11-0177 (MECH)P.O. BOX 1504 4
.78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
. FAX (760) 777-7011
INSPECTIONS (760) 777-7153
LICENSED CONTRACT 'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under ro isions of Chapter 9 (commencing with
Section 700 1 of Division 3 of the Business Profebfsio�faIs C d anq my License is in full force and effect.
Linens ass• C20 -C43 'Lice N 2765861
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 itsissuance, 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 1$5001.:
(_) 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 1, 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.).
(_ 1 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
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.
V, 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 INS CO OF WEST Policy Number WSD216397403
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 beco a subjvkto the workers' compensation laws of California,
and agree that, if I should becom ubject o t workers' co pensation provisions of Section
`37 0 of the Labor.0 de I shat ith o y with those ovisions.
te, App nt:
WARNING: FAILU TE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS 1$100,0001. 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 informs 's correct. I agree to comply with all
city and county ordinances and state laws relating to bu' 'ng nst trio , an hereby authorize presentatives
of thi oun o f 1ler upon the above-mentioned e f i ction ur es.
ate � I f Si ure (Applicant or Agent)
11
/A� Dan: —2 -/--Application
Number:lAlr'0000017-7-
Owner:
Property Address:
54610RIVIERA
PAUL ORNBAUN
PEF
APN:
775.-031-040- - -
54610 RIVIERA
3
Application description:
MECHANICAL
LA QUINTA, CA 92253
21;11
d
Property Zoning:
LOW DENSITY RESIDENTIAL
CCT`�ty� "_
LA*AUI--T.,A------••J11
Application valuation:
29467
F
Contractor:
Applicant:
Architect or Engineer:
DESERT AIR CONDITIONING,
INC.
590 WILLIAMS ROAD
PALM SPRINGS, CA 92264
Q�
(760)323-3383
Lic. No.: 276586
LICENSED CONTRACT 'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under ro isions of Chapter 9 (commencing with
Section 700 1 of Division 3 of the Business Profebfsio�faIs C d anq my License is in full force and effect.
Linens ass• C20 -C43 'Lice N 2765861
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 itsissuance, 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 1$5001.:
(_) 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 1, 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.).
(_ 1 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
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.
V, 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 INS CO OF WEST Policy Number WSD216397403
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 beco a subjvkto the workers' compensation laws of California,
and agree that, if I should becom ubject o t workers' co pensation provisions of Section
`37 0 of the Labor.0 de I shat ith o y with those ovisions.
te, App nt:
WARNING: FAILU TE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS 1$100,0001. 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 informs 's correct. I agree to comply with all
city and county ordinances and state laws relating to bu' 'ng nst trio , an hereby authorize presentatives
of thi oun o f 1ler upon the above-mentioned e f i ction ur es.
ate � I f Si ure (Applicant or Agent)
11
Application Number . . . . . 11-00000177
Permit . . . MECHANICAL
Additional desc .
Permit Fee . . . . 66.00
Plan Check Fee
16.50
Issue Date
Valuation . . . .
0
Expiration Date 8/17/11
Qty Unit Charge Per
Extension
BASE
FEE
15.00
2.00' 9.0000 EA MECH
FURNACE <=100K
18.00
2.00 16.5000 EA MECH
B/C >3-15HP/>100K-500KBTU
33.00
----------------------------------------------------------------------------
Special Notes and Comments
INSTALL 2 NEW SPLIT SYSTEMS, 19
& 16
SEER RESPECTIVELY IN EXISTING LOCATION.
2010 CODES.
-----------------------------------------------------------
Other Fees BLDG STDS ADMIN (SB1473)
------------
2.00
Fee summary Charged
---------- ----------
Paid Credited
------ - -------------
Due
-----------------
Permit Fee Total 66.00
.00 .00
66.00
Plan Check Total 16.50
.00 .00
16.50
Other Fee Total 2.00
.00 .00
2.00
Grand Total 84.50
.00 .00
84.50
LQPERMIT
02/18/2011 08:11 7603238983
DESERT AIR PAGE ,03/03
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC
Alterations CF-iR-ALT-HVAC
Climate Zones 10 - 3 5
Site Address:
54-610 Riviera La Quiflta, CA 92253
Enforcement Agency:
City of La Quinta
Date:
Feb 18, 2011
Permit
Equipment Typel
List Minimum EfficlencyZ
Duct insulation
requirement
Conditioned Floor
Area
Thermostat
❑ Package Unit;
0 Furnace
PI Indoor Coil
D AFUE go%
�; SEER �0
[3 COP
HSPF
0 R 6 (C7 10.13)
❑ R 8
Ser-ved,by system
0 Setback
res ant,
LTJ Condensing Uiit
❑ Other
Cj EER
[] Resistance
(CZ 14-1 s)'
�sf�
must be Installed)
1. Equ/pment TyP43: Choose the eQuipment being Installed; Kmore than one system, use another CF -IR -ALT -HVAC for each system.
2, IN/nimum Equipment E'/r/clencles: 13 SEER, 78% AF11E, 7.7HSPF for typical residential systems.
"ERS VERIFICATIONI 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 riork 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 -411 forms (no hand flllcd CF-4Rs allowed) arc filled out and sign ed.BegInn Ing
October 1, 2010, a registered copy of the CF -1R and C1F-6R shall also be on site for final inspection.
0 1. "VAC Chaligeout
Required Forms:
. All HVAC Equipment
CF -6R forms: MECH-04, ME -CH -21 -HERS and (for split systems) MECH-25-HERS
replaced
CF -4R forms: MECH-21 and (for split systems) MECH-25
. Condenser Coil and /or* Indoor CF -6R forms: MECH-04, MECH-2I-HERS and (fors lit stems MECH-25-HERS
SII enc /or )
. Furnace CF -4R forms;: MECH-21 and (for split systems) MECH-2S
For Split Systems: Duct leakage < 15 percent; RC, CCA 5 300 CFM/ton (Minimum Air Flow Requirement), TMAH
For Packaged Units., Duct leakage < 15 percent
Exempted from duct le -,gage testing if:
O I. Duct system was documented to have been previously sealed and confirmed through HERS verification, or
❑ 2. Duct sy!:tems with less than 40 linear feet in unconditioned space, or
❑ 3. Existltrg ductr y ems are Constructed; irrsulated,�r sealed vrlttnasbestps
❑ 2. Ne*elVAC
Requlred•Fot441!s:
system;
. Cut irilttr.Chanceout ; '
with ducts (all:
CF 6R.ft)rtn li'MECH-04, MEt�-2fl-HERS, hd"(kfr,split SyStElfiSl) MECH-22-HiR5, and.
new dtpi'�in9>�1'alh:::t
new a ui rit
q►► )
I CHg5-•H1 R i
L iFI`�xlrms: MECH 2H; acid t lr:sDllt sy5t�i9YF) kkl-1-2Z �and:MECH `ZS .... .
v;
For Split Systems: Duct Itakage 6 percent; RC, CCA.Z 350 CFM/ton, FWD, TMAH, STMS, and either HSPP or PSPP.
For Packaged Units: Duct leakage < 6 percent
❑ 3. ROw Ducts with/or without
Required Forms:
Replacement
. Includes replacing or installing all
new ducting and/or outdoor
condensing unll and/or Indoor coil
CF -611 forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS
and/or furnace. No or some
CF -4R forms: MECH-20 and (for split systems) MECH-25
equipment changed.
For Split Systems: Duct leakage < 6 percent; RC, CCA 2! 300 CFM/tan, TMAH
For Packaged Units: Duct leakage < 6 percent
❑ 4. New Ductlflg over 40 feet
Required Forms:
. Includes adding or replacing more
than 40 linear feet of duct in
CF -6R forms: MECH-04, MECH-2I-HERS
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 Certlflcate of Compllance documentation Is accurate and complete.
• I am eligible unde- Division I of the California Business and Professions Code to accept responsibility for the design Identifled on this
Certificate of CamAlance.
. I certify that the energy Features and performance specifications for the design Identified on this Certificate of Compliance conform to
the requirements .)f Tltle 24, Parts 1 and 6 of the California Code of Regulations.
a The design features Identified on this Certiricate of Compliance are consistent with the Information documented on other applicable
compliance forms, worksheets, calculations, Dlans and speclficatlons submitted to this enforcement agency for app'oval With the permit
aDplication.
Name: Jacqueline Zabik signature: Jacqucllme Zablk
Company: DESERT' AIR CONDITIONING INC Date: Feb 18, 2011
Address: 590 WILLIAMS ROAD License: 276586
City/State/Zip: PAI - M SPRINGS / CA / 97.264 Phone: (760) 323-3383
R
Reg: 7.11-A0009734A-00000D00-0000 Registration Date/Time: 2011/02/18 11:20:56 HER!; Provider: CAICBRTS, Inc.
2008 Residential ComPli•rnco Forma July 2010
02/18/2011 08:11 7603238983 DESERT AIR PAGE 02/03
Simplified Prescriptive CeIrtlficate of Compliance: 2008 Residential HVAC
Alterations CF-iR-ALT-HVAC
Climate Zones A0- IS
Site Address:
54-610Riviera La Qulnta, CA 92253
Enforcement Agency:
City of La Quinta
Date:
Feb 18, 2012
Permit*:
Equipment Typel
List Minimum Efflclency2
Duct insulation
requirement
Conditioned Floor
Area
Thermostat
Ej Package Unit
® Furnace
R Indoor Coil
0 AFUE 95%
[ SEER Y
L] COP0
(] HSPF
ElR 6 (CZ 10.13)
Served by system
Setback
If not already present,
E5 Condensing U-iIt
CJ Other
[i EER
(� Resistance
C1m
R 8 (C2 14-15)
QQsf
must be Installed)
1. Equipment Type: Chorrse the equ/pment NINO installed; If more then one system, use another CF -Ill -ALT -HVAC for each system.
2. Minimum Equipment EA4cfernclest 13 SEER, 7845 AFVc, 7.7HSPF for typtral resldentlaI 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 form! shall be left on Site for final inspection and a copy given to the homeowner. At final, the inspector
verifies that the viork 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 -411 forms (no hand filled CF-4Rs allowed) are filled out and signed Beginning
October 1, 207.(►, a registered copy of the CF -1R and CF -6R Shan also be on site for final insoectlon.
0 1, HVAC Charigeout
Required Forms:
• All HVAC Equipment
CF -611 forms: ME -CH -04, MECH-2I-HERS and (for split systems) MECH-25-HERS
replaced
CF -411 forms: MF.CH-21 and (for'split systems) MECH-25
• Condenser Coil and /or
• Indoor Coll arc /or
CF -6R forms: MECH-04, MECH-2I-HERS and (for split sys MECH-z5-HERS
.
. Furnace
mtems)
CF -4R fore: MECH-21 and (for split systems) MECH-25
For Split Systems; Duct leakage < 15 percent; RC, CCA 5 300 CFM/ton (Minimum Air Flow Requirement), TMAH
For Packaged Units: Duct leakage < 15 percent
Exempted from dict leagage testing If:
❑ 1. Duct sw tem 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
Q 3. Exlstkrg tfl>» ,1Wv ems ane,cpnstructeC;`Rlsulated. ,•seated w ®rstrestos ,r,o- •..ir;;nt s f.:,. •: ^,.
❑ 2. NevliINVA,C
Requirei?3Forift: ;: •: i ;,. ,
system.
C0iYR.•#osis; MECH-04 ME 10
-HERS
( -HERS, dei '(ftlh SPlit syst�rfis) MECH-22-T RS, arid,
I ;. . :
. Cut Iff"dr" Ch ane:tout
6h-Wducts (alk;"
new dt3Lfin9�1°211
new equ$FriFt)
1 4R.ftWms' pi 2d, Oil .spilt syslitrlk) MkH-22; dhd;MECH'-$5,
For Split Systems: Duct leakage < 6 percent; RC, CCA a 350 CFM/ton, FWD, TMAH, STMS, and. either HSPP or PSPP.
For Packaged Whits: Duct leakage < 6 percent
❑ 3. New Ducts with /or without
Required Fortes:
Replacement
. Includes replacing or Installing all
new ducting ani/or outdrmr
and/or indoor toll
condensingNo
CF -6R forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS
and/or furnace. or sorra
CF -4R forms: MECH-20 and (for split systems) MECH-25
equipment changed,
For Split Systems: Duct leakage < 6 percent; RC, CCA Z 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 linear f -et of duct in
CF -611 forms: MECH-04, MECH=21-HERS
unconditioned space.
C
CF -4R forms: MECH-21
For split system or packaged units: Duct leakage < 15 percent
C] EXCEPTION: Existing duct systems constructed, Insulated or sealed with asbestos.
Contractor (Do0imentation Author's /Responsible Designer's Declaration Statement)
. I certify that this f_ertllicate Df Compliance documentation 1.9 accurate and complete.
. I am eligible under Division 3 of the California Business and Professions Code to accept responslbrllty tar the deslon identified on this
Certificate of Compliance.
• I certify that the Energy features and performance specifications for the design Identified on this Certificate of Cornpllance conform to
the reauirements 3f ntie 24, Party i and 6 or the California Code Regulations.
of
• The design features Identified on this Certincate of Compliance are consistent with the information documented on other applicable
Compliance Forms, woriaheels, calculations, plans and specificatlons submitted to the enforcement agency for approval with the permit
application.
Name: Jacqueline ZaDIK Signature: Jacquelir. Zabik
Company: DESER" AIR CONDITIONING INC Date: Feb 16, 2011
Address: 590 WILI-IAMS ROAD License: 276586
Clty/State/Zip: PALM SPRINGS / CA / 92264 Phone: (760) 323-3383
Reg: 211-A00097:3A-0()000000-0000 Registration Date/Time: 2011/02/18 11:19;10 HERS Provider: C&ICERTA, Inc.
2008 Re.si.dentinl Compliance Forms Jvly 2010
02/18/2011 08:11 7603238983 DESERT AIR PAGE 01/03
Din #
City of La Quinta
boding St Safety DUslon
permit9i P.O. Box 1504, 78-495 Calle Tampku
v 12 Quina, CA 92253 - (760) 777-7012
i wilding Permit Application and Tracking Sheet o OJ ft J
Project Address:l '
i Owner's Name: �
A. P. Number: Addr=-
Legal Description: Citi', ST, Ztp:
Contractor: Deser t Air Conditioninct Ing, Telephone: ��
l
Andress: 5 9 0 Li' i l l i a m S Rd project Description: a e �• T'
City, ST, 72; p !1L_Snc,
Telephone: (760 3�3-3383LL
stateuc_#: 276586 CRY Lie.M 363
Arch., EW., Designer:
r ke
Address;
City, ST, Zip:
Tcicphone: _
State Lie- 0:
Name of Contact Pcrse n:o a a
@ jQ. Zqb ; k
Gonshvcnion Type: Occupancy:
project type (circle one): Now Add'n (AIp Repair Demo
Sq. FL:
0 Stories:
#1 Units:
Telephone # of Contac t Persc•n:(7 6 0) 323-3383
Fzdmated Value of Project:
APPLICANT; DO NOT WRITE BELOW THIS LINE
#
Submittal
H"'d
Ree'd
TRACKNG
MRMI:TFM
Plan Sets
Plan Check submitted
Item
Amount
Structural CIM
Reviewed, ready for eorrecdons
Plan, Check Depwit
Truss Calm
Called Contact Perwn
Pian Cheek Aolanee
Title 24 Cales.
Plains picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
Zee Review, ready fbr correctlonsftue
Electrical
SubWntactor Llsl
C111ed Contactrersou
Plumbing
Grant Deed
Plana picked op
S.M.I.
H.O.A. Approval
Pone+ resnbmitted
Grading
IN HOUS11:.
'"' Review, ready for eorreetioWinue
Developer impact Fee
Planning Approvid.
Called Contact Person
AXP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees