13-0363 (MECH):_"IP.O •BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
13-00000363
Property Address:
78600 ALDEN CIR
APN:
604-225-019-102 -23268 -
Application description:
MECHANICAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
7000
Applicant: Architect or Engineer:
•4 4a "
SCANNED
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: • 3/26/13
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: 3 26 13 Contractor
V..
t 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 70001 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).:
(_) 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, 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
1 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:
LQPMMIT
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
�c issued.
�f 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:3 i3 Applicant:
.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 125 Signature (Applicant or Agent): ��--
IIIIIIIIVIIIIIIVIIIIIII
Owner:
49
MCDOWELL ROBERT C &
KELLI
IE
78600 ALDEN CT.
LA QUINTA, CA 92253
(760)409-3066
D
Contractor:
MAR 2 6 2013
GENERAL AIR CONDITION G
u
31170 RESERVE DRIVE
THOUSAND PALMS, CA
�I
92276
(
CITY 05 LA QUINTA
FINA►dCEDEPT.
(760) 343-7488
'
Lic. No.: 686310
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: 3 26 13 Contractor
V..
t 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 70001 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).:
(_) 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, 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
1 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:
LQPMMIT
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
�c issued.
�f 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:3 i3 Applicant:
.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 125 Signature (Applicant or Agent): ��--
IIIIIIIIVIIIIIIVIIIIIII
49
IE
LQPERMIT
Application Number . . . . . 13-00000363
Permit . . . MECHANICAL
Additional desc .
Permit Fee . . . . 40.50 Plan Check Fee
10.13
Issue Date . . . . Valuation . . . .
0
Expiration Date 9/22/13
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
---------------------------------=------------------------------------------
Special Notes and Comments
HVAC - REPLACE 3.5 TON AIR CONDITIONING
PACKAGE & 90K BTU FURNACE, 13 SEER/78
AFUE [2008 ENERGY] CARBON MONOXIDE
ALARM(S) TO BE INSTALLED PRIOR TO FINAL
INSPECTION. 2010 CALIFORNIA BUILDING
-CODES.
----------------------------------------------------------------------------
. Other Fees . . . . . . BLDG SIDS 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
s,r,.
City. of, La Quinta
Bullding.8r Safety Division
P.O. Box 1504, *78-495 Calle Tamplco
La.Qulnta, CA 92253.:(760) 777-7012
Building Permit Application' and Tracking Sheet
Perin,t #
Project Address: '7 $ b cc)
Owner's Name:. ILI
A. P. Number.
Address: '7 a6 C0 /41 eA erg C: r c\c
Legal Description:
Contractor. ere,r-c�\
Address: 3\7 2 e v L �� -
City, ST, ZiP: CSA 4 Z Z3
H
Telephone: 760-409— 306(4
Project Description:
City, ST, Zip: 5 0.A q 227tH
\ace 3. 5- g A L 4! 9o�—'
Telephone: 760.-343--7488;
State Lia # : (,8G'31.0 City Lic, 9,
Arch., Engr., Designer.
Address:
City., ST, Zip:
Telephone:
State Lie. #:
Construction Type:. Occupancy:
Project type (circle one): New. Add'n Alter Repair Demo
Sq. Ft.: # Stories: # Univ:
Name of Contact Person:
Telephone # of Contact Person:
Estimated Value of Project 7, OC:o • c
. APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACICTiHG
PEIthIITFE£S
Plun Sets
Plan Check submitted
item Amount
Structutal Cake.
Reviewed, ready for corrections
Plan Check Deposit, .
Truss Calci.
Called Contact Person
Plan.Check Balance
Title 24 Calci,
Plans picked up
Construction
Flood plain plan
Pians resubmitted.' .
Mechanical
Giading plan
2'" Review, ready for correctious/issue
Electrical
SubcoutactorList
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE-,
''d Review; ready for correctionslissae
Developer Impact Fee
Planning Approval
Called Contact Person
Pub. Wks. Appr -
Date of permit issue
School Fees
Total Permit Fees
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-lR-ALT-HVAC
Climate Zones 10 - 15
Site Address:
Enforcement Agency:
Date:
Permit #:
78600 ALDEN CIRCLE La Quinta, CA 92253
City of La Quinta
Mar 26, 2013
Duct insulation
Conditioned Floor
Equipment Typel
List Minimum Efficiency2
requirement
Area
Thermostat
❑ Package Unit
® Furnace
® Indoor Coil
® AFUE 78%
® SEER 13.0
❑ COP
❑ HSPF
❑ R 6 PCZ 10-13)
Served by system
® Setback
If not already present, must be
® Condensing Unit
❑ EER
❑ Resistance
❑ R 8 (CZ 14-15)
1372 sf
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 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
CF-6R forms: MECH-04, MECH-2I-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 Coil and /or
CF-6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS
. Furnace
CF-4R 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 Pa..1.aged Units- Quiet leakage ; 19
p PA
Exempted from duct leakage testing if:
❑ 1. Duct system was documented to have been previously sealed and confirmed through HERS verification, or
[12. Duct systems with less than 40 linear feet in unconditioned space, or
❑ 3. Existing duct systems are constructed, insulated or sealed with asbestos
❑ 4. The,system,will not be Ducted (ie. Ductless Mini-SplitSystem) -(Also-Exempt �from Refrigerant Charge)
❑ 2. New HVAC System
Required Forms: i*
. Cut in or Changeout with'
CF-6R forms. MECH-04, MECH-20IHERS/and (for split systems) MECH722-HERS, and
new ducts: (all new
ducting and all new a"
MECH-25�HERS
CF-4R forms: MECH-20, and (for split systems) MECH-22; and MECH-25'
equipment) ��
r'7 e
.�r._...r ;
For Split Systems: Duct leakage < 6 percent; RC, CCA 2t 350 CFM/ton, FWD; TMAH, STMS, and either HSPP or PSPP.
For Packaged Units: Duct leakage < 6 percent
❑ 3. New Ducts with/or without
Required Forms:
Replacement
. Includes replacing or installing all new
ducting and/or outdoor condensing unit
CF-6R forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS
and/or indoor coil 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 >_ 300 CFM/ton, TMAH
For Packaged Units: Duct leakage < 6 percent
114. New Ducting over 40 feet
Required Forms:
. Includes adding or replacing more than 40
CF-6R forms: MECH-04, MECH-2I-HERS
linear feet of duct in 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 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: Danielle Garcia Signature: Danielle &orcia
Company: HARRISON ENTERPRISES INC Date: Mar 26, 2013
Address: 31-170 RESERVE DRIVE STE A License: 686310
City/State/Zip: THOUSAND PALMS / CA / 92276 Phone: (760) 343-7488
Reg: 213-A0018056A-000000000-0000 Registration Date/Time: 2013/03/26 13:05:05 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms July 2010
City W -CL Quit.
CHECK NO.
99483 ,
GENERAL AIR CONDITIONING 7055
05/14/2013
DATE INVOICE
ACCOUNT
DESCRIPTION
AMOUNT
05/09/13 BP#13364
101-5000-322-03.00
REFUND
32.40
05/09/13 BP#13364
101-0000-203-06.00
REFUND
1.00
05/09/13 BP#13363
101-5000-322-03.00
REFUND
32.40
05/09/13 BP#13363
101-0000-203-06:00
REFUND
1.00
� g - Loo
66.80
1189948311' 1:12L0002481: 4L5928248211'
Ti4 4 aCP Qaul�
DEMAND / CHECK REQUEST
XXX Return check to requestor
Name / Title of person requesting check
MONIKA RADEVA, SECRETARY
Department individual is associated with:
COMMUNITY DEVELOPMENT DEPARTMENT
Mail check
Check payable to:
ERIC JACOBY; IE INC. c/o General Air Conditioning 33.40
Amount: $
'(Name) (Vendor o.) $32,40 From Acct No. 101-5000-322.-03-00
5858 DOVETAIL DRIVEAccount Number: $1.00 from Acct No.
(Address) 101-0000-203,.06-00
AUGOURA HILLS, CA 91301 Project Number: 1300. PERMIT # 13-364
for 52-630 AVENIDA HERRERA
Check description and invoice number:
The homeowner cancelled the ,fob, the applicant is requesting a refund. Under the 2.010 CA
Bldg. Code Section 10109.6, a refund of 80% of the Permit Fee & 100% of the Imapeat Fee
is authorized. Please see the attached letter.
Sig
-7 t
Date)
APPROVED FOR PAYMENT
(Finance Department Use Only)
BY;
BY:
ACCOUNT NO.
;DESCRIPTION I
May 3, 2013
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253.
Eric Jacoby, owner
IE Inc. c/o General Air Conditioning
5858 Dovetail Drive
Agoura Hills, CA 91301
RE: Permit Refund ,
Address: 78-600 Alden Circle
Permit .13-363
Dear Mr. Jacoby,
4 4a"
Community Development Department'.
Building Division
PH;(760)777-7125
FAX (760) 777-7011
I have reviewed your letter dated April 24, 2013 requesting a refund to the
Mechanical Permit 13-363 due to cancellation by the owner. Under the provisions
of the 2010 California Building Code Section 10109.6 your request is hereby
granted. An 80% refund of the Permit Fee and 100% of impact fee is authorized.
Mechanical Permit of $40.50 x 80% refund ...... = $32.40
Acct. 101-5000-322.03-00
Building Standards Fee of $1.00 x 100% refund .= $1.00
Acct. 101-0000-203.06-0.0
Total Refund = $33.40
"�S;isl,cecely,:
Burt Hanada
Plans Examiner / Inspection Supervisor
Permit Refund Request Page 1 of 1
04/24/2013
To whom it may concern,
The homeowner of this job canceled, so we would like to have a refund. We never installed the
system.
The permit # is: 13-00000363
Permit amount $51.63
Address: 78600 Alden Circle
Please issue refund to:
iE, Inc., c/o General A/C
5858 Dovetail Drive
Agoura Hills, CA 91301
If you have any questions, please call my cell at: 818-262-1253.
Thank you,
Eric Jacoby
.a
RE�C�ll'ED
aQR 2013
CIiY CQF L
01A NOC pp i24►tM I T_
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-IR-ALT-HVAC
Climate Zones 10 - 15
Site Address:
Enforcement Agency:
Date:
Permit #:
78600 ALDEN CIRCLE La Quinta, CA 92253
City of La Quinta
Mar 26, 2013
Duct insulation
Conditioned Floor
Equipment Typel
List Minimum Efficiency2
requirement
Area
Thermostat
❑ Package Unit
® Furnace
® AFUE 78%
❑ COP
❑ R 6 (CZ 10-13)
Served by system
® Setback
® Indoor Coil
® SEER 13.0
[3HSPF
[3 R 8CZ 14-IS)
(
1372 sf
If not already present, must be
® Condensing Unit
❑ EER
❑ Resistance
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 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-111
and CF-611 shall also be on site for final inspection.
® 1. HVAC Changeout Required Forms:
. All HVAC Equipment CF-6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS
replaced CF-4R forms: MECH-21 and (for split systems) MECH-25
. Condenser Coil and /or CF-6R forms: MECH-04, 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 5 300 CFM/ton (Minimum Air Flow Requirement), TMAH
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
❑ 4. The system will not be Ducted (ie. Ductless Mini-Split System) (Also Exempt from Refrigerant Charge)
❑ 2. New HVAC System Required Forms:
. Cut in or Changeout with CF-6R forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-22-HERS, and
new ducts: (all new
MECH=25-HERS
ducting ArjQ, all new CF-4R forms: MECH-20, and (for split systems) MECH-22, and MECH-25
equipment)
For Split Systems: Duct leakage < 6 percent; RC, CCA Z 350 CFM/ton, FWD, TMAH, STMS, and either HSPP or PSPP.
For Packaged Units: Duct leakage < 6 percent
❑ 3. New Ducts with/or without
Required Forms:
Replacement
. Includes replacing or installing all new
ducting and/or outdoor condensing unit
CF-6R forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-tiERS�
and/or indoor coil 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 a 300 CFM/ton, TMAH
For Packaged Units: Duct leakage < 6 percent
0 4. New Ducting over 40 feet
Required Forms:
. Includes adding or replacing more than 40
CF-6R forms: MECH-04, MECH-2I-HERS
linear feet of duct in unconditioned space.
CF-411 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 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 I 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: Danielle Garcia Signature: punielle 6areia
Company: HARRISON ENTERPRISES INC Date: Mar 26, 2013
Address: 31-170 RESERVE DRIVE STE ALicense: 686310
City/State/Zip: THOUSAND PALMS / CA / 92276. Phone: (760) 343-7488
Reg: 213-A0018056A-000000000-0000 Registration Date/Time: 2013/03/26 1:05:05 HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms July 2010
IIIIIIIIVIIIIIIVIIIIIII 50
IE 44
P.O. BOX 1504
Building 78_6W Alden Circle78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner
Address
City
ractor
Address
Zip I Tel.
State Lic. City
& Classif. 1.2 7:�, ? 1,—d I Lic. If
Designer
Address Tel.
CityI Zip I State I
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that,l am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business�ar�d P f sio s ode, and my license is in full force and
effect. tf L / f�F �C
fi ! d !/ e' f rrj
SIGNATURE
✓ OWNER -BUILDER DECLARATION
I here 'affirm that I am exempt from the Contractor's License Law for the following
reason:
ec. 7031.5,Business and Professions Code: Any city or county which requires a
permit I construct, alter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for thealleged 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).
❑ 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, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon and who does such work himself or through his own employees,
provided that such 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 did not build or improve for the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
1 hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800. Labor Code.)
Policy No. Company
Ixopy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.)
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.
Date Owner
NOTICE TO APPLICANT. If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
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 city to enter the above-
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
BUILDING: TYPE CONST
No.
OCC. GRP.
A.P. Number Acacia HII
Legal Description Tract 237-68 Plzen A-,:3
Project Description 10102
Sq. Ft. No. No. Dw.
Size 1362 Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const. 527-00
Mech.
Electrical 4
Plumbing 120 9511)
S.M.I.
Grading
Driveway Enc.
Infrastructure 1ATO 10
TOTAL 1 2.410-a9 1 7 l, ll • �. j
REMARKS
4W)"t- �sttffL%: i�'> 2910. F9
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE—INSPECTOR(
Issued by: Date 5%4%9 Permit
Validated
Validation:
CCNSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. I SO. FT. ®
GROUT
WATER HEATER
WALL SQ. FT.
FINAL INSP.
DRINKING FOUNTAIN
SQ FT ®
WATER SYSTEM
FINAL INSP. — /(� "l / f;
(
URINAL
ESTIMATED CONSTRUCTION VALUATION $
LUMBER GR.
WATER PIPING
NOTE: Not to be used as property tax valuation
ot,
FLOOR DRAIN
MECHANICAL FEES
REMARKS:
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER. B.T.U.
SQ. FT. ® c
BATH TUB
MESH
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
FINISH GRADING
SQ.FT.GAR ® 3/ac
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
ZT 7'`
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP. — /(� "l / f;
(
GRADING
FINAL INSP. L cu. yd.
$ plus x$
=$
LUMBER GR.
FRAMING
ROOFING
ot,
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
IIIIIII VIII III VIII IIII 51 ��
IE _ 4 No.
.
P.O. BOX 1504 N
Building 78-105 CALLE ESTADO
Address 78-600 Alden Circle LA QUINTA, CALIFORNIA 92253
Owner
Address
City Zip Tel.
Contractor
Address
City lZip
;11,Jim .13 , >c 41fnllll s 4R 11
State Lic. City
& Classif. t ASl fit Lic. # 14
Arch., Engr.,
Designer
Address I Tel.
;ityZip State
Lic. #
LICENSED CONTR CTOR'S DECLARATION
I hereby affirm that I aL� licensed upder frg cions of Chapter 9 (comm in with 1pection
7000) of ivisi"o 3 df t eu'siriess and Py666fe�)sions Code, and my license is i full f5rce and
effect ,f'( f�^'jf / f �{ A ! l /Tt A
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law or the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to file a signed statement. that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. he 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, 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, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon and who does such work himself or through his own employees,
provided that such 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 did not build or improve for the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
0 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I havb a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No.Company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.)
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.
Date Owner
NOTICE TO APPLICANT., If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
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 city to enter the above-
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
JILDING: TYPE CONST.
P. Number
OCC: GRP.
Legal Description
Project Description
09106
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
3timated Valuation 11,600.00
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech. n
Electrical
Plumbing 21-00
S.M.I. Aly,
Grading
Driveway Enc.
Infrastructure
TOTAL 298,59
REMARKS
ZONE:
BY:
Minimum Setback Distances:
Front Setback from.Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by:
Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
COLL. AREA
2ND FL. SQ. FT.
YARD SPKLR SYSTEM
BONDING
MOBILEHOME SVC.
BAR SINK
FOR. SQ. FT. ®
SEWER OR SEPTIC TANK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
FOUND. REINF.
DRAINAGE PIPING
CAR P. SQ. FT.
HEATING (FINAL)
OTHER APPJEOUIP.
WALL SO. FT.
DRINKING FOUNTAIN.
SO. FT. ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
ROOFING
LAUNDRY TRAY
-AIR HANDLING UNIT CFM
L � ,
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1 Vi c
SEWAGE DISPOSAL
GAR. FIREWALL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
LATHING
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING --7--ift 9
UNDERGROUND (c 2 7-4(t
0 A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCKSTORAGE
FOUND. REINF.
GAS(ROUGH) L
!!
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
„ _ � ` � � � (
L � ,
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION S /Y
"L
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL