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11-0745 (MECH)
P.O. BOX 1504 VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX. (760) 77777011 LA QUINTA, CALIFORNIA 92253 BUILDING_ & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 7/08/11 Application Number: -07--15 Owner: Property Address: 512'3.0 WEA NIDA OBREGON HATCH G STANLEY APN: 773-052-02.6-10-OOOb00- 51230 AVENIDA OBREGON Application description: MECHANICAL LA QUINTA, CA 92253 Property Zoning: MEDIUM DENSITY RES' Application valuation: 12396 1 Contractor: Ii Applicant: Architect or Engineer: GENERAL AIR CONDITIONING I 31170 RESERVE DRIVE iti� THOUSAND PALMS CA 92276 i I (760,)343-7488. CITVQ?Ft.. .l.l Lic:.No.: '686310: Lr r d PihfA LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION I hereby affirm under penalt-y of perjury that I a icensed under' provisions of Chapter 9 (commencing with .1 hereby. affirm under penalty of•perjury one of the following declarations: Section 7000) of Division'3 of the Business an rofessionals Code, and my. License is in fulYforce and effect._ I have and will maintain a certificate of consent-to self-insure for workers' compensation, as provided License Class: - C20 License No.: 686310 for by•Section.3700 of the Labor Code, for the performance of the work,for'which this permit is _ issued:: - . - te: ontractor., 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 OWNER-BUILDER DECLARATION 'insurance carrierand policy number are: - 1 hereby affirm under penalty, ofperjury that I:arri exempt from the Contractor's State License Law .for the Carrier" EVEREST. NATL Policy Nuinber- . 7606006147101 following reason (Sec:J031.5, Business and rProfessions Code: Anyticity or county that-requires a permit to _. I certify that; in the performance of the work for which thispermitis issued, I shall not employ any construct, alter, improve, deirioiish,_orrepair any struc'tufe prior to its issuance; also iequires the applicant for the person in any manner so as to become sub' to the workers' compensation laws of California, permit to file a signed statement that lie or she is licensed pursuant _tothe provisions;of the Contractor's State and agree'that,.if I should become subject a workers' compensation provisions of Section *License Law (Chapter 9 Iconimencing with Section 7000) of Division 3bf the,Business�and Professions; Code) or 370,0 of the Labor Code, 1 shall forthwith o plywithdiose provisions: '• that'he or.she is'exempt therefrom and the basis for the alleged exemption.-Any,wolation'of�Section 7031.5 by ,� ��•, anyapplicant,for a permit sub)ectslthe applicant to a civil .penaity of,not more than five hundred dollars,(S500).:. Date: L1, licant: " (_ 1 'I, as owner of the properiy,.or my: employees with wages.as their: sole compensation, will do the work,' andthe structure: is noi-intended,or'offered for sale (Sec. 7044,"Business and Professions Code: The, WARNING: FA RE TO SECURE WORKER MPEN TION COVERAGE IS UNLAWFUL, AND SHALL Contractors' �State.License Law does not apply to an owner of. property'who'builds oriimproves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL; FINESUPTO ONE HUNDRED THOUSAND ' .and who -does the work,liimself.or herself through his or.her�own employees, provided that the DOLLARS (S100,0001.'•:IN ADDITION TO.THE'.COST OF t;ON1PENSATION, DAMAGES'AS PROVIDED FOR IN a improvements are not'intendedor offered for sale.' If,'however, the building or improvement is sold within SECTION 3706 OF THE LABOR. CODE, INTEREST-, AND.ATTORNEY'S•F,EES. , one :year: of completion,tlie "owner-builder will have*the burden of. proving that he or she did not build or improve purpose ofsale•)• APPLICANT ACKNOWLEDGEMENT A—) '1, as owner•iof 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 restrictiods 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 tolthe Contractors"State License Law:).. whose benefit work is performed under or pursuant to any permit issued as a result of this application, (_ 1 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 Quints, 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 aresult of thisepplication becomes null and void if work is not commenced within .180 days from date of issJthe mit, 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 1 certify that I have read this application and st(e 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 relanstruction,.and hereby authorize representatives of this county to enter u on the above-mentioinsp n purposes. Lender's Name: o t8 \ Signature (Applicant or A Lender's Address: LQPERMIT Application Number . . . . . 11-00000745 Permit MECHANICAL Additional desc . Permit Fee . . . . 40.50 Plan Check Fee 10.13 Issue Date . . . . Valuation 0 Expiration Date ". 1/04/12 Qty Unit Charge Per. Extension BASE-FEE 15.00 1.00 9.0000'EA MECH"F.URNACE <=100K 9.00 1.00 16.5000 EA. MECH B/C >3-15HP/>100K-500KBTU 16..50 Special` Notes-'and `Comments " INSTALL NEW 4 .TON HAVC SYSTEM,. ' CONDENSER, COIL zFURNACE. 2010-CODES.. ------------ ------_---_-------------------------------- Other'Fees BLDG�ZTDS ADMIN•(SB1473) 1.;00 'Fee summary Charged Paid -.Credited- Due Permit. Fee Total40.50 .00 .00 40.50' 4 Plan' .Check,..Total , 10.13 .00 .00 10.13 Other `Fee .Total 1.0.0 00 .00 1:00 Grand Total 51.63 .00 .00 51.63 LQPERMIT. Sim Iified. Pr.escri tive Certificate of Com liance: -2008`.Residential HVAC Alterations CF4R-ALT-HVAQ Climate Zones. 10,t6 15 2008 Residential Compliance Forms M-141 Mit) • All HVAC Equipment replaced CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH- 25 -HERS _ CF -4R forms: MECH- 21 and (for -split sstems) .MECH-25 • Condenser Coil and /or • Indoor Coil and/or CF -6R forms: MECH-2I-HERS and (for split systems) MECH- 25 -HERS • Furnace CF -4R ;fm ors: MECH- 21 and (for split systems) MECH-25 For Split Systems: Duct leakage < 15 percent; RC, CCA >_ 300 CFM/ton(Minimutn 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. Existing duct systems are constructed, insulated or sealed with asbestos ❑ 2. New HVAC System Required -Forms: . • Cut in or Changeout with new CF -611 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) CF -4R forms: MECH 20-1 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 ❑ 3. New Ducts with Replacement Required 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 CF -4R 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 CFM/ton, TMAH For Packaged Units: Duct leakage <.6 Rercent ❑ 4. New Ducting over 40 feet Re uired 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) • I certify that this Certificate of Compliance documentation is accurate and complete. • I am eligible under Division 3 of the California Business and. Profess ions Code to accept responsibility for -the design identified on this Certificate of Compliance. • f 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 California Code of Regulations. • -rhe design features identified on this Ceriifieate of Compliance are consistent with the ' _ onn tion documented on other •tpplic ompliance forms, worksheets, calculations, plans ands ecifications submitted to the enforccntenta enc fora ro al with t e ermit a lication. Name: 66 -oil uj�6o� Si ` ture: Company: �7&YG(C� Date. . Address: ,�w fid'/ . ✓� . License: City/State/Zip:-7-�t 4u�SG �L G13 %aa-7�o Phone:' 760-33_ %'' ffg 2008 Residential Compliance Forms M-141 Mit) CaICERTS - Plans', Page 1 of 1 DanielleGarcia Logged In [Logout] lob Nanie: 51230')►VENIDA OBREGON HomeD Plan Data (2008 Standards) Projects CF -1R SAVE Registration Certificate; Type: Title24<(Compliance) My Builders System Name. or ID -Tag: S 'siem 1 :' y Energy Consultants System Location or Area Served:` Whole,House ' Consultants My Installers;" Click Here to download the,Registered CF -IR: 210-A0020606A-00000000-0000' My Raters CF -1R Changeout CP -1R -ALT -HVAC View/Pay Invoice Training Schedule My Signature Agreements My Info Customer Info Reports Compliance Forms Website Updates Log Out Climate Zone:' 15. Need help• finding- your Climate Zone? (CLICK HEREJ . Approximate Conditioned Floor Area Served By -System: 3000 S/F , What is being INSTALLED? Package Unit A/C Condenser (Split System) Is ita Heat Pump?. Q No Yes w/ Electric�Back Up - OR - Yes with NO backup Yes, w/ GAS Back Up A/C Coil (Split System) NO Air Handler (Split System) for example: furnace, fan coil unit, etc. (Is it a .Gas Furnace? ( Yes 8 No , E411 Furnace Heat Exchanger -(but not replacing,the entire furnace) N More than 40'. of Ducts are being installedor replaced C Up to 40' of•Ducts are being installed or replaced Check All That Apply: . 9 Has ASBESTOS'. Existing Ducts or Plenums are insulated•or sealed with asbestos r The system will not be Ducted (ie. Ductless Mini -Split System) There will be less than 40 linear feet of Ducts in unconditioned space ,F6 The system was previously tested and certified by a HERS Rater (CF -4R Certificate #: ) Minium AFUE: 0:80 Minium SEER: Thermostat Acknowledgement: i! If not already present; an Approved Setback Thermostat will be installed. Check this box to agree: Documentation Author: Garcia; Danielle Required Forms: CFr6R Required: -CF-6R-MECH,.04) Space Conditioning CF-6R-MECH-21-HERS) Duct'L•;eakage'Test - Existing CF-6117MECH 24 -HERS, CF=61R-MECH-25-HERS OR-CF-6R-MECH-26-HERS) Refrigerant Charge CF -4R Required: -CF-411-MECH-21)•Duct Leakage; Existing Copyright.© 2010 CaICERTS, Inc. All rights reserved Revised: January i1, 2030 [Terms.and Conditions]: [Privacy Statement] [Class Cancellation Policy] • fix; SAV E`� CaICERTS, Inc. torna St Suite 120 HARRISON.:', 31 NaFolsom, CA 95630 ENTERPRISES Office: 916-985-3400 Toll Free: 877-HERS-R8R (877-437-7787) Fax: 916-985-3402 Contact' Us httrici-Vivivi r:alrPr,.tc :r.nm%nlanc .2,(l(lR ;altPratinne:r.fm-7rirniPrt Jd—_ 7/7/?.ni i Dill # - - • ' Qty of La:, Quintal Building 8,r Safety Divislon, Permit At �(� P.O::BQx 15.04, 78-495"0 16 Tampico La Qulnta, CA 92253 - (760) 777-7012 - �` BU►fding Perrrmii App[�cat6h and Tracking Sheet Project Address:. . Owner's-Name:.. A. P. Number: Address: Legal Description, City,.S'r, Zip: Contractor. ,.3 T Te.lephone: `j S� .. > : > an5a{ g•} .,.% r��> Address: Project Description: City, ST, Zip: 7 Telephone: '�„•' � y�� ``f �. '` a State Lie. # : 3 City Lie. # Arch., Engr., Designer: Address: City., ST, Zip: Telephone: • .,, f�,� `,�� . :,:{•:;:• :;:;z •<;'';'.::>z;;'s»> Construction Type: Occupancy: State Lie. #: :4<s: c-:r .w..:>>: ..:. roject tyPe:circle one):.New . Add'n Alter Repair Demo Name of Contact-Person: t 30::(OIIh Ft.: #.Stories: ” Units: Sq # Telephone # of Contact Person: Q.- 3-:'-7 Estimated Value of Project: /A " 3cd6G APPLICANT: DO NOT WRITE. BELOW-,THIS LINE # Submittal Req'd Rec'.d� TRACIQNG PERMIT FEES Plan Sets. Plan Check submitted Item , Amount Structural Cafes.` Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called•ContactPe'rson Plan Check Balance Title 24 Calcs.. Plans.picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2"e Review, ready for 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 I10USE:- '"' Review,.readyfor corrections/issue Developer Impact Fee Planning Approval Called Contact Person' A.LP.P. Pub. Wks: Appr Date of-permit•issue School Fees ' Total Permit Fees