MECH (13-0232)54860 Avenida Madero
13-0232
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
/Y l
If c, r
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/05/13
Application Number:
13-00000232
Owner:
Property Address:
54860 AVENIDA
MADERO
VANDIVER GWENDOLYN A
APN:
774-265=028-19
-000000-
54860 AVENIDA MADERO
Application description:
MECHANICAL
LA QUINTA, CA 92253
Property Zoning:
COVE RESIDENTIAL
(760)564-3348
Application.valuation:
3385
Contractor:
Applicant:
Architect or Engineer:
DCS AIR CONDITIONING
72078 CORPORATE WAY, #10
THOUSAND PALMS, CA 92276
\
(760)343-5562►„1Ap Oti
J
Lic. No.: 968141 I"IHR 2013
CITY OF Lq QUINTA
PIN NCF DEPT.
LICENSED CONTRACTOR'S DECLARATION
1 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 LicenseNo.: 968141
r
Date:3 S13 Contractor:
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 ISec. 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).:
(_) 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.). '
(_) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project ISec.
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. , B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
1 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: w 1
LQPE RAIIT
WORKER'S COMPENSATION DECLARATION
1 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 ZENITH INS Policy Number Z07174150'2
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 shalt forthwith comply with those provisions.
Date:3/g Applicant: s. a -
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS 1$100,0001. 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.
1 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
ofthis county to enter upon the above-mentioned property
for inspection purposes. r
Dater S )3 Signature (Applicant or Agent):
I.QPERAIIT
Application Number . . . . . 13-00000232
Permit . . MECHANICAL
Additional desc ." .
Permit Fee.. . . . 31.50 Plan Check Fee ".
7.88
Issue Date . . . . Valuation . . . .
0
Expiration Date 9/01/13 '
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 16.5000 EA MECH B/C >3-15HP/>100K-500KBTU
16.50
- --- ------------------------------------
Special Notes and Comments
REMOVE AND REPLACE EXISTING ONE TON
EVAPORATIVE COOLER 13 SEER 2010 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
I.QPERAIIT
Bin. #
City of La Quinta
Bufldfng 8L Safety DivIrion , .
P.O. Box 1504,78-495 Calle Tampfco
La.Qdnta, CA 92253 -:(760) 777-7012
Building Pennit'Application and Tracking Sheet
Permit #
Project Address:
er
,
Owners Name:. �jy� �y� oak. Give r
A. P. Number.
Address: Sq
Legal Description:
Contractor: �-
City, ST, Zip. L 0. C R ZZ 53
Telephone: 7(0(>- 2i _ 33 14 2
Address: -72.- 07 St Corporc, kc- # ICI
PmjectD=r pdon: -D e- 4. �e dote
City, ST, Zip: k�N A 2Z7(o
Exi I r ��%Q aA\V e
Telephone: 7G0-3y3-E5U- nQA
StateLic.#: q bg It4 I ia M
Arch., Engr., Designer.
Address:
City., ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person: S�weh k e- er
Construction Type: _ Occupancy:
Project type (circle one): New Add'a Alter Repair Demo
Sq. Ft.: # Stories: tS:
Estimatod Value of Project; 3 85. C�
Telephone # of Contact Person: - g ")
APPLICANT:
B Submittal Rey'd Recd'
DO NOT WRITE BELOW THIS UNE
TRACKIIVG PERIMT FEES
Plan Sets
Plan Check submitted
Item
Amount
Strgctural Cates
Reviewed, ready for corrections
Plan Check Deposit, .
Truss Calcs.
Called Contact Person
Plan Cheek Balance.
Title 24 Calci.
Plana picked up
Construction
Flood plain plan
Plans resubmitted..
Mechanical
Giading plan
2`f Review, ready for corrections/•issue
Electrical
Subcoutactor List
Called Contact Person
plbtag
Grant Deed
Plans picked up
ML
L
H.O.A. Approval
Plans resubmittedGradlug
DY HOUSE: -
3" Review; ready for correctlonslissae
Developer Impact Fee
Planning Approval.
Called Contact Person
AXP.P.
'
Pub. Wks. Appr
Date of permit Issue
School Fees
Total Permit Fees
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF -IR -ALT -HVAC
Climate Zones 10 - 15
Site Address:
Enforcement Agency:
Date:
Permit #:
54860 AVENIDA MADERO La Quinta, CA 92253
City of La Quinta
Mar 1, 2013
Equipment Typel
List Minimum Miiciency2
Dud insulation
requirement
Conditioned Floor
Area
Thermostat
❑ Package Unit
❑ Furnace
[3 Indoor Coil
❑ AFUE
® SEER 3
1 =
❑ COP
[1HSPF
❑ R 6 (CZ 10-13)
Served by system
® Setback
not already present, must be
® Condensing Unit
[3 EER
❑Resistance
[IR 8 (CZ 14 -IS)
1248 sf
installed)
❑ Other
1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -ZR -ALT -HVAC for each system.
2. Minimum Equipment Efficiencies: 13 SEER, 78% AFUE, 7.7HSPF for typical residential systems.
HERS VERIFICATION SUMMARY 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 -111
and CF -6R shall also be on site for final inspection.
® 1. HVAC Changeout
Required Forms:
. All HVAC Equipment
CF -611 forms: MECH-04, MECH-2I-HERS and (for split systems) 04EGH 26 ij@R& EXEMPTED
replaced
CF -4R forms: MECH-21 and (for split systems) MgGH 25 EXEMPTED
. Condenser Coil and /or
. Indoor Coil and /or
CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) EXEMPTED
. Furnace
CF -411 forms: MECH-21 and fors lits stems m 26
( P systems) .m,_G�,--� EXEMPTED
For Split Systems: Duct leakage < 15 percent; RC, CCAS 300 CFM/ton (Minimum Air Flow Requirement), TMAH
Exempted from duct.leakage testirf4 if:
0 1. Duct system Was documented to have been previously sealed and confirmed through HERS verification, or
❑ 2, Duct systems with fess than :40 linear feet in unconditioned space, or
0.3. Existing duct systems are constructed, insulated or sealed with asbestos
E1.4.-- The system yhll not be Ducted (ie: Ductless Minr Split System)j(Also Exempt from Refrti3erant Charge)
112. New;HUAC System
Required Porins:'
. Cut in.`dr Gtiangeout with":'
new duds (all new
CF 6Rfiorms ;MECH-04 MECH` 20 HERS �andaffor split systerris) MECI F22 tdERS, and nncru_�c_ucnc
duding�t d all new`
equipmetxf) {.
EXENiPTED� t ; F y
Cf -4R forms MECH 20 and (for split systems] GtEGH-22; ani �.�� EXEMPTED '
.;
_ _ =
r
For Split Systems: Duct.;leakage < 6 pefeent, RC: CCA 2' 35D CFM/ton fWD TMAH, SIMS, and`.A"l er HSPP or PSPP.
For Packaged Units: Dud leakage <:6'percent.
❑.3:.New. Ducts.viiith./or without.
Required Forms:
ReplacenYeitt
. Includes replacing or installing all:`::,
new ending and/or outdoor.
condensing unit and/or indiior coil
CF -6R forms: MECH-04, MECH-20-HERS, and (for split systems) EXEMPTED
and/or furnace. No or some
r
CF -4R forms: MECH-0 anfors lits stems M
d 2 ( P systems) ,-.E --H 2g-� EXEMPTED
equipment changed.
For Split Systems: Duct leakage < 6 percent; RC, CCA a 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 linear feet dud in
CF -6R forms: MECH-04, MECH-2I-HERS
unconditioned spacee..
CF -4R forms: MECH-21
For split system or packaged units: Duct leakage < 15 percent
Ll EXCEPTION: Existing duct systems 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.
. I 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, calculations, plans and specifications
submitted to the enforcement agency for approval with the permit application.
Name: BEATRIZ MORA-PICASO Signature: BEATRIZ MORA-PICASO
Company: HARRISON ENTERPRISES INC Date: Mar 1, 2013
Address: 72078 CORPORATE WAY #101 License: 968141
City/State/Zip: THOUSAND PALMS / CA / 92276 Phone: (760) 343-5566
—!-J: — -nvuAzSzzi-uuuuuuuuu-u000 Registration Date/Time: 2013/03/01 18:46:13 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms July 2010