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13-0649 (MECH)P.O: BOX 1504. VOICE (760) 777-7012 78-495 CALLE.TAMPICO FAX (760) 777-7011 LA QUINTA,'CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 5/22/13 Application Number: 13-00000649 Owner: Property Address: 53040 AVENIDA OBREGON TOBY BROSJO APN: 774-045-002-2 -000000- 53040 AVENIDA OBREGON Application description: MECHANICAL LA QUINTA, CA 92253 Property Zoning: COVE -RESIDENTIAL (3.10)748-S883 Application valuation: 1600 D Contractor: 2'Z013 Applicant: ' Architect or Engineer: ONE HOUR A/C & HT MAY Lu 3 3030 MYERS STREET RIVERSIDE,. CA 925 3CITY QUINTA (951) 276-9744 FINANCEDEPT,` Lic. No.: 878533 ----------------- LICENSED CONTRACTOR'S' DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 70001 of Division 3 of the Business and Professionals Code, and my License is in full force and effect. Licen�s.e-C+y�ass: C20 ��ry.,Al ' License No.: '878533 Dat" (;7;r -( ' Contract`o- i": VV � 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 (Sec: 7031..5, Business and Professions Code: Anycity or county that requires.a permit to construct, alter, improve, demolish, -or repair any structure, prior to its issuance, also requwies the applicant for -the' permit to file a signed sta[emenJ'tha[ 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).: ( _) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is n'6tintended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of prdperty 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: Tfie Contractors` State license Law does'not• apply town owner of property who builds or improves thereon, and who contracts for the projects with a contractorls) licensed' pursuant to the Contractors' State License Law.). - 1 1 I am exempt under Sec. B.&P.C. for this reason Date: Owner: CONSTRUCTION LENDING AGENCY Thereby 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: LQPFRM IT WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by+Section 3700of the Labor Code, for the performance of the work for which this permit is /. e�llrave 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 INS CO OF WEST Policy Number WVES02266100 _ 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 C6de,.l shall: for comply•with those provisions. Date:APPlican" t' . 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 181 OO;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 building construction, and hereby authorize representatives of this county to enter upon the above-mentionedrproperty for in�purposes. Dat 7 �\gnature (Applicant or Agent). I.QPF.RMIT 1 Application Number 13=00000649 Permit . . . . . . MECHANICAL 2013 Additional desc . - Permit Fee 35.75. Plan Check Fee .00 Issue Date Valuation 0 Expiration Date 11/18/13 Qty Unit Charge Per. Extension 1:00 35.7500 EA MECH CONDENSER/COMP 35.75 Special Notes and Comments HVAC CHANGE OUT (1)_ 4 TON 13SEER. :(2008 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPCTION•: 2010 CALIFORNIA BUILDING CODES.' ---------------------------------------------------------------------------- Other Fees . . . . . . _ _ . BLDG STDS ADMIN (SB1473)- 1.00 PERMIT ISSUANCE M/P/E 90.57. PLAN CHECK, MECHANICAL 2.3.83 Fee summary Charged Paid Credited Due. Permit Fee Total 35..75. .00 00. 35`.75 J Plan Check Total .0.000. ..00 .:..00 Other Fee Total 115-.40 :00 . .00 115.40 Grand Total 151.15 00, 00 ..151.15 I.QPF.RMIT Bin. # • . Crty of La Qui* Buiiding 8t Safety Division P.O. Box 1504,'78-495 Calle Tampico la.Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # Project Address: 15--304 O �V NY� � Owner's Name: ! A. P. Number. , . to t7 —0 Address: Legal Description: City, ST, Zip: Contractor.'DicA e � n Telephone:5 Address:Pmject Description: City, ST, Zip: e V� O� J��J Telephone:I5i -x-1 —cA—I �c °� State Lic. # : City Lic. C Arch, Engr., Designer. N Qr Address: City., ST, Zip: Telephone: State Lic. #: Name of Contact Person: Construction Type:. Occupancy: Project type (circle one): New Add'a Alter Repair Demo Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Rcq'd Recd TRACMG PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Wes. Reviewed, ready for corrections Plan Check Deposit. . Truss Calcs. Called Contact Person Pian Check Balance. Title 24 Cates. Pians picked up Construction Flood plain plan Plans resubmitted Mecharilcal . Grading plan 2`! Review, ready for correctionsfissue Electrical Subcoutactor List Called Contact Person Plumbing Grant Deed Plans picked up ML I1.0.A. Approval Plans resubmitted Grading IN ROUSE:- ''d Review, ready for correctionvIssue Developer Impact Fee Planning Approval Called Contact Person Al..P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees Sim lified Prescriptive Certificate.of Com liance:'2008" Residential • HVA C. Alterations CF -IR -ALT -HVAC Climate Zones 10 to 15 Site Address: 53040 Avenida Obregon Enforcement Agency: city of La Date: 5-22-2013 Permit #: Conditioned Floor Equipment T e' List Minimum Efficiency2 Duct insulation requirement Area Thermostat Packaged Unit Furnace EIAFUE_ 0 COP Over 40 ft of ducts added or El Setback Indoor Coil BEER 13 HSI � re laced. in unconditioned space p R 6 (CZ 10-13) Served b system Y Y tsoo sf pr-ve already present, must he x Condensing Unit ©i EER Resistance R 8 (CZ 14-15) installed) Other /. 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,re istered copy of the CF -1R and CF-6R•shall also be on site•for.final inspection. Q 1. HVAC Changeout Required Forms: CF -6R forms: MECH-04, MECH-2l-HERS and (for split systems) MECH- 25 -HERS • All HVAC Equipment replaced CF -4R forms: MECH- 21 and for split sstems MECH-25 • Condenser Coil and /or CF -6R forms: MECH-2I-HERS and (for split systems) MECH- 25 -HERS • Indoor Coil and /or CF -4R forms: MECH- 21 and (for split systems) MECH-25 • Furnace 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 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 in or Changeout with new CF -6R forms: MECH-04, MECH-20-HERS,and (forsplit systems) MECH-22-HERS, and MECH-25-HERS ducts: (all new ducting and all CF -4R forms: MECH 20-, and (for split systems)MECH-22, and MEC_ H 25 new equipment) 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/or without 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 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 > 300 CFM/ton, TMAH For Packaged Units: Duct leakage < 6 percent f- 4. New Ducting over 40 feet Required Forms: • Includes adding or replacing.more than 40 CF -6R forms: MECH-04, MECH-2I-HERS CF -4R forms: MECH-21 linear feet of duct in unconditioned space. For splits stem 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. • l am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on thi Certificate of Compliance. • I certify that the energy features and performance specifications for the design identified on this Certificate of Comp '_ ce confor o 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 document on her plicable compliance forms, worksheets, calculations, plans andspecifications submitted to the enforcement agency for approval with the ermit' a Name:Jane Recktenwald Signature: Company: Ballard Inc., DBA Dial One Date: °ate:5=22-2013 Address: Myers St License:, Lice"Se:878533 City/State/Zip: Riverside, CA 92503 Phone:951-276-9744 ?MR Po ;d.nt;nl rl;nano Fnrmc AAi—h ?nln