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11-0353 (MECH)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA,- CALIFORNIA 92253 Tiht 4 4 Q" BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Appli I t: Architect or Engineer: A" v ------------------ LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commenyfyg with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in fug!�at effect. License Class: C20 LicenseNo.: 725283 Date: Lf �!� 1t Contractor: L\ sa OWNER -BUILDER DECLARATION _ hereby affirm under penalty of perjury that.) am exempt from the Contractor's State License Law for the following reason (Sec. 7031.5, Business and Professions Coder 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 1$5001.: ( 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.). " (_ 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.). (_ 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 Owner: CHRISTIAN RESIDENCE 55030 RIVIERA 76375 COUNTRY CLUB DR LA QUINTA, CA 92253p Contractor: , AIR EXPERTS AIR PO BOX 94 LA QUINTA, CA 92 (760)777-1724 Lic. No.: 725283 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 4./08/11 ----------------------------------------------- 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 Nu er PAWC120854 I certify that, in the performance of the u4. rk for which this permit is issued, I shall not employ any person in any manner so as to bec a subject%to the workers' compensation laws of California, and agree that, if Is ould beco subject to the workers' compensation provisions of Section `f3700 of the Labor C e I sh hwifFi comply with those provisions. `Date:'- y' & I I'-- Applicant: WARNING: FAILURE TO SECURE W KERS' 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 Ouinta, 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 ation of work for 180 days will subject permit to cancellation. . . ��. I certify that I have read this application and state that the above formation is correct. I agree to comply with all city and county ordinances and state laws relati g to buildlin�Eonstr�tion, and hereby authorize representatives of this county to enter upon the above -mention "prope or ins ection purposes. , Date: H I & I Signature (Applicant or Agent):, Application Number: 1-00000353 L11-00000353 Property Address: 55030 RIVIERA APN: 775-153-074- Application description: MECHANICAL Property Zoning: LOW DENSITY RESIDENTIAL " Application valuation: 6300 Tiht 4 4 Q" BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Appli I t: Architect or Engineer: A" v ------------------ LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commenyfyg with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in fug!�at effect. License Class: C20 LicenseNo.: 725283 Date: Lf �!� 1t Contractor: L\ sa OWNER -BUILDER DECLARATION _ hereby affirm under penalty of perjury that.) am exempt from the Contractor's State License Law for the following reason (Sec. 7031.5, Business and Professions Coder 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 1$5001.: ( 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.). " (_ 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.). (_ 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 Owner: CHRISTIAN RESIDENCE 55030 RIVIERA 76375 COUNTRY CLUB DR LA QUINTA, CA 92253p Contractor: , AIR EXPERTS AIR PO BOX 94 LA QUINTA, CA 92 (760)777-1724 Lic. No.: 725283 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 4./08/11 ----------------------------------------------- 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 Nu er PAWC120854 I certify that, in the performance of the u4. rk for which this permit is issued, I shall not employ any person in any manner so as to bec a subject%to the workers' compensation laws of California, and agree that, if Is ould beco subject to the workers' compensation provisions of Section `f3700 of the Labor C e I sh hwifFi comply with those provisions. `Date:'- y' & I I'-- Applicant: WARNING: FAILURE TO SECURE W KERS' 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 Ouinta, 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 ation of work for 180 days will subject permit to cancellation. . . ��. I certify that I have read this application and state that the above formation is correct. I agree to comply with all city and county ordinances and state laws relati g to buildlin�Eonstr�tion, and hereby authorize representatives of this county to enter upon the above -mention "prope or ins ection purposes. , Date: H I & I Signature (Applicant or Agent):, Application Number 11-00000353 Permit . . . MECHANICAL Additional desc . Permit Fee . . . . 40.50 Plan Check Fee 10.13 Issue Date . . . . Valuation . . . . 0 Expiration Date 10/05/11 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 Special Notes and Comments FURNACE AND•CONDENSING UNIT CHANGE OUT 16 SEER 5 TON UNIT. ------------------------------------------------------------------------------ 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 Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-1R-ALT-HVAC Climate Zones 10 - 15 Site Address: Enforcement Agency: Date: Permit #: 55-030 Riviera La Quinta, CA 92253 City of La Quinta Apr 8, 2011 Equipment Type1 List Minimum Efficiency2 Duct insulation requirement Conditioned Floor Area Thermostat ❑ Package Unit p Furnace • Indoor Coil Rl AFUE 78% Q SEER 16.0 ❑ COP ❑ HSPF ❑ R 6 (CZ 10-13) Served by system 0 Setback If not already present, © Condensing Unit ❑ EER ❑ Resistance ❑ R 8 (CZ 14-15) 1800 sf must be 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 Efiiclencles: 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-411 forms (no hand filled CF-411s allowed) are filled out and signed.Beginning October 1, 2010, a registered copy of the CF-1R and CF-611 shall also be on site for final inspection. 0 1. HVAC Changeout Required Forms: . All HVAC Equipment CF-611 forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS replaced CF-411 forms: MECH-21 and (for split systems) MECH-25 . Condenser Coil and /or . Indoor Coil and /or CF-611 forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS . Furnace CF-411 forms: 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: Dud leakage < 15 percent Exempted from dud leagage testing if: ❑ 1. Dud system was documented to have been previously sealed and confirmed through HERS verification, or ❑ 2. Dud 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 Required'Forms: System . Cut in or Changducts: all with new ducts: (all CF-6R.forms..MECH-04, MECH-20-HERS, and (for, split systems) MECH-22 HERS, and new ducting X , all new equipment) MECH-25-HERS CF 4R'forms: MECH 20, and (!Or split systems) MECH-22, a, .MECH 25 For Split Systems: Dud leakage < 6 percent; RC, CCA >_ 350 CFM/ton, FWD, TMAH, SIMS, and either HSPP or PSPP. For Packaged Units: Dud leakage < 6 percent ❑ 3. New Ducts with/or without Required Forms: Replacement . Includes replacing or installing all new ending and/or outdoor condensing unit and indoor coil CF-6R forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS and/or furnace. No orr some CF-411 forms: MECH-20 and (for split systems) MECH-25 equipment changed. For Split Systems: Dud leakage < 6 percent; RC, CCA _> 300 CFM/ton, TMAH For Packaged Units: Dud leakage < 6 percent ❑ 4. New Ducting over 40 feet Required Forms: . Includes adding or replacing more than 40 linear feet of dud in CF-611 forms: MECH-04, MECH-2I-HERS unconditioned space. CF-4R forms: MECH-21 For split system or packaged units: Dud leakage < 15 percent ❑ EXCEPTION: Existing dud 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: Paul Van Vlymen Signature: Paul Van Vlyrnen Company: AIR EXPERTS AIR CONDITIONING-HEATING Date: Apr 8, 2011 Address: PO BOX 94 License: 725283 City/State/Zip: LA QUINTA / CA / 92247-0094 Phone: (760) 777-1724 Reg: 211-AO01755BA-00000000-0000 Registration Date/Time: 2011/04/08 11:39:46 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms July 2010 Bin.# City of. La Quinta Building &r Safety Division , Permit # P.O. Box 1504, •78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 BuildingPermit Application and Tracking Sheet Project Address: 5<--O-bo 9—`i, eza Owner's Name: Q�-A A. P. Number: Address: S,57 b 3 e Legal Description: City, ST, Zip: (� nn 1 Contractor: Y� r rG �� t{ 5 Telephone: Address: P p X q �` Project Description: City, ST, Zip: 6 to Telephoner 1p V `7"x'7 l-7 2 ::4;;,.<•;xa` •,<:<::<::>::<>:::. ..:: i, kt•i:•iii}}is•:Jii:i.i:L.i'•iiv:::..:::::: n•:?. �:: State Lic. #: ?i �• I� City Lic. #.: �an Arch., Engr., Designer: Address: City, ST, Zip: Telephone: P `..;:`• s. '? `'' :tr w •' �'` •.' :;:..;•: ,� �:aw :t.','..�".k�>< Construction Type: Occupancy: State Lic. ,., .`:'.,�2• ;��, Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person: Sq. Ft.:op # Stories: ` # Units: Telephone # of Contact Person: Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'd TRACIGNG PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Pian Check Balance Truss Calcs. Called Contact Person Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2" Review, ready for correctionstissue Electrical Plumbing Subcontactor List Called Contact Person Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- '"' Review, ready for correctionswAssue Developer Impact Fee Planning Approval' Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Ft- Total Permit Fees