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12-0941 (MECH)P.O. BOX 1504 . T-4bf 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Application Number. e-712-00000941 ' Owner: Property Address: .80405 OAK TREE KURLAN HERB APN: 775-081-086- - - 80-405 OAK TREE Application description: MECHANICAL LA QUINTA, CA 92253 Property Zoning: LOW DENSITY RESIDENTIAL (415) 850-5781 Application valuation: 7000 Contractor: Applicant: Architect or Engineer: PALM DESERT AIR COND 42081 BEACON HILL (/(-f PALM DESERT, CA 92211 (760)346-0677 1114-- Lic. No:: 374937 LICENSED CONTRACTOR'S DECLARATION I 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 C e, and my License is in full force and effect. License Class: C20 enseNo.: 374937 Date:— `4' �Contraci rT� OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that Iam exempt from the Contractor's State License Law 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 pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division3'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 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 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. ` , BAP.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 VOICE (760) 777-7012 FAX (7 60) 777-7011 INSPECTIONS (760) 777-7153 Date: 8/20/12 Q 0 FAU p 2012 C I CITY OF LA QUINTA FINANCE DEPT. 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. 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 MID CENTURY Policy Number A09454905-12 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 agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shat) fort hwit o ply with those provisions. Dat . j.G v Appllant: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). 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 building construction, and hereby authorize representatives of this county to enter upon the above-mentioned property for inspection pu�. 'Date: ~i Signature (Applicant or Agent):�3— i`!' Application Number . . . . . 12-00000941 Permit . . . MECHANICAL Additional desc . Permit Fee 40.50 Plan Check Fee •10.13 , _ Issue Date . . . . Valuation. . . . . 0 Expiration Date 2/16/13 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) AIR CONDITIONING SPLIT SYSTEM 13 SEER 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 - Grand Total 51.63. .00 -.00 51.63 LQPERMIT - 5 Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF -IR -ALT -HVAC Climate Zones 10 - 15 Site Address: Enforcement Agency: Date: Permit #: 80-405 oak tree La Quinta, CA 92253 City of La Quinta Aug 16, 2012 Duct insulation Conditioned Floor Equipment Type1 List Minimum Efficiency2 requirement Area Thermostat ❑ Package Unit m Furnace 0 AFUE 78% ❑ COP ❑ R 6 (CZ 10-13) Served by system B Setback ❑ Indoor Coil m SEER 13.0 ❑ HSPF ❑ R 8 (CZ 14-15) 1600 sf If not already present, must be @ Condensing Unit [I EER ❑ Resistance 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 -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 -11% and CF -61% shall also be on site for final inspection. m 1. HVAC Changeout Required Forms: . All HVAC Equipment CF -611 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 . Indoor Coil and /or CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS • Furnace CF -4R 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 11pits. I leakage 4 15 n r.f For. Parska ed urt Exempted from duct leakage testing if: p !.-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 system=will not be Ducted (ie.-Dyctless3Mini-Split--System).(Also-Eaempt-,frorn;R igera nt-.Charge) ❑ 2. New HVAC System Required Forms: . Cut injor Changeout with-' new ducts: (all new 2= - CF 6R forms: MECH-04, MECH-20-HERS Land (f'or split systems) MECH-2HERS, and ductingall new m MECH-25'HERS s) M=22, and, -25 CF-4Rffor`ms: MECH-20, and (for split systemECH equipment) �+n d t.: -F. ;'�� �". _s .. - Jt.- For Split Systems: Duct leakage <,6 percent; RC, CCA 2: 350`CFM%ton; FWD, TMA MS, and'either HSPP oVPSPP, 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 -4R 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: Duct leakage < 6 percent ❑ 4. New Ducting over 40 feet Required Forms: • Includes adding or replacing more than 40 CF -6R forms: MECH-04, MECH-2I-HERS linear feet of duct in unconditioned space. CF -411 forms: MECH-21 For split system or packaged units: Duct 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: Karl Brown Signature: Karl Brown Company: PALM DESERT AIR CONDITIONING CO INC Date: Aug 16, 2012 Address: 42-081 BEACON HILL License: 374937 City/State/Zip: PALM DESERT/ CA/ 92211 Phone: (760) 346-0677 2Reg: 212-A0044872A-00000000-0009i Registration Date/Time: 2012/08/16 13:42:51 HERS Provider: Ca10ERTS, Inc. - - --- 2008 ResYdenEial Compliance�Forms July 2050 721 t �. (/I�Irw 4 r�tU1 V\JJJ"✓�� T (f �G P.O. Boz 1504.78-495 Calle Tampico, • La Quinta, California 92211 3 4V� Tel: (760) 777-7012.• Fax: (760) 777-7112 —GFMild.DESERT —.- Website: www.La-Quinta.Org • Email: Building@La-Quinta.Org' for.. Bin #: Pe.rrnit #: tL�J] Building Permit Application & Tracking Sheet -Project Address: 80-405 OAK TREE Owner's Name: KURLAN, HERB A.P. Number: Address: 80-405 OAK TREE Legal Description: City, State, Zip: LA QUINTA, CA 92253 Contractor: Palm Desert Air Conditioning,& Heating Company Telephone: (415) 850-5781 Address: 42-081 Beacon Hill, Project Description: City, State, Zip: Palm Desert, CA 92211 REPLACE (1) AIR CONDITIONING SPLIT SYSTEM. r Telephone `No. (760) 346-0677 ff �� _.n State: Lic. #: 374937 City. Lic. #: 100886 Arch./Engr./Designer. Address: City, State, Zip:, Telephone No:: y .."L°.r� Construction Type:Occupancy:, State: Lic. #: t '" �� oto X11' �K,��*'� e r � _� , e - Project Type:', 0 New • ®Add'n • 0 Alter • O Repair • 0 Demo Name of Contact Person: KARL BROWN Sq: Ft.:. # Stories: # Units: Contact Telephone No.: (760) 346-0677 Estimated Value of Project: $7,000.00 " -APPLICANT: DO: NOT WRITE BELOW THIS LINE # Submittal Rego Recd Tracking Permit Fee's Plan Sets Plan Check Submitted Item Amount Structural Cates. Reviewed, Ready for 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 2n° Review, Ready for Corrections Electrical Subcontractor List -Called Contact Person Plumbing Grant Deed Plans Picked Up S.M.L. H.O.A. Approval Plans Resubmitted Grading + IN HOUSE V Review; Ready for Corrections Developer Impact Fee Planning Approval Called Contact Person AJ.P.P. Pub. Works Appr'I 4 ", Date of Permit Issue School Fees - Total Permit Fee's