MECH (10-0707)54120 Avenida Madero
10-0707
r- - 'I
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
10-00000707
Property Address:
54120 AVENIDA MADERO
APN:
774-193-025- -
Application description:
MECHANICAL
Property Zoning:
COVE RESIDENTIAL
Application valuation:
6000
Tity 4-44"
Applicant: q Architect
,,or—
Engineer:
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 Class: - - - - - - - - - - License No.: C20
Date: Contractor:
OWNER-13LRLDER 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 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, 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
Owner:
BUTLER GREG
54120 AVENIDA MADERO
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/30/10
I
Contractor.
BUDGET AIR D'
PO BOX 1066
LA QUINTA, CA 92 7 s►; 02 2010
WCC: EXEMPT --
Lic. No.: C20 G1TY(afrS.Afuf ► —
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 EXEMPT 05/31/111olicy Number 796186
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: Applicant:
ab
r kkfffffWO
WARNING: FAILURE TO SECU RKERS'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 inspectio , purposes.
Date:Z A Signature (Applicant or Agent) r
Application Number . . . . . 10-00000707
Permit . . . MECHANICAL
Additional desc . .
Permit Fee . . . . 33.00
Plan Check Fee
8.25
Issue Date . . .
Valuation . . .
. 0
Expiration Date . . 1/26/11
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
CHANGE OUT A/C UNIT AND REPLACE DUCT
WORK REPLACE HEATING 4 TON UNIT.
14
SEER
----------------------------------------------------------------------------
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
05/18/2010 08:49 7607777011 LA QJINTA BLDG DEPT PAGE 01/01
Site
rtl•
13 Packaged Unit ---- - "••`•" [netmostat
O Furnace O AFUE O COP Over 40 R of ducts added or j�Setback
91 btdoor coil OSEER PT0 O 1iSPF� '� '"'"� space Served by systan f fftw-f &
}RI-Condrnsing Unit O EER LV40 Resistenca OR 6 (a 10-13) Pic arst
Pbe
D Olix�r ORB (CZI*-ISS
i. Egrrrpmaarr Type Chcocse thee9r0mon being itvtalled: fjn ore than ow*wem. we amike,C•F-IR-SILT-HYACfcr each symem,
2. Minimum EqxIPwewBWWe,,00 /3SEElt 78%AFU&7.7H5PFjartfflkdresidential5ysteats.
HERS V ERMCATWri SUMMARY tested below ane four HVAC dkmdm Optum& The Iemstaller decides v4M work is being done and
ips one of the "P QpA w 0pboes. Each OPtiou lists the HBRS m as n s that must be conducted. A copy or&e focus shell be kR onsite for find
pidinspection and a copy t� to the Iwuroowner. At finaL the inspector verif a that the work listed an this form oras in Ret the work completed by the
installer. 7be inspector also raises that each atppeopriate CF -6R ted ee&MW CF411t talion hand filled CF -4W
si linin OeWter 12010 a stmt! CF -IR orad CF4R a11a1 alto be hh elft i9sr my dam) ate filled out and
O 1. HVAC Chatmmout Rean:md V..;.—
■ All HVAC Equipment replaced a.rrvR fond,: Mt Ul {t4, NELW214MU and (tor M syMM � '
CF -4R forms MECI{- 21 Old (for •t MF.CH-2S
•
Condenser Coil ad for
• Indoor Coil and/or CF -6R fiatmx MMI -21 -HERS and (for split syskms) MEOW 25 -HERS
• Fwnam CF -4R forms: MECH. 21 orad (for split sysw") MECH-25
For Split Systems: Duct leakage < 15 p pen RC. CCA
ate ? 300 CFMhoo fMirlinttlm Air Fkry Requ mnent). TMUI�
For Pkagtd Units: pact kadcage < l S S paeetlt
empled from duet leakage testing if
O t Uutx system .vas documented to hove beat previmaly styled and ootmfiMW tluoum FIEFS raiftCition. or
112. Duct syztam with kss than 401inc r feet in =mWitioned spoor, or
O 3. Ex duet are insulated or seated with asbestos
2. New HVAC System R0911111ed Foy'
• Cut in or with new
ducts: (all new ducting ad all Cll 6 formr. MM11". MECH-20-M RSAW (fa split sy'st=) MMI -22 -HM. and MECH-23-HERS
„ CFAR fcernx MECH 2o•, and (for apm s»pemsl CH�2. atd MAX 25
For Split Systmw pad ktaknge < 6 P91 RC RC. CCA > 3" CFMRon, FWD, 7MAli, Mr? -sand efdwf HSPP or PSPP.
For Packaged Vaits: pact kakage c.6 Percag
O 3. New Ducts with
Forms:
• lrnrluft r*ldng or into iM all new ducting I CF -M forms: MECH.04• MM1-W4MR$, d (for split syskuls) MFXK-2S-HERS
and/or outdoor oondeas ng writ MAIM indoor CF -4R fonds: M£CH-20 and (for split systems) NECH-u
coil and/or fvrrtsoe. Not all eoukmemt ch ma&
• Ur Wrtt aystenw.. vuct leakage < 6 per RC, CCA >_ 300 CFMhoel, TMAH
or Pa Units: Duet LWOW < 6
4. New Ducting over 4o feet Reqdred Foram
• Include% adding or replacing more dol 40
line feet of duct in wmmwtwmd smM_ I CF -6R forms: MECH-04, MECH-214fM
For split system or packs6ed units: pact leak8gt < 15 peroetlt
CF -4R forms: MECH-21
-••+ �•�•,•• %A— mwow or seaw ws.
tth asbesto.
Contractor (Dnenmtt►tmion Authses /Rapoosibde Valptes Deeb twin Statemesiq
• 1 cutify runt Olin CatiricaterCmnpti needOeom'.pun is aava0e and convkm
• ram etigme sada vision 3 of the Ctddormo Bask= ad PnghsioM Code tc oatep respomallft ibr the d.V idati8pd oa lltit Catifearte of Canplterm,
• I calif tint or t' a Cal famia dend f Rc �firoOMS for Ore ftp idenOw d en this Ctrwiaoc of Costpiitmoa aorr ... to the mQuirarrmts of Tate 24.
• Puts 1 and 6 of Ifo Catifomia Cody ar Repdatipms.
• 'ilk Terga fcamros identified an tens CertiF
calculu and taro and �6 of Conpliaape ora conshftnt wilt dee infornatim doaermcntd on Odw MPplieatfe aortptia m foam. warkshmm
subrmaed to the a tceux l Mpmy ray n=pwd with be nerneit s," j."_
2008 Residential C-oraplfaace Fonar March 2010
Bin #
City of La Quinta
Building $e 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: 'IV444Owner's
Name:
A. P. Number:
Address:
Legal Description:
Contractor d fir,
City, ST, Zip:
Telephone ,.y ..• :•,.«
{
Address:
Project Description:
City, ST, Zip:
Telephone:
VC f
State Lic. # :
City Lic. #;
Arch., Engr., Designer.
ZaAl
Address:
City., ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person:
Construction Type: Occupancy:
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
N
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Tide 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2i° 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:-
'"' 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