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10-1129 (MECH)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 10-00001129 Property Address: 54100 RIVIERA-____ APN: .775 -031 -046 - Application description: MECHANICAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 5000 Tu�/ 4 s(A Qu&& Applicant: Architect or Engineer: PIA BUILDING & SAFETY DEPARTMENT BUILDING PERMIT ---------------------------------------------------- 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 Divisio P the Business and Professionals Code, and my License is in full force and effect. License Class: C 0 License No.: 619091 Contractor: 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: 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).: (_) 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.). ( ) 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 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 10/28/10 Owner: COOK JOHN/PATRICIA TRUSTEES 122'15 BRISTOL DRIVE LA MIRADA, CA 90638 Contractor' PALOMA AIR CONDITIONING' P.O. BOX 3501 PALM DESERT, CA 92261 (760)347-1212 Lic. No.: 619091 ----------------------------------------------- WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I haveandwill 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 SOUTHERN INS CO Policy Number WSIO02303402 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 _VA?if I should become subject to the workers' compensation provisions of Section .-. 101x0 Labor Code, I shall forthwith comply with those provisions. ' /Applicant: 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. certify that 1 have read this appl'!!qa�tion and state that the above information is correct. I agree to comply with all - city and,ebunty ordinances pdstte laws relating to building construction, and hereby authorize representatives of county to e�S' �ature(l above-mentioned property for inspection purposes. Date: t O .--pplicant or Agent): LQPERMIT Application Number . . . 10-00001129 Permit . . . MECHANICAL Additional desc . Permit Fee . . . . 42.50 Plan Check Fee 10.63 Issue Date . . . Valuation . . . . 0 Expiration Date 4/26/11 Qty-. Unit Charge Per Extension BASE FEE 15.00 1.00 11.0000 EA MECH FURNACE >100K 11.00 1.00 16.5000 EA MECH B/C 53-15HP/>100K-500KBTU 16.50 ---------------------------------------------------------------------------- Special Notes and Comments. INSTAL NEW HVAC SYSTEM 16 SEER CONDENSER, COIL AND FURNACE. 2007 CODES. -----------------_---------------------------------.--- - Other Fees BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged Paid Credited Due Permit. Fee Total 42.50 .00 .00 42.50 Plan-Check Total 10.63. .00 .00 10.63 Other Fee-Total 1.00 .00 .00 1.00 Grand Total 54.13 .00 .00 54.13 LQPERMIT Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC CF -M -ALT -HVAC Climate Zone 16 Site Address: Y/00 21 v 1� &C— Enforcement Agency: Date: io 8^/0 Permit #: -( Conditioned Equipment T r List Minimum Efficiency 2 Floor Area Duct insulation re uirement Thermostat Packaged UnitOver urnace ® O AFUE COP 40 ft of ducts added or replaced in oor Coil ondensing Unit SEER 6 EER ® HSPF _ ®Resistance Served b system 27 sf unconditioned space ®R 8 (CZ 16) Setback (mfust be inst�ed) sent 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 CF4R forms (no hand filled CF4Rs allowed) are filled out and signed. Beginning October 1, 2010, a registered copy of the CF -1R and CF -6R shall alsoXe on site for final inspection. 1. HVAC Changeout Required Forms: • All HVAC Equipment replaced CF -6R forms: MECH-04 and MECH-2I-HERS CF4R forms: MECH-21 • Condenser Coil and /or CF -6R forms: MECH-2I-HERS • Indoor Coil and/or CF4R forms: MECH-21 • Furnace For Split Systems: Duct leakage < 15 percent For Packaged Units: Duct leakage < 15 percent Exempted from duct leakage testing if - f1. 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 ducts: (all CF -6R forms: MECH-04 and MECH-20-HERS new ducting and all newequipment) CF -4R forms: MECH-20 For Split Systems: Duct leakage < 6 percent For Packaged Units: Duct leakage < 6 percent ® 3. New Ducts with Replacement Required Forms: • Includes replacing or installing all new ducting and/or outdoor condensing unit CF -6R forms: MECH-04 and MECH-20-HERS and/or indoor coil and/or furnace. Not all CF4R forms: MECH-20 equipment char ed. For Split Systems: Duct leakage < 6 percent For Packaged Units: Duct leakage < 6 percent ® 4. New Ducting over 40 feet Required Forms: • Includes adding or replacing more than 40 CF -611 forms: MECH-04 and MECH-2I-HERS linear feet of duct in unconditioned space. CF -4R 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) • 1 certify that this Certificate of Compliance documentation is accurate and complete. • 1 am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this Certificate of Compliance. • 1 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: N ( j?, Signature: Company*( V� W Date: D ^ -?�n ( e, �j n n / Address: / atxe �t License: ( 9 a City/State/Zip: Phone: -7.6 o -3 Y -7/ ` 2008 Residential Compliance Forms July 2010 I1 Bin #. -- - City of La Qutnta Building & Safety Division • .. Box 1504, 78-495 Cage Tamplco l p ����� } LPOa Qulnta, CA 92253 • (760) 777-7012 BUllding Permit Application and Tracking Sheet Project Address: Owner's Name: - f " f o A. P. Number Add Loegal Description: ress-- G V/00 P I v I e v c� City. ST, zip:L C� C Contractor d � ( C Telephone: ' / Address: ?� (� / � �..-Q �i ProjW Description: - (' V 'City, ST, Zip: Telapttone: p y% / It T'a Al Stats Lic. d : / . 0 City Lie. g: Arch., Engr., Des4pw. Ad}�Ql =: City. ST. Zip: Telephone: Construction Type:. Occupancy:State Lid, il:. . type (circle one): New Add'n Albrr Ropair Demo Name of Contact Person: Sq. FL: 9tor Stories: g Units: Telephony # of Contact person: Estimated Value of Project: APPLICANT: DO NOT WRITE B®.OW THIS UNP TRACKING PERMIT FEES a bmitted Item Amount IF Submittal Req'd Recd . ready for corrections Plan Check Deposit Plan Sets Plan Check Balance . piclkcd tip Construction resubmitted Mechanical Pian Check Electrical Stmetand Cala. Plumbing picked up S-M.L resubmitted GrRdiog Rehcured Developer Impact Fee Fia Cates. ALP-P. Called Mile 24 Cala. Mile Total Permit Fees Flood plain pun Plans Grading plan 2'! R Subcontactor List Called Grant Deed Plans H.O.A. Approval Plana IN HOUSE:- Re Planning Approval Called Pub. Wks. Appr FFq Date School Fees I eview, of . ready for corrections Plan Check Deposit Contact person Plan Check Balance . piclkcd tip Construction resubmitted Mechanical ready for eorrectious/itsae Electrical Contact person Plumbing picked up S-M.L resubmitted GrRdiog New, ready for correctionallssue Developer Impact Fee Contatt Person ALP-P. permit Issue Total Permit Fees