13-0388 (MECH)<_�:
P.O. BOX 1504 '
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 13-00000388
Property Address: 54835 RIVIERA
APN: 775-031-003- -
Application description: MECHANICAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 14000
Applicant:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
BEN MOXON
- LA QUINTA, CA
(
Architect or Engineer:
92253
Contractor:
GENERAL AIR CONDITIONING
31170 RESERVE DRIVE
THOUSAND PALMS, CA 92276
(760)343-7488
Li c. No.: 686310
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/01/13
o �a
D
0F QUi��A
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_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ —
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 Division 3 of the Business and Professionals Code, and my License is in full force and effect.
License Class: C20 License No.: 686310
Date, 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
Licenso 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 (5500).:
(_ I 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 buildsor 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 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:
lender's Address:
{-LQPBRMIT
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 ZENITH INS CO Policy Number Z071741502
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 Code, I shall forthwith comply with those provisions.
Date: 1 ;ant: '
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 relating to building construction, and hereby authorize representatives
of this county to enter upon the above-mentioned property for inspection purposes.
Date Cyi.0 13' Signature (Applicant or Agent): X57"'.2 "
f
Application Number . . . . . 13-00000388
- Permit . . . MECHANICAL
Additional desc .
Permit Fee' 40.50 Plan Check Fee..
10.13
Issue Date . . . . Valuation
0
Expiration Date 9/28/13
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
3 TON PACKAGE UNIT, INCLUDES FURNACE AND
A/C. 2010 CALIFORNIA BUILDING 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
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CIW Of ra Qui(1ta
BAIIng 8f Safety Division
P.O. Box 1504,78-495 Calle Tampico
14 Quanta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit -#
Project Address: 54 9 3
Owner's Name:.1 M
A P. Number
Address: SLVg35 V zV Cl-
iLegal
LegalDescription:
city. ST, tip: GA q ZZ 53
Contractor. er C.� A� %jj
Tdephone:
Address:3117U �e .rye vc.
Project Description: 34r0
C•tty. ST. Zip: 11 `G` fY� �j Ci z Z
Telephone: %b0- 3,43. 714 88
-IL ,� L
Stan Lia # : (v Z l0 310 «ty Lie. 9,
Areft., Eager Designer:
Address:
City. ST. Zip:
Telephone: Construction Type: , Occupatuy:
State Lia S: Project type (cirde one): New Add'n Atter Repair Demo
Name of contact Person:Sq. Ft: #Stories: # Unity
Telephone # of Contact Person: Estimated Value of Project I 1700
APPLICANT: DO NOT WRITE BELOW THIS UNE
N
Submittal
Plan Sets
Req'd
Recd
TRACKING
Plea Ckeck submitted
PERMIT FEES
Item Amount
Strudata! Cala
Reviewed, rady for corrections
Plan Check Deposit. .
Tress Gla.
Called Contact Person
Plan Cheek Balance.
Mde24.Cales.
Placa picked up
Construction
Flood plain plan
Plans resubmitted
Mecia"
Grading plan
2" Review, ready for correctiowAssue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
SM -1
ILOA. Approval
Phos resubmitted
Grading
IN HOUSE:
Review, ready for correctionshme
Devdoper Impact Fee
Planning Approval
Called Contact Person
A.LP,P.
Pub. Wks. Appr
Date of permit Issue
School Fees
Total Permit Fees
3
Sim lified.Prescri tine Certificate of Compliance: 2008 Residential RVACAkerations CF -IR -ALT -HVAC
Climate Zones 10 to 15
Site Address:
EnforeementAgeney:
Date:
Permit#:
i VL
Li C5' La Q nuc.
ti 13
r
Conditioned Floor
Equipment T
List Minimum EfficiencyZ
Duct insulation requirement
Area
Thermostat
P
Packaged Unit
FOver
Furnace
Ja AFUE 78 e
® COP
40 ft of ducts added or
Setback
Indoor Coil
Condensing Unit
SEER 13
®.EER
HSPF
BResistance
re laced m unconditioned space
6 (CZ 10-13)
91R]'
Served by system
22-72 sf
(If not already
present, must be
Other
8 (CZ 14-15)
installed)
L' Equipment 4pe: Choose the equipment being installed• if more than one system, use another CF -IR ALT HVAC for each system
2. Afu:imunt 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 ' tered co of the CF -1R and CF -6R shall also be on site for final inspection.
H 1. HVAC Changeout
Required Forms:
• All HVAC Equipment replaced
CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS
CF -4R forms: MECH 21 and. (for split stems) MECH 25
• Condenser Coil and /or
• Indoor Coil and/or
CF -6R fors: MECH-2I-HERS and (for split systems) MECH-25-HERS
• Furnace
CF -4R fors: MECH-21 and (for split systems) MECH-25'
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 duct systems are constructed, insulated or sealed with asbestos
2. New HVAC System
Required Forms:
• Cut in or Changeout with new
ducts: (all new ducting and all
CF -6R fors: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-HERS
new equipment)
CF4R fors: MECH-20, and (for split systems) MECH-22, and MECH-25
For Split Systems: Duct leakage < 6 percent; RC, CCA > 350 CFM/ton, FWD, TMAH, SIMS, and either HSPP or PSPP.
For Packaged Units: Duct leakage < 6 percent
® 3. New Ducts with 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
CF4R fors: MECH-20 and (for split systems) MECH-25
coil and/or furnace. Not all equipment changed.
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
linear feet of duct in unconditioned space.
CF -6R fors: MECH-04, MECH-2I-HERS CF -4R fors: MECH-21
For splits stem 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 oatify that this Certificate of Compliance documentation isaccurate 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: Sfte_ve.
Signature:
Company -
Date: 411113
Address:
License:
City/State/Zip: 7�_kCACQ 22:7-7&.0�(.
Phone: -�_ 3z4 3,
-/M,w Residential Compliance Forms July 2010