12-0153 (MECH)4 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: 2/17/12
Application Number: t 12-0.0000153, Owner:
Property Address: 54190 RIVIERA HEAVRIN RALPH
APN: 775-031-043- - - 54190 RIVIERA
Application description: MECHANICAL LA QUINTA, CA 92253 i
Property Zoning: LOW DENSITY RESIDENTIAL !O A
Application valuation: 6085 f
Contractor. JFEB 7 2012 f!
Applicant: Architect or Engineer: HYDES 42949 MADIO STREET � 1
INDIO, CA 92201 CITY0F!.A:1ylNTA -
(760)360-2202
�
Lic. No.: 906115
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LICENSED CONTRACTOR'S DECLARATION
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 Code, and my License is in full force and effect.
Licegge Class: C20 C36 License No.: 906115
Date: p ntractor-.
/ OWNER -BUILDER DECLARATION
1 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).:
(_ 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.).
(_ 11, 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 1 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: I_
Lender's Address: P
LQPERMIT
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 NORGUARD INS Policy Number CEWC243358
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 1 should become subject to the workers' compensation provisions of Section
3700 of the Labor Code, I shall forthwit ply with those provisions.
icant:��
WARNING: FAIL RE 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 gggupon the above-mentioned property for inspe ion pur oses.
te: Z —`/ T /�iAAAature (Applicant or Agent): r/
Application Number . . . . 12--00000153
Permit . . . MECHANICAL
Additional desc .
Permit Fee 40.50
Plan Check Fee
10.13
Issue Date . .
Valuation . . . .
0
Expiration Date 8/15/12
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
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Special Notes and Comments
HVAC CHANGE -OUT, 2 TON 16 SEER SYSTEM,
FURNACE, CONDENSER, INDOOR COIL,
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
1.00
Grand Total 51.63
.00 .00
51.63
LQPERMIT
Siriipiified-Prescriptive Certificate of -Compliance: 2006 'Residential HVAC Alterations ' CF.-1R-ALT=H\/AC
Climate Zones 10 -.15 -
Site•Address:.
Enforcement Agency.
Date:.
Permit #:
54=190, Rivera. La. Quinta, CA 92253
City.'of La Quinta
Feb 16, 2012
Equipment Typel
List Minimum Efficiency2
Duct insulation
requirement
Conditioned Floor
Area
Thermostat
❑ Package Unit
0 Furnace
0 Indoor Coil
0 AFUE 78%
0 SEER 13.0
❑ COP
ElHSPF
❑ R 6 (CZ 10-13)
Served by system
0 Setback
If not already present, must be
0 Condensing Unit
❑ EER
❑ Resistance
[IR 8 (CZ 14-15)
Boo sf
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 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 -6111 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 -111
and CF -611 shall also be on site for final inspection.
0 1. HVAC Changeout
Required Forms:
. All HVAC Equipment
CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS
replaced
CF -411 forms: MECH-21 Ill NOand (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:G 15 percent; RC, CCA <_ 300 CFM/ton (Minimum Air Flow Requirement), TMAH
;
Exempted from duct leakage testing'f:
❑ 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
❑ 4. The system, , vvill not be Ducted'(ie DucflesxMiniiL plit75ystem) (Also Exempt fro Refrigerant -Charge)
❑ 2. New HVAC System
Requir"ed Forms:
. Cut in or Changeout with
new ducts: (all new
'•tts
ducting
CF 6R forms: MECH-04 MECH 20 -HERS and forsystems) :MECH-22=HERS and
.-split-
MECH-25 HERS
and all n w
equipment):.
CF44Rifor s-: MECH 20, a'nd (for splits stems MECH ,Z,an!�Mtt i=25
�.
_ r r
For Split Systemsc'D'uct leakages<6npercent,jRC CCA:?�350iCFM/tcn !FWDNTMAH }STMS, and'eltfier:HSPP-oi'PSPP'. "
For Packaged Units: Duct leakage0< 6. percent"'
❑ 3. New Duets with/or without `'
Required Forms:
Replacement t ;"
. 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. q.
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 -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)
. 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: Mark Hyde Signature: Mark Hyde
Company: CERTIFIED COMFORT SYSTEMS INC Date: Feb 16, 2012
Address: 42-949 MADIO STREET License: 906115
City/State/Zip: INDIO / CA / 92201 Phone: (760) 360-2202
Reg: 212-A0008548A-00000000-0000 Registration Date/Time: 2012/02/16 15:02:34 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms July 2010
Bin #
Permit # (n
Project Address:
A. P. Number:
Legal Description:
Contractor. e- IS
Address: Z tj
City, ST, Zip:
t?
Telephone:
State Lic. #
Arch., Engr., Designer:
Address:
--------------
City, ST, Zip:
Telephone:
---------------
State Lic. #:
Name of Contact Person:
----------------
Telephone # of Contact Person:
# Submittal
Plan Sets
Structural Calcs.
Truss Calcs.
Energy Calcs.
Flood plain plan
Grading, plan
Subcontactor List
Grant Deed
I1.0.A. Approval
IN ROUSE: -
Planning Approval
Pub. Wks. Appr
School Fees
G
CA
,2 -zo'z-
ity of La Quinta
Building & Safety Division
1'•0. Box 15041 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Owner'sName.
Address: en/� O
AVe/rt
City, ST, Zip: r' !
G Z 7-5
Telephone:
Project Description:
�t vvt t?t�
City Lic. #:
Construction Type:
Occupancy:
Project type (circle one):
New Add'n Alter r Re ai
P' Demo
Sq. Ft.:
# Stories:
# Units:
Estimated Value of Project: 600-
APPLICANT: DO NOT WRITE BELOW THIS LINE
TRACKING
Plan Check submitted
PERMIT FEES
.
Reviewed, ready for corrections
Item
Amount
Plan Check Deposit
Called Contact Person
Plan Check Balance
Plans picked up
Construction
Plans resubmitted
Mechanical
2°e Review, ready for corrections/issue
Electrical
Called Contact Person
Plumbing
Plans picked up
S.M.I.
Plans resubmitted
Grading
34 Review, ready for corrections/Issue
Developer Impact Fee
Called Contact Person
A-I.P.P.
Date of permit issue
Total Permit Fees