11-1037 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
'Application Number: e1-1,-0'0:0.01037
Property Address: 5565.0 OAK TREE»
APN: 775-231-008-
Application•description: MECHANICAL
Property Zoning: LOW DENSITY. RESIDENTIAL
Application valuation: 13000
Applicant:
Architect or Engineer:
aim
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I ai>kpsed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3of the Business ofessionals Code, and my License is in full force and effect.
lice aC�al /C20 C38 LicenseNo.: 577952
Date: v — �° 0 Co ct
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 ISec. 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 provisions of 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 ($500).:
(_ 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, Business and Professions Code: The
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
and who does the workhimselfor 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, 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 orimprovesthereon, 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:
JAY GRIFFEY
55650 OAK TREE
BERMUDA DUNES, CA 92203
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/26/11
Contractor: _
PAUL'S AIR COND & Ht CO IN
P.O. BOX 1818 ±i
CATHEDRAL CITY, CAiI 35-1818 t
(760)323-4776
LIC. No.: 577952 3
CfFV F Ui WTA
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.
l 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 CO Policy Number WSIO046869-01
_ I certify that, in the performance of the work for which this permit is issued, I shall not employ any
person in any manner so Absubject
a subject to the workers' compensation laws of California, -
and agree that, if I should to the workers' compensation provisions of Section
Codwith comply with those provisions.
pplicant
WARN,��,bor
ILURE TO SECRE WO S' COMPENSATION COVERAGE IS UNLAWFUL; AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS 1$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 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 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 buildi truction, and hereby authorize representatives
of this c nt to enter upo he above-mentioned prop pecti n purposes.
�v �r ignature (Applicant or Agen
LQPERMIT
Application Number . . . 11-00001037
Permit . . . MECHANICAL
Additional desc .
Permit Fee . . . . 66.00 Plan Check Fee
10.13
Issue Date . . . . Valuation . . . .
0
Expiration Date 3/24/12'
Qty Unit Charge Per
Extension
BASE `FEE
15.00
2.00 9.0000 EA MECH FURNACE <=100K
18.00.
2:00 16.5000 EA MECH B/C >3-15HP/>100K-500KBTU
33.00
----------------------------------------------------------------------
Special Notes and Comments
CHANGE OUT•(2) COMPLETE SYSTEMS:
FURNACE, CONDENSER, COIL. 2010 CODES.
------------------------------------ ----------------------------------------
Other Fees . . ... . . .'. BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
---------- ---------
Due
-----------------
Permit Fee Total 66.00 .00 .00
66-00
Plan Check Total 10.13 .00 .00.
10.13
Other Fee Total 1.00, .00 .00
1.00
Grand Total 77.13 .00 .00
77.13
LQPERMIT
Stniplified•;Prescrip.tive Certilickte of Coir
_Climate'Zonis'1'0 ti ,15 -
Site Address:; �S /, SV
ice! •1008 Resrdetilia' fIVAC Aile'riztibns
Enforcement Agency: Date:
CF-1R-A,LT'=HVAC. .
Permit
Equipment Conditioned Floor
T List Minimum Efficienc y? Duct insulation requirement Area Thermostat
❑ Packaged Unit
urnac�� FUESOZ ❑ COP Over 40 ft of ducts added or R{�etback
Indoor Coil-dSEER_ O HSPF feplaced to unconditioned space Served by system (1 nor alreaQv
JCF
ondensing Unit ArEER 8 ❑ Resistance ❑ R 6 (CZ 10-13) sf present, must, be
❑ C)ther ❑ R 8 (CZ 14-15) installed) .
l Equipment Type: Choose the equipnrew being installed: if more than one system, use anotherCF-I R-ALT-HV.1 C for each system.
1. Minimum Equipment Efficiencies: 13 SEER. 78.16 AFUE, 7.7HSPF jor 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 fad the work completed by the
installer. The inspector also verifies that each appropriate CF -6R and registered CF4R forms (no hand filled CF4Rs allowed) are filled out and
sigped. Beginning October 1, 2010 a registered copy of the CF -IR and CF -6R stall also be on site for final Inspection.
t!KL HVAC Changeout Required Forms:
• All HVAC Equipment replaced CF-61kforms: MECH-04, MECH-2I-HERS and (for split systems) MECH- 25 -HERS
CF -4R fomes: MECH- 21 and ifors lit stems MECH-25
• Condenser Coil and /or
• Indoor Coil and/or CF -6R forms: MECH-2I-HERS and (for split systems) MECH- 25 -HERS
• Furnace CF4R forms: MECH- 21 and (for split systems) MECH-25
For Split Systems: Duct leakage <.I 5 percent; RC, CCA > 300 CFM/ton(Minimum Air Flow Requirement), TMAH
For Packaged Units: Duct leakage < 15 percent
f.rempted 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. Existing ducts stems are constructed. insulated or sealed with asbestos
❑ 2. New HVAC System Required Forms:
Cut s: al Chang outducting
with new CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-HERS
ducts: (all new ducting and all CF -4R forms: MECH 20-, and for Int stems MECH-22, and MECH 25
new equipment) ( split ry )
For Split Systems: Duct leakage < 6 percent; RC, CCA > 350 CFM/ton, FWD, TMAH, STMS, and either HSPP or PSPP.
For Packaged Units: Duct leakage < 6 percent
❑ 3. New Ducts with Replacement . Requtred Forms:
• Includes replacing or installing all new ducting CF -61K forts: MECH-04, MECH-20-HERS,and (for split systems) MECH-25-HERS
and/or outdoor condensing unit and/or indoor CF -4R forms: MECH-20 and (for split systems) MECH-25
mil and/or furnace. Not all equipment changed.
For Split Systems: Duct leakage < 6 percent, RC, CCA > 300 CFM/ton, TMAH
For Packaeed Units! Mart -,<
❑ 4. New Ducting over 40 feet Required Forms:
• Include: adding or replacing more than 40
CF -611 forms: MECH-04, MECH-2l-HERS
linear feet of dud in unconditioned space.
CF -4R forms: MECH-21
For split system or packaged units: Duct leakage < 15 percent
❑ EXCEPTION: Existing ducts stems consorted, 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
• I cenifj that the energy features and performance specifications for
design identified on this Certificate of Compliance.
'
the design identified on this Certificate of
Parts I and 6 of the California Code of Regulations.
Compliance conform to the requirements of Title 24,
• 'i he .ie ign features identified on this Certificate of compliance are consistent with the information
calculations, lans ands cifications submitted to the enforcement a encu for vat with the
on other applicable compliance forms. worksheets.
t'
Name:
r r r
Signature:
Company:Date:
G+USS ,iy1• (.�N�1�il>v>^•^ jy �JcH�r �/i�r,g L S� SF�
�iliG�l
Address: IL �� ✓'
License:
City/$tate2ip: �'� .•rt, S Gam%
Phone: -760 32,3 776
ZUUo neslaenttal ( ompliance Forms March 2010
Siiiipli?W; Preserippye Certiftcate.6rCompliiiuce' 2008 Resrdeniia! HVAC
Climate Zones 10 io 15 .
Sue Address: /
rj Sp �U QA l � n:� / `,
Enforcement Agency:
Date.
Permit #: l..
Equipment T +
List Minimum Efficiency'
Duct insulation requirement
Conditioned Floor
Area
Thermostat
O Packaged Unit
1Furnace
1ndoor Coil
,, /A�FUESO O COP
-
Over 40 ft of ducts added or
in
etback
6S
AbSEER ❑ HSPF
replaced unconditioned space
Served by system
already
Condensing unit
WEER 13 O Resistance
O R 6 (CZ 10-13)
sf
present. must be
O U,Iler
OR 8 (CZ 14-15)
installed)
l EquipmentType: Choose rhe equipment being installed: if more than one system, use another CF -1 R -ALT -HVAC for each system.
2. Minimum Equipment Efficiencies: 13 SEER. 78916 AFUE, 7.7HSPF for typical residential systems.
HERS VERIFICATION SUMMARY Listed below are four HVAC alteration Options. The installer decides what work is being dome and
picks one of the appropriate Options. Each Option lists the HERS measures that trust be conducted. A the forms be left
copy of shall 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 -6R and registered CF -4R forms (no hand filled CF-4Rs allowed) are filled out and
sigped. Beginning October 1, 2010 a r istered copy of the CF -111 and CF-611shall also be on site for final Inspection.
1. HVAC Changeout Required Forms:
• All HVAC Equipment replaced
CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH- 25 -HERS
CF -411 forms: MECH- 21 and fors lit stems MECH-25
• Condenser Coil and /or
• Indoor Coil and /or
CF-61kforms: MECH-2I-HERS and (for split systems) MECH- 25-14ERS
im Furnace
CF4R forms: MECH- 21 and (for split systems) MECH-25
For Split Systems: Duct leakage < 15 percent; RC, CCA > 300 CFM/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
O 2. Duct systems with less than 40 linear feet in unconditioned space, or
O 3. Existing ducts stems are constructed. insulated or sealed with asbestos
O 2. New HVAC System Required Forms:
•. Cuts: al Chang outducting
with new CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-HERS
ducts: (all new ducting and all
new equipment,) CFforms:fors: MECH 20-, and (for split systems)MECH-22, and MECH 25
For Split Systems: Duct leakage < 6 percent; RC, CCA > 350 CFM/ton, FWD, TMAH, STMS, and either HSPP or PSPP.
For Packaged Units: Duct leakage < 6 percent
O 3. New Ducts with Replacement
Requlred-Forms:
• Includes replacing or installing all new ducting
CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-25-HERS
and/or outdoor condensing unit and/or indoor
CF411 forms: MECH-20 and (for split systems) MECH-25
coil and/or furnace. Not all equipment changed.
For Split Systems: Duct leakage < 6 percent, RC, CCA > 300 CFMhon, TMAH .
For Packaged Units: Duct leakage < 6 percent
D 4. New Ducting over 40 feet
Required Forms:
• • 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)
• 1 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 ion this Certificate of Compliance.
r 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 ofthe California Code of Regulations.
• the dem.-n features identified on this Certificate of Compliance are consistent with the information on other applicable compliance forms, worksheets.
calculations, plans and s cifica[ions submitted to the enforcement agency fora oval with the tin t'
Name:
t t
c
Signature:
Company:
IS 4/
�l r ,,A -moo" � ��F!1" �/�+<<S L s5.�
Date: 11AA
Address:
la 5-5 V '
License:
City/Statc/Zip: G ^c S 014-
Phone:
�6a 32,3 776
2008 Residential Compliance Forms
March 2010
Bin.#
0ty, 0f Qiltntd
Building 8r Safety Division
P,O. Box 1504,78-495 Calle Tampico
1 a .Quanta, CA 92253 -:(760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
AVI.`0
Project Address: S S D� (' . T-IGG I
Name:.
A P. Number.
IT
: S
Legal Description:
City, ST, Zip: ti Gf}
d'^
Contractor, ANIS Ar 4,V)J,-:r1Un.'h
Telephone: �.
Address: �ZS3 V.Id" Vt., w SA� /g
Project Description:
City, ST, Zip: Jam, h �i�Gz
Pe,-ov& Alnd 6 )Nu. Z eAiS-n h
Telephone: /6-77
:rs�,z:'
,
.7V . City Lic. #; r✓ l�
State Lic. # : 7q. - jZ
Arch., Engr., Designer
Address:
City., ST, Zip:
Telephone: Construction Type:. Occupancy:
State Lic. #: „ ;6 V Project type (circle one): New Add'n to , Repair Demo
Name of Contact Person: Sq. Ft.: # Stories: # Unit: Z
Telephone# of Contact Person: Estimated Value of Project: 13pw
APPLICANT: DO NOT WRITE BELOW THIS UNE
N
Submittal
Req'd
Reed
TRACIMG PERMITFEESS
Plan Sets
Plan Check submitted Item Amount
Structural Cales.
Reviewed, ready for corrections Plan Check Deposit. .
Truss Cates.
Called Contact Person Pian Check Balance
Titie24 Calci.
Plans picked up Construction -
Flood plain plan
Plans resubmitttd.' , Mechartical
Giading plan
tad Review, ready for correctionsrissue Electrical
Subeontactor List
Called Contact Person Plumbing
Grant Deed
Plans picked up S.M.I.
H.O.A- Approval
Plans resubmitted Grading
IPI HOUSE:-
'^` Review, ready for correctionsAssue Developer Impact Fee
Planning Approval
Called Contact Person
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees