MECH (09-1110)79245 Mandarina
09-1110
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA; CALIFORNIA 92253 -
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number:
.09,-A0001110 '
Property Address:
79245 MANDARINA
APN:
772-360-007- - -
Application description:
MECHANICAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
8021
Applicant: 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 yyLicense .: 374937
Date: !G Contract ./3L.
OWNE-R-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).:
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 (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 contractors) licensed
pursuant to the Contractors' State License Law.).
(_) '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:
LQPERI\•IIT
Owner:
WAGNER .DAVE
79245 MANDARINA O
LA QUINTA, CA 92253
(760) 564-0050
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/19/09
Contractor:
PALM DESERT AIR CON CO I 1¢ `
42081 BEACON HILL;-
PALM DESERT, CA 92211. "• ljvr
(760)346-0677 ;Q7. A
Lic. No.: 374937
-----------------------------------------------
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 STATE FUND -Policy Number 238-0004656-08
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 co ly with those provisions.
Date:' APPIrC2R—G
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 ($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 inspection purposes.
;___Date: l Signature (Applicant or Aged ' G.ycr
LQPERM[T
Application Number .
. . . . 09-00001110
Permit . . .
MECHANICAL_
Additional desc . .
Permit Fee
33.00
Plan Check Fee
8.25
Issue Date . . . .
Valuation
0
Expiration Date ..
4/17/10
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
__.___.__ _.. ,...�....,.. REPLACE (1) EXISTING
3.50 TON SYSTEM
WITH (1) 3.50 TON 16
SEER SYSTEM.
----------------------------------------------------------------------------
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
LQPERM[T
El
Certificate of Comoliance Presr_rintive MPthnd — HVAr..Only _ Altarntinn r.F_1 R-pnnr
Project Title: 1
Date:'4 5C ,,$>F,a„r'
DAVE WAGNER
10/19/2009
,'Ensor dhiint,agenc'ytJseon1,
Project Address:
Climate Zone:
Bwldmg Perrnat No Q '
79-245 MANDARINA / LA QUINTA
15
" :
G
Documentation Author:
Annalu Lopez
Telephone Number:
Plan Check Date. 3
r
760-346-0677'''
_
t
Company Name:
Palm Desert Air Conditioning & Heating Company
Field Check Date .
IMPORTANT: This CF -1 R=PDAC form is only for use when an HVAC only alteration is made on an existing home. Use one
form for each system being altered. This is system number 1 of 1. systems being altered in this house.
Section 1 — HVAC System:
1 Configuration: - 0 Split System 0 Package Unit
2 0 An Air Handler is to be installed or replaced.
3 O A Furnace with a Heat Exchanger is to be installed or replaced. .AFUE: 80%
4 O An Outdoor Condensing Unit is to be installed or replaced.
4a Q Air Conditioning SEER: 16.00 EER: _ 13.00
4b ' O Heat Pump SEER: EER: HSPF:
5 O A Cooling or Heating Coil is to be installed or replaced. O Air Conditioning O Heat Pump
6 0 More than 40 feet of new or replacement ductwork are to be installed in unconditioned space.
6a O Entire duct system was replaced.
7 0 No items in this section are checked; go to section 6.
Section 2 — Duct Sealing Exceptions:
8 O This system was previously sealed and tested, and was certified by a HERS rater. Attach previous CF4R form.
9 O This system is in Climate Zone 1, 3, 4, 5, 6, 7 or 8.
10 O This system is sealed or insulated with asbestos.
,
11 O This system has less than 40 feet of ducts in unconditioned space.
12 O This system is in Climate Zone 10, 13 or 15: An SEER 14 AND EER12 oCgreater condenser will be installed with
TXV (RCA) verification'AND added duct insulation (R-4 wrap on existing ducts or R-8 on new ducts).
13 O This system is in Climate Zone 10, 13 or 15: An SEER 14 AND EER12 or greater condenser will be installed with
TXV (RCA) verification AND a 92% or greater furnace will be installed.
14 O No items in this section are checked, duct sealing is required. Continue.
Section 3 — TXV (RCA)' Verification: (Only if lines 4 or 5 are checked, otherwise go to section 4.)
15 O This system'is a package unit. No TXV (RCA) verification is required.
16 O No items in this section are checked, TXV (RCA) verification is required. Continue.
Section 4 — HERS Rater Verification:
17 O If line 14 is checked, HERS verification is required for duct sealing.
18 O If lines 12, 13 or 16 are checked AND line 15 is not checked, HERS verification is required for TXV (RCA).
Section 5 — Equipment Efficiencies:
19 O If lines12 or 13 are checked; upgraded equipment efficiencies are required in section 1.
Section 6 — Duct R -Values:
20 O If more than 40 feet of duct work is being installed or replaced, duct R -value must meet or exceed Package D
requirements.
21 0 If less than 40 feet of duct work is being installed or replaced, duct R -value must meet or exceed R-4.2.
Compliance Statement: This certificate of compliance lists the building features and specifications needed to comply with
Title 24, Parts 1 and 6 of the California Code of Regulations, and the administrative regulations to implement them. This
certificate has been signed by the individual with overall project responsibility. The undersigned recognizes that compliance
using duct sealing, verification of refrigerant charge, and TXV require installer testing and certification and verification by an
approved HERS rater.
Docum or i at r
Document Author Addr
42-081 Beacon Hill, Palm D e , CA 92211
s
Bin #
Qty of La Quinia
Building 8T 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: 79-245 Mandarina
Owner's Name: Dave Wagner
A. P. Number:
Address: 79-245 Mandarina
Legal Description:
Contractor: Palm Desert Air Conditioning &Heating Company
City, ST, Zip: La Quinta, Ca. 92253
Telephone : 760-564-0050R,
Address: 42081 Beacon Hill
Project Description:
City, ST, Zip: Palm Desert, CA 92211
Replace 1 existing 3.5 tons stem
Telephone: (760) 346-0677
:: •.;? ::kx? ;.:..:::;{.::. ;>:'>:f::
->
With 1 3.5 ton 16 SEER system.
State Lic. # : 374937
City Lic. #: ' 100886
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
State Lic. #: :>;:«<:;?:::•:;:r:;.:::: ;;,..,<,::::;:;
Construction T ype: Occupancy:
Project type circle one New Add'n Alter Repair Demo
Name of Contact Person: Annalu Lopez
Sq. Ft.:#Stories:
# Units:
Telephone* of Contact Person: (760) 346-0677
Estimated Value of Project: $8,021.00
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
l
Reviewed, ready for corrections
Plan Check Deposit
Truss Cates.
Called Contact Person
Plan Check Balance
Title 24 Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
21" 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