12-0663 (MECH)79800 Arnold Palmer
- IIIIIIIIVIIIIIIVIIIIIII 03
P.O. BOX 1504 IE VOICE(760)777-7012
78-495 CALLE TAMPICO __ 4 FAX(760)777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING&SAFETY DEPARTMENT INSPECTIONS(760) 777-7153
BUILDING PERMIT
Date: 6/14/12
Application Number: 12-00000663 Owner:
Property Address: 79800 ARNOLD PALMER MIKE HALLOWAY
APN: 775-241-072- - - 79800 ARNOLD PALMER
Application description: MECHANICAL LA QUINTA, CA 92253 a
Property Zoning: LOW DENSITY RESIDENTIAL D, 1 ( 7
Application valuation: 2700 J
J
UN 42012t I
Contractor. -..
Applicant: Nv Architect or Engineer: DCS AIR CONDITIONING j
(J 72078 CORPORATE WAY, #101 G"IY)( iF':, Q-"U).M'
THOUSAND PALMS, CA 92276 t
(760)343-5562 --
Lic. No. : 968141
------------------------------ --------------- ----------------------------------- -----------------
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licen d under provisions of Chapter 9 Icommencing with I hereby affirm under penalty of perjury one of the following declarations:
Section 7000)of Division 3 of the Business and Prof onals Code,and my License is in full force and effect. _ I have and will maintain a certificate of consent to self-insure for workers'compensation,as provided -
Lice Class: C20 VcenseNo.: 968141 for by Section 3700 of the Labor Code,for the performance of the work for which this permit is
issued.
tractor: 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
W R-BUILDER DECLARATION insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier ZENITH INS Policy Number Z071741501
following reason(Sec.7031.5,Business and Professions Code: Any city or county that requires a permit to _ I certify that,in the performance of the work for which this permit is issued,I shall not employ any
construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for the person in any manner so as to become sub' t t0 the workers'compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that,if I should become subject the the
compensation provisions of Section
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or 3700 of Labor Code,I shall forthwit with those provisions.
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).: Date: 6 pplicant:
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 WARNING: FAILURE TO SECURE WORKERS'C51D
ATION COVERAGE IS UNLAWFUL,AND SHALL
Contractors'State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees,provided that the DOLLARS($100,000). IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If,however,the building or improvement is sold within SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
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.): APPLICANT ACKNOWLEDGEMENT
(_) I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044,Business and Professions Code: The Contractors'State License Law does not apply to an owner of conditions and restrictions set forth on this application.
property who builds or improves thereon,and who contracts for the projects with a contractor(s)licensed 1. Each person upon whose behalf this application is made,each person at whose request and for
pursuant to the Contractors'State License Law.). whose benefit work is performed under or pursuant to any permit issued as a result of this application, ,
(_) I am exempt under Sec. ,B.&P.C.for this reason 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.
Date: Owner: 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
CONSTRUCTION LENDING AGENCY permit to cancellation.
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify that I have read this application and state that the a e information is correct. I agree to comply with all
work for which this permit is issued(Sec.3097,Civ.C.I. city and county ordinances and state laws relating to buildi onstruction,and hereby authorize representatives
eat.th..,r'countyto enter u n the above-mentioned property i ctionpurposes.
Lender's Name: 6 Z ignature(Applicant or Agent):
Lender's Address: ,
LQPERMIT
Application Number . . . . . 12-00000663
Permit . . . MECHANICAL
Additional desc . .
Permit Fee . . . . 21.50 Plan Check Fee 5.38
Issue Date . . . . Valuation . . . . 0
Expiration Date 12/11/12
Qty Unit Charge Per Extension
BASE FEE 15.00
1.00 6.5000 EA MECH OTHER MECH EQUIPMENT 6.50
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Special Notes and Comments
CHANGE OUT 1 SIDE MOUNTED COOLER. 2010
CODES.
-------------------------- -------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 21.50 .00 .00 21.50
Plan Check Total 5.38 .00 .00 5.38
Other Fee Total 1.00 .00 .00 1.00
Grand Total 27.88 .00 .00 27.88
LQPERMIT '
Sim,)Med prescriptive Certificate of Compliance:2008 Residential HVACAIteradons. CF-1R ALT-HVAC T
Climate Zones 10 to 15
i
Ske,g cess: n D Permit 6:
—KE Condition oor
ant r List Minimum Effi ' Duct insulation t Ana Thermostat
§290—Pam Unit p� Over 40 R of ducts added or Furnace gra
E Ov%a COP lid in unconditioned space Served by system qo=
be
Indoor Cori HSPF_ R 6 (CZ 10-13) sf P� moat
Unit 1 Wince R 8 (CZ 14-15)
t*ment Type Choose the equipment being installed if more than one system,use another CF-IR-ALT HVACfor each system.
2,MlnhMm Egrdpment Efficimcies:13 SEER 780A AFUF 7.7HSPFfor typical residential systems
HERS VERIFICA110N SUM ARY 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 verities that each appropriate CF-6R and registered CF4R forms(no hand Bed CF4Rs allowed)ane filled out and
October 1 2010 s regisftred copy of the CF-1R and CF-6R shall also be on site for final htspecdon.
1.HVAC ChanMvt mired Forms:
• All HVAC Equipment replaced CF-6R forms: MECH-04,MECH-2I-HERS and(for split systems)MECH-25-HERS
CF4R forms: MECH-21 and for split systeTO MECH-25
• Condenser Cort and/or CF-6R forms: lv C -2I4IERS and(for split systems)MECH-25-HERS
• Indoor Corr and/or CF4R forms: MUM-21 and(for split systems) MECH-25
• Furnace
For Split Systems:Dud leakage<15 percent; RC,CCA>_300 CMIton(Mmimuml Air Flow Requir+ement),T'MAIi
For Packaged Units: Dud leakage<15 percent
Exempted fi om tinct 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 dud sust=MWareconstructed.msWAed or sealed with asbestos
p.2.New HVAC SY49M Required Forms:
• Cut in or Changeout with new CF-6R forms: MECH-04,MECH-20-HERS,and(for split systems)NOM-22-BM,and MECH-25-HERS
ducts:(all new ducting 11Md all CF4R forms: WM 20-,and(for split systems)MECH-22,and MECH 25
new
For Split Systems:Duct leakage<6 pereent;RC,CCA>_350 CFM/ton,FWD,TMAH,STMS,and either HSPP or PSPP.
For Packaged Units:Dud leakage<6 percent
3.New Dads with/or without Replacement Required Forms:
• Includes replacing or installing all new ducting CF-6R forms: MECH-04,MECH-20-11M.and(for split systems)MECH-2S-HERS
and/or outdoor condensing unit and/or indoor.coil CF-4R forms:MECH-20 and(for split systems)MECH-25
and/or fumace. No or some egWpment gaged.
For Split Systems:Duct leakage<6 percent,RC,CCA>_300 CFM/ton,TMAH
For Packaged Units:Dud leakm<6 percent
4.New Dacting over 40 feet Pixtaired Forms:
• Includes adding or replacing more than 40 CF-6R forms: MECH-04,NOCH-2I-HERS CF4R forms: MECH-21
linear feet of dud in unconditioned
For split system or packaged units: Dud leakage<15 percent
EXCEPTION: dud systems constructed.insulated or sealed with asbestos.
Contractor(Documentation Anthoes/Responsible Designer's Declaration Statement)
a I Cff*that this Certificate of Compliance don nation is accurate and complete.
• I am eligible under Division 3 of the Califomia Business and Professions Code to accept responsibr7ity for the design idem on this Certificate of Compliance.
I certify that the energy featums and performardre specifications for tha design ider>tified on this Certificate of Compliance conform to the requirements of Title 24,
Parts I and 6 of the California Code of Regulations.
• The design fesum identified or this Certificate of Compliance are cu nistent with the' other a complimrce forms,wodc eats,
on
cat and speciftations sut&tted to the embrcement a9mm for WrOval with
Name: Le Signature:
Company: GS ' 9r '
(J License:
Address:1P.MZ #ZD 19
Q -
City/StatelLip: �Z Phone: `1!00 {S-SSfo a'
Bin# City of La Quinta
Binding 8t Safety DfvFrton
Permit# P.O.Box 1504,78495 Calle Tampico '
La Quanta,CA 92253-(760)777-7012 t
Building Permit Application and Tracking Sheet
Project Address: Owner's Name:
A.P.Number. Address.
Legal Description: City,ST,Zip:Ld
Contractor. s&/1 - le-DA X..5 Telephone: d
Address::?-Z.6 Y ject Descriptio .
City,ST,Zip:
Telephone:1y3—
State Lie. 40City Lia#;
Arch.,Eng.,Designer.
Address:
City,ST,Zip:
Telephone: Construction Type: Occupancy:
rc.#: Project type(circle one): New Add'n Alter Repair Demo
Name of Contact Person: .�`C.e Sq.Et.: #Stories: #Units:
Telephone#of Contact Person: �j-�S 2� Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
# Submittal Req'd Recd TRACKING PERMIT FEES
Plan Sets Plan Check submitted Item Amount
Structural Calcs. Reviewed,ready for corrections Plan Check Deposit
Truss Calls. Called Contact Person Plan Check Balance
Title 24 Calcs. Plans picked up Construction
Flood plain plan Plans resubmitted. Mechanical
Grading plan 20.Review,ready for correctionvIssue Electrical
Subcontactor List Called Contact Person Plumbing
Grant Deed Plans picked up S.M.L
H.O.A.Approval Plans resubmitted Grading
IN HOUSE:- 3"Review,ready for oorrectionslissue Developer Impact Fee
Planning Approval Called Contact Person A.LP.P,
Pub.Wks.Appr Date of permit issue
School Fees
Total Permit Fees