MECH (12-0903)79485 Mandarina
12-0903
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
12-00000903
Property Address:
79485 MANDARINA
APN:
772 -350 -001 -
Application description:
MECHANICAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
7200
T,ityl aF4w
Applicant: Architect or Engineer:
Y
----------------- I
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT .
I hereby affirm under penalty of perjury that I anNicensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and rofessionals,Code, and my License is in full force and effect.
License Class: C20 License No.: 686310
/Date: ./I L Contractor:
`\-J
WNER-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.).
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. , 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:
MILLER VIRGINIA A.
79485 MANDARINA
LA QUINTA, CA 92253 f
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/10/12
U
GENERAL AIR CONDITIONI GryLfj 10
31170 RESERVE DRIVE
THOUSAND .PALMS, CA 92 6 C1r%(aII
(760) 343-7488 .0F4AQ(hJV
Li c . No.: 686310
-----------------------------------------------
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 ZENITH INS CO Policy Number Z071741501
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 becom subject to the workers' compensation laws of California,
and agree that, if I should becomes j ct to the workers' compensation provisions of Section
3700 of the Labor Code, I shall fort ith co ply with those provisions.
Date: fc Applicant:
WARNING: FAILURE TO SECURE WOR PENSATION 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 abtiformation is correct. I agree to comply with all
city and county ordinances and state laws relating to buildingon, and hereby authorize representatives
of this coouunty to enter upon the above-mentioned property fon purposes.
Date: y' O Signature (Applicant or Agent):
c
Application Number . . . . 12-00000903
Permit . . . MECHANICAL
Additional desc .
Permit Fee 40.50
Plan Check Fee
10.13
Issue Date
Valuation . . . .
0
Expiration Date 2/06/13
Qty Unit Charge Per
Extension
BASE
FEE-
15.00
1.00 9.0000 EA MECH
FURNACE <=100K
9.00
1.00 16.5000 EA MECH
B/C >3-15HP/>100K-500KBTU
16.50
----------------------------------------------------------------------------
Special Notes and Comments
HVAC CHANGE OUT 13 SEER FURNACE
&
CONDENSING UNIT INDOOR COIL 2010
CODES.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged
Paid Credited
Due
Permit Fee Total 40.50
.00 .00
40.50
Plan Check Total 10.13
.00 .00
10.13.
Other Fee Total 1.00
.00 .00
1.00
Grand Total 51.63
.00 .00
51.63
LQPERMIT
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-1R-ALT-HVAC
Climate Zones 10 - 15
Site Address:
79485 MANDARINA La Quinta, CA 92253
Enforcement Agency:
City of La Quinta
Date:
Aug 8, 2012
Permit #:
Equipment Typel
List Minimum Efficiency2
Duct insulation
requirement
Conditioned Floor
Area
Thermostat
❑ Package Unit
® Furnace
® Indoor Coil
® AFUE 78%
®SEER 13.0
❑ COP
❑ HSPF
❑ R 6 (CZ 10-13)
Served by system
® Setback
® Condensing Unit
❑ EER
❑ Resistance
❑ R 8 (CZ 14-15)
1600 sf
not already present, must be
innot
in
[3 Other
1. Equipment Type; Choose the equipment being installed; if more than one system, use another CF-IR-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 that listed
verifies the work 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-IR
and CF-611 shall also be on site for final inspection.
R 1. HVAC Changeout
Required Forms:
• All HVAC Equipment
CF-6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS
replaced
CF-4R forms: MECH-21 and (for split systems) MECH-25
• Condenser Coil and /or
• Indoor Coil and /or
CF-6R forms: MECH-04, MECH-2I-HERS and (for split systems) .MECH-25-HERS
• Furnace
CF-4R forms: MECH-21 s MECH-25
and ( forPlits Ystems )
For Split Systems: Duct leakage < 15 percent; RC, CCA <_ 300 CFM/ton (Minimum Air Flow Requirement), TMAH
Exempted from duct leakage testing if:
❑ 1. 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
[13. Existing duct systems are constructed, insulated or sealed with asbestos
❑ 4. The sy_sterra;will not be Ducted (ie. r ystern ,t tso, fxerriptsfr rry Req!ger ctli 4karge)
❑ 2. New HVAC System Regwled.ffins: ' y
• Cut in, r.Cha ngeout ith:1 x .._
C-6R fo .MECH-04 HERS r lit s
new auGtS; (all new MECH125 sP Y ) MECI22 HERS, rand
ducting .a II new
e ui rrter1t foroSSi MECH- 0, fors its MECH- ME 25
P Ystems: Duct kage-< 6` F*t,, 'SCA 50
For Split S pe ,1 _G, GFM/toft; .FWD;=TMAH, S'TMS, and er HSPP or'PSPP.
For Packaged Units: Duct leakage < 6 percent
❑ 3. New Ducts with/or without
Required Forms:
Replacement
• Includes replacing or installing all new
ducting and/or outdoor condensing unit
and/or indoor coil and/or furnace. No or some
CF-6R forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS
CF-4R forms: MECH-20 and (for split systems) MECH-25
equipment changed.
For Split Systems: Duct leakage < 6 percent; RC, CCA z 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
CF-611 forms: MECH-04, MECH-2I-HERS
linear feet of duct in unconditioned space.
CF-4R forms: MECH-21
For.split system or packaged units: Duct leakage < 15 percent
❑ 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, and specifications
plans submitted to the enforcement agency for approval with the permit application.
Name: Danielle Garcia Signature: Dnnielk Garcia
Company: HARRISON ENTERPRISES INC Date: Aug 8, 2012
Address: 31-170 RESERVE DRIVE STE A license: 686310
City/State/Zip: THOUSAND PALMS / CA / 92276 Phone: (760) 343-7488
---1• ---- ncyisLraclon nate/rime: 2012/08/08 20:44:08 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms July 2010
Bin. #
Cj / Of Quinta
Building S Safety Division
P.O. Box 1504,78-495 Calle Tampico
La.Quinta, CA 92253 - (760) 777-7012
Building.Permit Application and Tracking Sheet
Permit #
jectAddress:,.Q v vlA Q 1 hq
Owner's.Name:. V nI A
A- P. Number. 62I Q 0 Q
Address: X11 c iC
Legal Description:
City, ST, Zip: CN "_r
Contractor: . :
Telephone:
Address: 3 (- l?D 'L
Project Description:
g: CA gZZ76
J
6 3Q ?4 0 s = y
Lie.: 4' l C Z) City Lia #;
., Designerp:
ffEngr.,
Telephone:
State Lie. #:
Name of Contact Person:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft : #Stories: # Unitg:
Telephone # of Contact Person:
Estimated Value of Project
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRICKNG
PERMPI'FEES-
Plan Sets
Plan Check submitted.
Item Amount
Stmetural Calm
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Cales•
Called Contact Person
Plan Check Balance
Title 24 Calci,
Pians picked up
Construction
Flood plain plan
Plans resubmitted. •
Mechatilcal
Grading plan
2'! Rcview, ready for correctionslissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.L
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'^' Review', ready for correctionslissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit Issue
School Fees
Total Permit Fees