13-0329 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
13-00000329
Property Address:
.54460 RIVIERA
APN:
775 -031 -052 -
Application description:
MECHANICAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
8375
Applicant: Architect �or Engineer:
------------------
LICENSED CONTRACTOR'S DECLARATION
d64 '4
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
e
j
Owner:
WRAY WILLIAM/RITA
54460 RIVIERA
LA QUINTA, CA 92253
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 Code, and my License is in full force and effect.
LicenseC ss: 20-C36 /\n LicenseNo.: 481393
Date,: 14 r 7 Contractor:
C/ 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).:
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.).
(_ I 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: 3/20/13
Contractor. k221 MAPLE LEAF PLBGQZ\OND 0 2013P.O. BOX 3653PALM DESERT, CA(760)346-67581FiNA�iCFfj��-PTINT��--
Lic. No.: 481393
-----------------------------------------------
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
/j issued.
I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
"1— Code, for the performance of the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier BBSI Policy Number 2246
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 s lect to the workers' compensation provisions of Section
3700 of the LaboP4't5 e, h;? fo comply with those provisions.
Date 9 Applicant:.
JI " tP(n
`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 relatin 'Iding con u i n, and hereby authorize representatives
of this co ty t enter upon the above-mentione prope y r i p i n purposes.
Date: i b )7 Signature (Applicant or Agent):
Application Number 13-00000329
Permit . . MECHANICAL
Additional desc .
Permit Fee 42.50 Plan Check Fee
10.63
Issue Date . . . . Valuation
0
Expiration Date 9/16/13
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 >3-15HP/>100K-500KBTU
16.50
-------------------------------------------------------------------------•---
Special Notes and` Comments
HVAC CHANGE -OUT - REPLACE WITH NEW 5 TON
AIR CONDITIONER AND CONDENSOR AND 110K
BTU FURNACE. CARBON MONOXIDE ALARM(S) TO
BE INSTALLED PRIOR TO FINAL INSPECTION.
2010 CALIFORNIA BUILDING 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
LQPEIN11T
Prescriptive Certificate of Compliance: Residential CFA R -ALT
Residential Alterations Page 1 of 7
Project Name: Climate Zone # of Stories
lA) 1 G.wi UJv'L,,
General Information:
Site Address: 5-q — y bc)
Date
Enforcement Agency:
2cy % 3
Building Type: WSingle Family ❑ Multi Family
Front Orientation: ❑ N ❑ E W ❑ S
Project Type: ❑ Alteration ❑ HVAC Replacement ❑ Duct Replacement ❑
Conditioned Floor Space (CFS): -Cy-%7 -5
NOTE: This form is not to be used for new construction or additions.
HVAC Systems — Heatin
:
Duct Insulation
Thermostat
Configuration (Split
Equipment Type
Capacity
AFFU/E'
HSPF
R -Value
Type
or Package)
HVAC Systems — Coolin
:
Pipe Insulation
Thermostat
Configuration (Split
Equipment Type
Capacity
SEER
EER
R -Value
Type
or Package)
.-v V4
HERS Verification Summary:
Duct Sealing & Testing — HERS verification is required for this measure.
❑ Yes ❑ No In Climate Zones 2 and 9-16, if more than 40 linear feet of new or replacement ducts are installed in unconditioned
space, the ducts are to be sealed per §152(b)1Dii and the newly installed ducts are to be insulated per §151(f)10.
❑ Exception: Existing duct systems that are extended, which are constructed, insulated or sealed with asbestos.
❑ Yes ❑ No In Climate Zones 2 and 9-16, if the existing space -conditioning system (HVAC equipment and ducting) is replaced,
the ducts are to be sealed per §152(b)1 Di.
the
Yes El In Climate Zones 2 and 9-16, if the existing HVAC equipment is replaced (including the replacement of air
handler, outdoor condensing unit of a split system, cooling or heating coil, or the furnace heat exchanger) the ducts
are to be sealed per §152(b)1 E.
❑ Exception: Duct systems that are documented to have been previously sealed confirmed through HERS
verification in accordance with procedures in the Reference Residential Appendix RA3.
❑ Exception: Duct systems with less than 40 linear feet in unconditioned space.
❑ Exception: Existing duct systems are constructed, insulated or sealed with asbestos.
frigerant Charge — Split System — HERS verification is required for this measure.
Yes ❑ No In Climate Zones 2 and 8-15, when the existing HVAC equipment is replaced (including the replacement of the air
handler, outdoor condensing unit of a split system A/C or heat pump, cooling or heating coil, or the furnace heat
exchanger) a refrigerant charge measurement shall be verified per §152 b 1 F.
Central Fan Integrated (CFI) Ventilation System and Fan Watt Draw
The ventilation requirements of §150(o) do not apply to existing residential homes.
gucted Split Systems — Air Conditioners and Heat Pumps: Airflow — HERS verification is required for this measure.
1�l.Yes ❑ No In Climate Zones 10 through 15, when the existing space -conditioning system (HVAC equipment and ducting) is
I replaced, the airflow and fan watt draw shall be verified per 152 b 1 Ci to meet the requirements of §151(07B.
Documentation Author's Declaration Statement
I certify that this Certificate of Compliance documentation is accurate and com le
Name: _
Signature:
G G4 --
Company: �e,
Date: 3 116
Address: U
•-s- 3
7�
City, State, Zip Code:
Phon (v� -2
Registration Number:
2008 Residential Compliance Forms
Registration Date & Time: HERS Provider:
PDAC January 2010
MAPLE LEAF .PLUMBING,
HEATING AND AIR CONDITIONING, INC.
P.O. Box 3653
PALM DESERT, CALIFORNIA 92261
(760) 346-671� 9
Lic. #461393
SALLIBMITTED TO
+
STREET,')
( JOB NAME
CITY, STATE, AND ZIP COE JOB LOCAL
JA v..r 4,4 q Wiz- ✓ 3
A A # 37,
ACCEPTANCE
®TY. TYPE SIZE ENERGY RATING MAKE
MODEL
c{ vay t' -p
'Z- i3 3
S_J 0 111-1 V
Parts warranty
Compressor warranty--�✓\,
Heat exchanger warranty "f W -a
Labor warranty I&P ioN 14,
D .
❑ Modifications of Supply Plenum ❑ Return Plenum
❑ Fabricate New Supply Plenum ❑ Return Plenum
❑ New Supply Register ❑ Bar ❑ Curved Blade City._
❑ New Return Grille ❑ Filter Grille ❑ Non Filter
X Hook Up to Existing Duct Work
❑ Disconnect Box
❑ Other
'K'Use Existing
❑ Condensate ❑ Primary ❑ Secondary ❑ Copper
❑ PVC ❑Attic Safety Pan Cost_
❑ Refrigerant Lineset
❑ Vent Pipe Size: ❑ Single ❑ Double
❑ Gas Line ❑ Flex ❑ Pipe To From
Use Existing
a
❑ Condenser Pad ❑ Crane ❑ Large Crane
All work performed in a neat and professional manner. Job
site will be clean at the conclusion of each day's work and
all debris removed from the premises.
❑ 30 Amp. ❑ 60 Amp. ❑ Other
®• a ,ee s
❑ High Efficient Air Filter
❑ Humidifier
Thermostat Q j
❑ Attic Safety Pan
❑ Condensate Pump
❑ U.V. Lights
NOTICE TO OWNER: Contractors are required by law to be licensed and regulated by the
contractors' state license board. Any questions concerning a contractor may be referred to the
registrar of the board whose address is: Contractors' State License Board, 9821 Business Park
Dr. Sacramento, CA 95827
Proposal does not cover:
Customer Signature: -
Maple Leaf Signature:
All material is guaranteed to be as specified. All work to be completed in a workman -like
manner according to standard practices. Any alteration or deviation from above specifications
involving extra costs will be executed only upon written orders, and will become an extra charge
over and above the estimate. All agreements contingent upon strikes, accidents or delays
beyond our control. Owner to carry fire, tornado and other necessary insurance. Our workers
are fully covered by Workman's Compensation insurance.
❑ Vibration Pads ❑ ISO Pad ❑ Ball Suspension
❑ Use Existing Platform
❑ Build Roof Curb ❑ Sheet Metal Cap
❑ Modify Existing Platform
Your New System Price is ..................................
Options..............................................................
State Required 4�actTiesting and Permits...........
Rebates ................
Factory Rebates .................................................
Other..................................... :.......... :..................
Total....................................................................
Payment Terms: A10 % down, balance upon completion
❑ Credit Card ❑Check #
Balance due up o c letion
Customer Sig..- Date:
i t
Maple Leaf Sig.: Date: ` t
Bin.#
Qty Of ic7 Quthtd
Bufldfng 8r Safety Duron
P.O. Box 1504,78-49S Caffe Tampico
La..Quinta, CA 92253 -:(760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
f �7
Project Address: 5' -
Owner's Name:.
A. P. Number.
Address: '1 Ll eD G 2 L) -.R 4-(,
Legal Description:
Contractor. a �X 4 I," i' ^
City, ST, Zip: C ✓� �( 2�-S3
Telephone:
Address: �_ U �v� ^Ye _J__3
Projei4 Description: �.7 .-- 47 ,„_
City, ST, Zip: IP4 1 k- Yv)r Ct/j- q t't-GP G
�+
� "2N �'v �,� lv,
Telephone: 01-0) 3 We 7 -is
State Lia # : 4913/3 City Lic. #:
�r « �J�%► c�
Arch, Eng., Designer.
UU 1 L CCJVJQJ A
Address:
City, ST, Zip:
Telephone:
State Lic: #:
Name of Contact Person: —1- G JZ6
'Construction Type:. Occupanry:
Project type (circle one): New Add'n Alter Repair Demo
Sq. a: !v # Stories: __F# Unit$:
Telephone # of Contact Person: (J g j 0 2 1-
Estimated Value of Project: 6 . 7j
APPLICANT: DO NOT WRITE BELOW THIS LINE
Req'd
Reed
TRACICIIIG PERMIT FEES
FNSubmittal
Plan Sets
Plan Check submitted Item Amount'
Structural Cales.
Revkwed, ready for corrections Plan Check Deposit. .
Truss Cala.
Called Contact Perron Pian Geek Balance
Title 24 Cala.
Plans picked up Construction
Flood plain plan
Pians resubmitted.. Mecharikal
Grading plan
2`! Review, ready for correctionslissue Electrical
Subcontactor List
Called Contact Person Plumbing
Grant Deed
Plans picked up
H.O.A. Approval
Plans resubmitted Grading
IN HOUSE:-
''` Review; ready for correctionManc Developer Impact Fee
Planning Approval
Called Contact Person v A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees