10-0420 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T4ht 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 10-00000420 Owner:
Property Address: 54661 AVENIDA MONTEZUMA SLEZAK REX & JAI_1 I"
APN: 774-264-004-4 -000000- 54661 AVENIDA MONTE
Application description: MECHANICAL LA QUINTA, CA 92253
Property Zoning: COVE RESIDENTIAL (760) 771-3992
Application valuation: 1100
a
ant:
Architect or Engineer:
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 icense No.: 878533
Dat •�� Contractor:
WNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury t t I a exempt from the Contractor's State License Law for the
following reason (Sec. 7031 .5, Business nn P—ions 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 ($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.).
(_ 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
Contractor: . .
DIAL ONE'S ONE HOUR
2712 E. LACADENA D
RIVERSIDE, CA 92507
(951)276-9744
Lic. No.: 878533
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/13/10
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
far 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 vrr�r
CarrierIP1W
*t WSD500334900
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 ode, I shall forthwith co f3 with those provisions.
Date,N_VD Applicant:
WARNING: FAILURE TO SECURE WORK S' C MPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL P LT S AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS 1$100,000). IN ADDITION TO THE • ST 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 pllWerty for inspection p ores.
Date: Signature (Applicant or Agent)
Application Number . . . . . 10-00000420
Permit
MECHANICAL
Additional desc . .
Permit Fee . . . .
33.00
Plan Check Fee
8.25
Issue Date . . . .
Valuation . . .
. 0
Expiration Date . .
11/09/10
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
1.00 9.0000
EA MECH
FURNACE <=100K
9.00
1.00 9.0000
EA MECH
B/C <=3HP/100K BTU
9.00
----------------------------------------------------------------------------
Special Notes and Comments
INSTALL '(4) TON -HEAT
& AIR HANDLER IN -"
SAME LOCATION.
-------------------------------7--------------------------------------------
Other Fees . .
. . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged
---------------------------
----------
Paid Credited
--------------------
Due
Permit Fee Total
33.00
.00 .00
33.00
Plan Check Total
8.25
.00 .00
8.25
Other Fee Total
1.00
.00 .00
1.00
Grand Total
42.25
.00 .00
42.25
LQPERMIT
9513285988
00:28:50 a.m. . 05-13-2010 212
Sits lifted Press ' ' e Certificate of Com 'ane: 2009 Rea#denfial HVACANemtlons CF -1 C
Climate Zwes 10 to 15
Sur Ad1�ss:
ERforcenrraat
Dots
Equigmwnt T 1Couditia oaf
l tSt INiartrltmm Etfide Dud uu�tion meuient Area Thcmwstat
❑ Paclteged Unit
13 Furnace o AFUE O COF over 40 4 of darts added as 131�tback
C3IndoorCad OSEER '0 HsPF replaced in unconditioned space system (ifnwormly
D EER O Resistance 0 R 6 (CZ 10-13) sf Przft% naw be
Oth=Unit
I O R 8 (CZ 14-15j
1. Equ4mieW Chaose tke equ7pmem belreg inuo11er1, (fmorrttmn o system �re on er C�T-WACjor em* systrm.
2. MlninarmEquonzwtWxkr.13SSFA 78%AFU$ Z7h1SPFfor )plculrestd*MWsystem
HERS VERIFICATION SUMMARY Listed below are four HVAC tilteratior Options 71Cinstaller decides what work is being done and
IMI of the appraptiaae Opt[oas Each Option lists the HERS measures That must be conducted. A copy of the. forms shall be lei1 far
on site haat
irupecbw cads copy givsa to the hamneowner. At final, the inspectarverifier do the work listed an tbrs farm was in fact the work completed by the
installer. the irat� also verifies that each appropriate CF -6R and regigmed CF4R forms: (no band failed CF=4Rs elk nval) we fillet out mid
Odeber 1.2010 arealstered ppy of the.CF-IR and CF -611 shall also be on site for final i
1. HVAC Change at Required Forms:
• All HVAC Egagmreat replaced CF -6R roma MECH-04, M CH-ZI-HER3 and Mrsplit system) MUH- 2541E RS
CF -4R Rams MECH- 21 and f ren gyrit M ECH-75
• Condeftw call and/or
• Indoor Coil and/or CR6R forms: WX11-2l-HERS and ffor split systems) NWW 25 -HERS
• . Furnace CF -4R forms: MWW 21 and (far split systems) MECCti-25
For Split Systems: Duct lraekue < 15 pereen4 RC, CCA >_ 300 CFMfton(Minimurn Air Flaw ftluiremexttA TMAH
For Packaged Units: Duct leakage < 15 perceat
Exempted froth duct leakage testing if:
0 1. Duct system was documeated to haw boon pmiamty styled and confirmed a ouugh HERS verification, or
13 Z Duct syainns less
with than 40 linear fcct in. Unconditioned sptic+:,, or
O 3. ExhW9 duct sYslems are constructed, insulated or sealed with adwstem
Q 2. New AVAC System Required Formes;
• Cut in or f oew d a ti with maw CF -6R fortes: MECH-04, MECW20�HEJL' d for
druts: (a11 new ducting gg� all � f sprit systemsf NECA ZZ-HF.R.Sti and MECI�F25-FIEtt5
new mat CF -4R favus; MHCH 7.0•, and (res split systerms)MECH-2Z mrd MECkE 25
For Soft Systems: Duct leakage < 6 pamezW, RC, CCA >_ 350 CFM/lou, FWD, TMAH, SIMS, and either HSPP or PSPP.
For PROMW
Unfts: Duct trackage < 6
13 3. New Duets with Replacement h'ed Forms:
Inchulas replacing or installing all new ducting CP -6R forms: MECR=04. MEM20,HMjmd (far split systems) MEE3i-25-11M
and/or outdoor condensing unit and/or indoor CF4R forms: MECK-20 and (for split systems) NECtf25
coil and/or fuimaoe. Not all equipment changed.
For Split Systems: Dart leabW < 6 p •� RC, CCA _> 300 CFMh0n, TMAH
.For PAC11119W Units. Dud kabp <6
O 4. Mery Datdfm aver 40 fed fired Forms.
• Includes tal tg or replacing mole d= 40
CF -6R fimns: MECH-K MEC11-214HERS CF -411 fomes: MECtf21
linear feet of duct in unconditioned space. I
For split system or pamaged manse Duct leakage < 15 pmt
13 EXCEPTION Emsting duct Uj= constructed, bmdued or seated vft ad=sk s,.
Contractor (Doctmrenlatinm Author's /Respow%le Designees Declaration Statement)
certify Bret this Ctsiifacote ofCbnplimme d=wnenmtdon is acmume end Campbatm
• 1 am diglhle ander Division 3 orthe Califomia Bosimae cad Professions Code to weep reapoarihifuy for the idevtc= as tftis t.mti[icros ofCoaopli�
• 1 ccrr fj dwt the energy r aflts elf poibn ance sgecifuatfoms far the d idaaifiaxl
amPt
on this Cere�lctae of Caop3iaace coaform.ro the mychaoaeatzt ofTnte 24,
Pmts 1 stat 6 of dte t'.ofifamia Code of R I:gatatlatiti.
• The dwp reattaas kkmlilied an this Certificate ofCmapthutce are coma stent with the udomrmtian �Icalttxared anter agpiav6te canpl'tsaca tatinr semtsheNy.
ewe"arts and sw9rdtted to ftattltrvCmCw
rw rd ith the
Name : wit ,
SignaHue:
Company:Yr -
Dm,,:
Addt�s ,
.� ldcease
City/Statemp:
Phone:
2W8 Resj&ntlrtl Complhrrue Forms Mardi 2010
J'
bin #
Permit #
v
Project Address: 5y A n 1
A. P. Number:
Legal Description:
Contractor:
Address:
City, ST, Zip: 5
Telephone: q 7 t
State Lie. # : %r7 e)
Arch., Engr., Designer: �1
Address:
City, ST, Zip:
Telephone:
State Lie. #:
Name of Contact Person:
Telephone # of Contact Person:
# Submittal Req'd
Plaa Sets
Structural Cafes.
Truss Calcs.
Title 24 Calcs.
Flood plain plan
Grading plan
Subcontactor List
Grant Deed
H.O.A. Approval
IN HOUSE: -
Planning Approval
Pub. Wks. Appr
School Fees
City of La Quinta
Building 8r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Owner's Name: '� F �
MBh�'QZU�`cY�a- Address:SIALeee\
City, ST, Zip: ( A4 T'\',
we
Lie. #:
Project Description:
Total Permit Fees
`<'�'Z`e
on Type:Occu anc#moy/
(circle one): New Add'n Alter Repair Demo
rValue
# Stories:
# Units:
' , —'`�
of Project:
/
APPLICANT: DO NOT WRITE B /OW THIS LINE
Recd
TRACKING
PERMIT FEES
Plan Check submitted
Item
Amount
Reviewed, ready for corrections
Plan Check Deposit
Called Contact Person
Plan Check Balance
Plans picked up
Construction
Plans resubmitted
2"! Review, ready for corrections/issue
Called Contact Person
Mechanical
Electrical
Plumbing
Plans picked up.
S.M.I.
Plans resubmitted
3'4 Review, ready for corrections/issue
Grading
Developer Impact Fee
Called Contact Person
A.I.P.P.
Date of permit issue
Total Permit Fees