13-0154 (MECH)a-
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 13-00000154
Property Address: 80176 RIVIERA
APN: 762 -130 -023 -
Application description: MECHANICAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 6000
Applicant:
VT
''
Architect or Engineer:
O\N
LICENSED CONTRACTOR'S DECLARATION
VOICE (760) 777-7012
FAX (760) 777-7011
BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
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
Dat eiZ 11 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
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.:
l _ 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 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.).
(_) 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:
LQPERMrr
Owner:
BURNS JOHN D
80176 RIVIERA
LA QUINTA, CA 92253
(
Contractor:
GENERAL AIR CONDITIONING
31170 RESERVE DRIVE
THOUSAND PALMS, CA 92276
(760)343-7488
Lic. No.: 686310
Date: 2/11/13
tFE5 112013
' CITY OF lA QUINTA
FINANCE DEPT.
-----------------------------------------------
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.
' 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, 1 shall forthwith comply with those provisions. -
Date: Zt (.3 Applicant:C.��a�'
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:"-jj 11 r3 Signature (Applicant or Agent)",�
I
Application Number . . . . . 13-00000154
Permit . . . MECHANICAL
Additional desc . .
Permit Fee . . . . 32.50 Plan Check Fee 8.13
Issue Date Valuation . . . . 0
Expiration Date 8/10/13
Qty Unit Charge Per Extension
BASE FEE 15.00
1.00 11.0000 EA MECH FURNACE ->100K 11.00
1.00 6.5000 EA MECH OTHER MECH EQUIPMENT 6.50
----------------------------------------------------------------------------
Special Notes and Comments
REPLACE 110K BTU FURNACE & COIL. 2010
CODES.
------------------------------- :
Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00
Fee summary Charged
Permit Fee Total 32.50
Plan Check Total 8.13
Other Fee Total 1.00
Grand Total 41.63
LQPPRNI[T
Paid
Credited
Due
----------
.00
---------- ----------
.00
32.50
.00
.00
8.13
.00
.00
1.00
.00
.00
41.63
Bin.#
Ot}r 0f I.C>< Qt11n
Bulfding 8[ Safety Division
P.O. Box 1504,78-495 Calle Tamplco
Ia.Quinta, CA 92253 -:(760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: FS O 1�
Owner's Name:. vrr� 5
A. P. Number.
Address: iz: v
Legal Description:
City.ST Zip : /� . �t ZZ53
L�.Q�:r•�� c
Contractor. e-\,-\e_c-c-\
Telephone:
Project Description:
Address: 31170 1Ceg�rYe. �� ,
City, ST, Zip:T�NOVSo_Y\ciImS CA gZZ7b.
Re cc-e- 11o1L i�7\,r�ncc_e ��'
Telephone: 76o-3143-7L/88 .
State Lic. #: (18b 3 (o City Lic. #c
Arch, Engr., Designer.
Address:
City., ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo .
Sq. Ft.: # Stories: # Univ:
Telephone # of Contact Person:
Estimated Value of Project (a OCX7
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Pian Sets
Req'd
Recd
TRACKNG
Plan Check submitted
PERI T=FEES
Item Amount
Structural Calcs.
Reviewed, ready for corrections
Pian Check Deposit. .
'buss Cales.
Called Contact Person
Plan Check Balance
Title 24 Calci.
Plana picked up
Construction
Flood plain plan
Plans resubmitted
Meeharikal
Grading plan
2� Review, ready for correctionstissue
Elecbical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
''' Review, ready for correctionailime
Developer Impact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit Issue
School Fees
Total Permit Fees
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF -IR -ALT -HVAC
Climate Zones 10 to 15
Site Address:
Enforcement Agency:
D-� e:11
Permit #:
Zorn. {��Y1�L`
O L0. L 0-
l3
Conditioned Floor
Equipment T et
List Minimum Efficiency2
Duct insulation requirement
Area
Thermostat
Packaged Unit'
Furnace
� AFUE7H� p
� COP
copHSP
Over 40 ft of ducts added or
� Setback
Indoor Coil
IndoorofUnit
Condensing
SEER
EER
El Resistance
replaced in unconditioned space
R 6 (CZ 10-13)
Served by system
37c� sf
(Ifnot already
present, must be
R 8 (CZ 14-15)
installed)
Other
1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -/R ALT -HVAC jor 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 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 registered copy of the CF -1R and CF -6R shall also be on site for final inspection.
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 (fors lit stems) MECH-25
• Condenser Coil and/or
CF -6R forms: MECH-2I-HERS and (for split systems) MECH-25-HERS
• Indoor Coil and/or
CF -4R forms: MECH-21 and (for split systems) MECH-25
• Furnace
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:
e1. 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
CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-HERS
ducts: (all new ducting and all
CF -4R forms: MECH-20, and (for split systems) MECH-22, and MECH-25
new equipment)
For Split Systems: Duct leakage < 6 percent; RC, CCA > 350 CFM/ton, FWD, TMAH, STMS, 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
CF -4R forms: 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
CF -6R forms: MECH-04, MECH-2I-HERS CF -4R forms: MECH-21
linear feet of duct in unconditioned space.
For splits stem or packaged units: Duct leakage < 15 percent
EXCEPTION: Existing ducts stems constructed, insulated or sealed with asbestos.
Contractor (Documentation Author's /Responsible Designer's Declaration Statement)
• I certify that this Certifioate 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 a enc forapproval with the it application.
Name:
Signature: C,
�r1 i
Company: GeAir Ca :�;
Date:
-4 V �3
h,ex�l
Address:
License:
City/State/Zip: ^\ YYIS CAs 9ZZ7io
Phone: -7(,0- 31,1,3 --1qaa
2008 Residential Compliance Forms July 2010