; Resubmitted
Mechanical
Grading Plan
Ind Review, Ready:for C orrections
Electrical
Subcontractor List
CaII6&Cohtadt'Pe1`son
Plumbing
Grant Deed
Plans Pldked..Up
S.M.I.
H.O.A. Approval
Plans Resubmitted
Grading
IN HOUSE
? Review, Ready for,Correction,s
Developer Impact Fee
Planning Approval
Called.'Contact Person
A.I.P.P.
Pub. Works Appel
Date of Permit Issue
School Fees
M i
i i
Total Permit, Fee's