MECH (10-1245)77733 Avenida Madrugada
10-1245
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: ( i0-00001245
Property Address:
77733 AVENIDA MADRUGADA
APN:
773-340-002-2 -14496 -
Application description:
. MECHANICAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
11965
( ?44-.4vQ"
Applicant: Architect or /Engineer:
----------------- I
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
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 Cl ss: C20
Li No.: 686310
Dater Contracto /
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 ($500).:
(_ 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 _ 1 I am exempt under Sec. , BAP.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:
RILEY MARLA
77733 AVENIDA MADRUGADA
LA QUINTA, CA 92253
(760)777-6674
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/15/10
Contractor:
GENERAL AIR CONDITION G
31170 RESERVE DRIVE*111-1
THOUSAND PALMS, CA 9 27 ,
(760) 343-7488 Cl1ry F v
Lic- No.: 686310 F±NgJy oNrt
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 EVEREST NATL Policy Number 7600006147101
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 1 should become subject to the workers' compensation provisions of Section
1 3700 of the Labor de, I Ilforthwithcompl wah e provisions.
Date:` Applicant:
WARN G: FAILURE TO SECURE W RKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS 1$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 umy to enter upon the above-mentioned pr erty for inspection purposes.
r n
'Date)- '7 Signature (Applicant or Agent)
Application Number . . . . . 10-00001245
Permit . . . . .
. MECHANICAL
Additional desc .
Permit Fee
33.00
Plan Check Fee
8.25
Issue Date . . .
.
Valuation . . .
. 0
Expiration Date
5/14/11
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
HVAC CHANGE OUT 13
SEER PACKAGED
UNIT.
----------------------------------------------------------------------------
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 .QO
8.25
Other Fee Total
1.00
.00 .00
1.00
Grand Total
42.25
.00 .00
42.25
LQPERMIT .
y -•
Sim lified Prescriptive Certificate of Com fiance: 2008 Residential HVACAlterations CF -IR -ALT -HVA
Climate Zones 10 to 15
Site Address:
1 2/►'JA
F.nforceme gencv:
Date;
(— "iii
Permit
Conditioned Floor
i ment Type'
List Minimum Efficienc 2
Duct insulation requirement
Area
Thermostat
VPackaged Unit
ace
o
❑ AFUE U16
❑ COP
Over 40 ft of ducts added or
Setback
El Indoor Coil
❑SEER
❑ HSPF
replaced in unconditioned space
p p
Served b system
Y Y
(If not already
C) Condensing Unit
❑ EER
_
❑ Resistance
❑ R 6 (CZ 10-13)
sf
present, must be
❑ Other I
I
❑ R 8 (CZ 14-15)
installed)
1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF- IR -ALT -HVA Cfor each system.
2. Minimum Equipment Efficiencies: 13 SEER, 78%AFUE, 7.7HSPFfor typical residential systems.
HERS VERIFICATION SUMIMIARY 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 lits stems) MECH-25
• Condenser Coil and/or
• Indoor Coil and/or
CF -6R forms: MECH-2I-HERS and (for split systems) MECH- 25 -HERS
CF-41tforms: MECH- 21 and (for split systems) MECH-25
• Furnace
For Split Systems: Duct leakage < 15 percent; RC, CCA> 300 CFMAon(Minimum Air Flow Requirement), TMAH
For Packaged Units: Duct leakage < 15 percent
Exempted from duct leakage testing if:
❑ 1. Duct system was documented to have been previously sealed and confirmed through HERS verification, or
112. 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
ducts: (all new ducting and all
CF -6R forms: 'MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-HERS
new equipment)
CF -4R forms: MECH 20-, and (for split systems)MECH-22, and MECH 25
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
linear feet of duct in unconditioned space.
CF -6R forms: MECH-04, MECH-2I-HERS CF -4R forms: MECH-21
For split system 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 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.
• 1 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,
calculatio,v,%plans and specifiGatkons submitted to the enforcement a enc fora proval with thej)eqnit applicdQ1.
Name:
Signature:
Company:
naA
Date:K-0
Address: e r
License:
2 0
City/State/Zip: n N ,1 /, n /I I /vl , ' n
Phone: ' , t7n , (J ?w%VP
Kin #
City of La QUinta
Building &' Safety Division
Permit #
P.O. Box 1504,78-405 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Perm- it'Application and. Tracking Sheet
Project Address: -7 3Q
Owner's Name: t
A. P. Number:
U
Address:Mali
Legal Description:
City, ST, Zip: (JLGtcs►,fd" G' a
Contractor:
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Telephone: ? , .,.,;,;;,
Address: ✓
Project Description:
City, ST, Zip:7 y `IJV
l),
Telephone:
( .•4.f{.
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State Lic. # : 3
City Lic. #;
Arch., Engr., Designer:
Address:
City., ST, Zip:
'
Telephone:'
f .;tib x: •`•}:: %: :'.y,:)'+y ... t;
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Construction Type: Occupancy:
State Lic. #:
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' Project tYPa circle one): NewAdd'n Alter Repair Demo
<
Name of Contact'Person:
Sq. Ft.:
#Stones:
#Units:
Telephone # of Contact Person:
Estimated Value of Project: 9(OS • D O
APPLICANT: DO NOT WRITE. BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACMG
PERMIT FEES
Plan Sets
Plan Check submitted
Item Amount
Structural Caics.
Reviewed, ready for corrections
Plan Check Deposit
Truss Caics.
Called Contact Person
Plan Check Balance .
Tide 24 Caics.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2n' Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up.
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
3rd Review,.ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P..
Pub. Wks. Appr.
Date of permit issue
School Fees
Total Permit Fees