MECH (10-0388)53160 Avenida Madero
10-0388
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA; CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
4,10-00000388
53160 AVENIDA MADERO
774-032-023-17. -000000-
MECHANICAL
COVE RESIDENTIAL
8830
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
SPECTIONS (760) 777-7153
Dater 5/03/10
Owner:
SLEZAK, JACKLIN ( O
53160 AVENIDA MADERO
LA QUINTA, CA 92253
(760) 771-3992. ' C .
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
of La Qurnta, 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 resultof 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.
certify that I have read this application and state that the above information is correct. 1 agree to comply with all
city and county ordinances and state laws relating to building c ruction, and hereby authorize representatives.
of this ccoounty to-enter-upon.the above-mentioned property fo pecti pur osgs.
Date:Signature .(Applicant-or'Agent):
Applicant: Architect neer.
DIAL ONE'S ONE HOUR A/C' & HTG .
2 712 E .. LA CADENA DRIVE ..
.
RIVERSIDE, CA 92507
(951)276-9744
Lic. No..: 878533
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
I hereby affirm under penalty of perjury one of the following declarations: -
-
Section 7000) of Division 3 of the Business a Professionals 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
. License Class: C20 - icense No.: 878533 -
for by Section 3700 of the Labor Code, for theperformanceof the work for which this permit is
issued,
.
CR@te:3V -/O f. Contractor: -?
_ 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
-
OWNER -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 GOLDEN ENGLE Policy Number WSD500334900
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 subject to the workers' compensation laws of California,
permit to file a signed statement that Fie or she is licensed pursuant to the provisions of the Contractor's State
and agree that, if I should b me subject to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
3700 of the Labor Code, - II fort provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
_ omplyose
%
-any
applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
•--Dater (J , Appicant:
(_) 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' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply town owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND 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,
..
• (_ 1 I am exempt under Sec. - , B.&P.C. for this reason -
the owner, and the applicant, each agiees to, and shall defend, indemnify and hold harmless the City
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
of La Qurnta, 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 resultof 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.
certify that I have read this application and state that the above information is correct. 1 agree to comply with all
city and county ordinances and state laws relating to building c ruction, and hereby authorize representatives.
of this ccoounty to-enter-upon.the above-mentioned property fo pecti pur osgs.
Date:Signature .(Applicant-or'Agent):
Application Number . . . . 10-00000388
PermitMECHANICAL
Additional desc .
Permit Fee 31.50 Plan Check Fee
7.88
Issue Date Valuation
0
Expiration Date 10/30/10
Qty Unit Charge Per
Extension
BASE FEE
15.00
' 1.00 16.500.0•EA MECH B/C >3-15HP/>100K-500KBTU
16.50
- - - - -----------------------------------_------------------
Special Notes and Comments
REPLACE/CHANGE OUT 4 TON HEAT PUMP& 4
---- - --- --- - --- -- - ._ _.._ .- ----'TON-AIR-HANDLER WITH DICONNECT "BOX. -16
--
SEER 2007 CODES.
Other Fees . . . . ... BLDG STDS ADMIN (SB1473).
1.00
Fee summary Charged Paid Credited
Due
Permit Fee Total 31.50 .00 .00
31.50
Plan Check Total 7.88 .00 .00
7.88
Other Fee Total 1.00 .00 .00
1.00
Grand Total 40.38 .00 .00
40.38
LQPERMIT
Simplified Prescriptive Certificate of Compliance: 2008Residenflat HVACAIteratioirs CF -IR -ALT -
Climate Tones 10 to 15
Sile Address:Irxxf
0d
)T2j611:
Dale
Permit
Condifionca Floor
Equipment Type'
List Knimtun Efficiencyt
Duct insulation uitcment
Area
Thermostat
❑ Packaged Unit
❑ Furnace
❑ AFUE
❑ COP
Over 40 Il of ducts added ur
L9 getback
❑ Indoor Coil
❑SEER
D HSPF
replacedin space
f tem(If
notolr dy
❑ Con Unitcr
❑Resistance
1 on)
R
JAN• rMWbe
❑ R 8 (CZ 14-15)
bwalled)
1. Egaiprt w pe ft5ase the equi/uttent being inunlled; if more than one system, are mtother CF -1 R -AL T -H VA Ffir e=h; s m.
2. Minimum EguipmrW Effleirncties: 13 SEER, 78%AFUZ 7.7HSPFfor npleal rerlrtentlal s} rternc
HERS VERIFICATION SUMMARY Listed below an fou• HVAC alteration Options. The installer decides what work is being dare and
picks one of the appropriate Options. Each Option lists the HERS meamu that must be conducted. A copy of the firms 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 the farm was in fact the work completed by the
installer. The inspector also verifies that each appropriate CF -0R and registtn ed CF -4R tarns (no hand filled CF-4Rs allowed) are F01cd out and
signed. Beginning Oc ber 1 2010 a reghUvW cop of the CF -IR and CF -6R s6n0 also 1>e on site for final Lamection.
1. HVAC Changeout
Required Forma:
• All IJVAC Equipment re laced
P
CF -6R forms: MECH-04, MECH-21-}HERS and (for split systems) MECH- 25 -HERS
CF -4R forms: MECII- 21 and far lit stems MECH-25
• Condenser Coil and/or
• indoor Coil and/or
CF -6R fors: MECH-21-l:IERS and (for split systems) MECH- 25 -HERS
CF -411 forms: MECH- 21 and (for split systems) MECH-25
• Furnace
For Split Systems: Duct leakage < 15 percent; RC, CCA > 300 CFMhon(h inimum Air Flow Requirement), TMAH
For Packaged Units: Duct leakage < 15 percent
Exempted from dud leakage testing if:
❑ I, 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 ate constructed,insulated or sealed with asbestos
❑ 2. New HVAC System
Required Form:
• Cut in or Chmtgcout with new
ducts: (all new dulling and all
CF -6R forms: MECH-04, MECH-20-HERS,and (for split system) MECH-22-HERS, and MECH-Z5-HERS
MEGA A 20-, and (for split systems)WXH-22, sad MECH 25
new eat)CF-4R
For Split Systems: Duct leakage <6 percent; RC, CCA >_ 350 CFM/ton, FWD, TMAH, STNIS, and either HSPP or PSPP.
For Pa ed Units: Duct leakage < 6 percent
❑ 3. New Ducts with Replacement Required Forms:
• Includes replacing or installing all new ducting CF -6R forsam MECH-04, MECH-2041ERS,and (fa• split systems) MECH-25-HERS
and/or outdoor condensing unit and/or indoor CF4R forms: INCH -20 and (for split system) MECH-25
coil and/or fumttcc. Not all equipment change&
For Split Systems: Duct leakage < 6 percent,.RC, CCA 2! 300 CFMhon, TMAH
For Packaged Units: Duct leakage < 6 percent
114. New Ducting over 40 feet
Required Forms:
• Includes adding or replacing more than 40
linear feet in
CF -6R forms: MECI-14K MECH-2I-HERS CF -411 forms: MECH-21
orduct unconditioned space.
For split system or packaged units: Duct leakage < 15 percent
❑ ID(CEPMON: Existing dud system constructed, insulated or scaled with asbestos.
Contractor (Documentation Author's /Responsible Designer's Declaration Statement)
• 1 certify that this Certificate of Compliance donanenmtion 6 acaumte cad complete.
• l am digiible undo Division 3 of the Colifomin Busin= sad Pmt'mioms Code to accept respomibitity for the design identtfrcd an this Certificate of Cumphmnoe
I eenify that the energy featttm amt performmmce speeifteatiom for the design idmtifed on this Cutificate of Cnmpbinnce conform to the restuiremens afTnle N.
Pans 1 end 6 of the California Code of Regulations.
• The design features identified en this CerHfkate of compliance ore wtoistent with the lalbrawtion doeuniaAW on other appliwbhr conipkiame lbrms, worksheets,
tale:ulati and :mccificaliow submitted to the ctifumcmeat Umcy fa approval with the mmis wqAiCWinn,,4
Signature:
Name:M-HI
Company:fv-
dlj-r Ar
Deter Lya o
Address:
J
License: I WA
City/Slate rzip.)
Phone
2008 Residenual Compliance Forms Mbrch 2010
Bin #
City of La Quinta
Building &r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: .
Owner's Name:
A.P. Number:
Address: Q
Legal Description:
City, ST, Zip: r✓ _
Contractor::?a:
.
,y"r Telephone: :? sn ;;. l.•.rasy:.x • n?c,n•:L
Address: a 1
Project Description:
e e..
City, ST, Zip:
Telephone:
State Lic. # : City Lic.
Arch., Engr., Designer:.
Address:
City., ST, Zip:
'4' :: Jh•vtii\~`i'C.'x."`r 3.: ,.i-Win:{i<' >,
Telephone: ::,. ,•.,; .. : .z..:-... %hf,:.::
::-t :•::,' -:, £ "y c°''.; ; '. , 1
i`z2`'o ; . .' 44<•'y ..$•r7 y
State Lic. #:
Name of Contact Person:
Construction Type: Occupancy:
an D% o
. S P GC
Project type (circle one): New Add, n Alter Repair Demo
Sq. Ft.:
#Stories:
#Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE. BELOW THIS LINE .
# Submittal Re Td Recd TRACKING PERMIT FEES
Plan Sets. Plan Check submitted Item Amount
Structural Calcs.
Reviewed, ready for correctionsPlan
Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2'd Review, ready for correctionslissue
Electrical
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 correctionstissue
Developer Impact Fee
Planning Approval
. Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees,
Total Permit Fees `
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-21
Duct Leakage Test - Existing Duct System (Page 1 of 2)
Site Address: Enforcement Agency: Permit Number:
53160 Avenida Madeo, La Quinta CA 92253 (Home) City of La Quint a 10-388 • .
Enter the Duct System Name or Identification/Tag: Home
Enter the Duct System Location or Area Served: Home
Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the
dwelling. '
This installation certificate is required for compliance for alterations and additions in existing dwellings to
space conditioning systems and duct systems.
Note: For existing dwellings, a completely new or replacement duct system can also include existing parts of
the original duct system (e.g.,, register, boots, air handler, coil, plenums, etc.) if those parts are accessible•
and they can be sealed. For a completely new or replacement duct system installed in an existing dwelling,
use the Installation Certificate titled "Duct Leakage Test - Completely New or Replacement Duct System.-"
Duct Leakage Diagnostic Test - existing duct system r t
Select one compliance method from the following four choices.
1.
R 1 -Measured leakage less than 15% of fan flow
T
• A.
'A _
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-21
Duct Leakage Test - Existing Duct System (Page 1 of 2)
Site Address: Enforcement Agency: Permit Number:
53160 Avenida Madeo, La Quinta CA 92253 (Home) City of La Quint a 10-388 • .
Enter the Duct System Name or Identification/Tag: Home
Enter the Duct System Location or Area Served: Home
Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the
dwelling. '
This installation certificate is required for compliance for alterations and additions in existing dwellings to
space conditioning systems and duct systems.
Note: For existing dwellings, a completely new or replacement duct system can also include existing parts of
the original duct system (e.g.,, register, boots, air handler, coil, plenums, etc.) if those parts are accessible•
and they can be sealed. For a completely new or replacement duct system installed in an existing dwelling,
use the Installation Certificate titled "Duct Leakage Test - Completely New or Replacement Duct System.-"
Duct Leakage Diagnostic Test - existing duct system r t
Select one compliance method from the following four choices.
1.
R 1 -Measured leakage less than 15% of fan flow
❑ 2. Measured leakage to outside less than SO% of Fan Flow
•
,331a i, r.
❑ 3. Reduce leakage by 604and conduct smoke and fix all leaks
'A _
4. Fix all accessible leaks using smoke and HERS rater verify
❑ a
Note: .(Option. 1,2 OR 3 must be attempted before utilizing Option 4) '
N_
Determine nomnahFamFlow using -one of'the following three calculation methods. ,
® Coolinng,rsystem method: Size of^ycondenser in Tons 4 x'400 = 1600 CFM A
r
✓ ❑Heating -21 Z utput Capacity,in Thousands Btu/hr
system method x of
}, lNk
✓ ❑ Measured system airflow using RA3 3 airflowbtestrprocedures: CFM;n
Option4-used then: w {` .':` - r . x, w«•c : c6 tea,
r"?
1
Allowed leakage Fan Flow ° 1600 " x 0 15 = 240' CFM
Actual Leakage = "-189 CFM,,,-,..
t
Pass if Leakage Actual is less than Allowed
Pass ' Fail
Option 2 used then:
2
Allowed leakage "Fan Flow_ x 0.10 = _ CFM '
Actual Leakage to outside;'= --•- CFM
Pass if Leakage Actual is less than Allowed
Ej Pass ❑ Fail .
• •
Option 3 used then: - K
, I
'
Initial leakage prior,to start of work = _ CFM
I '
yy
Final leakage after sealing all accessible leaks using smoke test = CFM
F
3
Initial leakage _ - Final leakage= Leakage reduction — CFM
c' .
((Leakage reduction _ / Initial leakage 1 x 100% _ % Reduction
Pass if % Reduction > 60%
❑ Pass Fail
Option 4 used then: - - -
; Registration Date/Time:
4
All accessible leaks repaired using smoke. HERS rater must verify (No sampling). No smoke
! r
w
allowed to leak from system. Including ducts, plenums, air handler and door panel.
•
Pass if all accessible leaks have been repaired using smoke
Pass Fail
Nk
'
• •
• ,.
1, `•
, I
'
' '
4'.
yy
F
Reg: 210-A0006212A70000000007M21A
; Registration Date/Time:
2010/05/17 20:58:59 HERS Provider:
CalCERTS, Inc.'
2008 Residential Compliance Forms
w
- •
August 2009
F• -
, }.
Cid
[ rf
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-21
Duct Leakage Test - Existing Duct System (Page 2 of 2)
Site Address: Enforcement Agency: Permit Number:
53160 Avenida Madeo, La Quinta CA 92253 (Home) I City of La Quinta 10-388 .
2 Outside. air. (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped-off41
k'
'during,duct leakage testing. CFI OA'ducts that utilize controlled motorized dampers, that open only when OA
ventilation is required to meet ASHRAE Standard 62:2, and close when OA ventilation is not required, may ,
be configured toAhe. closed position during, duct, lea3kage,testing _
/ +; L•s ` " r ten,!{ ..5 v4. Jtj__F• .` q y 1.. •,•..i '
O All supply, and return, reglsteriboots must besealed to the drywall if,smoke test is utilized for compliance
— applies to duct leakage- c`o mpliance option 3(Ieakage reduction by'60%) and option 4'(fiz all accessible'
:leaks) dq escribed abofve%, fe ^ ^ y r
.2 New duct installations cannot utilize`building cavities as plenums or platform returns In lieu of ducts.
0 Mastic and d6' W bands must tie used in combination with doth backed rubber,adhesive duct tape to seal '
leaks at all, new duct connectioris - j
DECLARATION STATEMENT-
.
TATEMENT . I certify under penalty of perjury; under the laws of the State of California, the information provided on this form is true and correct.
. I am the certified HERS rater who performed the verification services identified and reported on this certificate (responsible rater).
. The installed feature,.material, component, or manufactured device requiring HERS verification that is identified on this certificate (the
Installation) complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified
on the Certificate(s) of Compliance (CF -1R) approved by the local enforcement agency. + • '
. The information reported on applicable sections of the Installation Certificate(s) (CF -6R), signed and submitted by the iperson(s)
' responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -111) approved -by the
enforcement agency.
Builder or Installer information as shown on the Installation Certificate (CF -6R)
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
VENVEST BALLARD INC € .
Responsible Person's Name:
CSLB License: j
Jim Mc Eligot ,,
878533 . .. '.
HERS Provider Data Registry Information
Sample Group #'(if applicable): N/A • -
® tested/verified dwelling
❑ not-tested/verified dwelling in
la
HERS sample group
HERS Rater Information Ca10ERTS Certificate # CC1-1798494817 i
•
HERS Rater Company Name: r -'
Athens Air ► '. `
Responsible Rater's Name:
Responsible Rater's Signature
Andrew Pulos
Signature on File at Ca/CERTS, Inc.
Responsible Rater's Certification Number w/ this HERS Provider:
Date Signed: 5/17/2010
CC2004503 1
i
Reg: 210-A0006212A-000000000-M21A.' Registration Date/Time: 2010/05/17 20:58:59 HERS Provider: CalCERTS, Inc.
2008 Residential'Compliance'.Forms`,-„ i ° r ✓ August 2009
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16
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