MECH (11-0827)79665 Mandarina
11-0827
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 11-00000827,
Property Address: 79665 MANDARINA
APN: 772-191-008- -
Application description: MECHANICAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 13710
Applicant: Architect or iV
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LICENSED CONTRACTOR'S DECLARATION
c&ht °F 4 Q"
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'CI s: jC20 License No.: 595145 '
` Date: Contractor:
ti/O -BUILD 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 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 contractors) 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
i work for which this permit is issued (Sec. -3097, Civ. C.)•
Lender's Name:
Lender's Address:
LQPERMIT
Owner:
BRANNEMAN ERNIE
79665 MANDARINA ST
LA QUINTA, CA 92253
Contractor:
DCS HEATING/AIR CONDITONNG
72078 CORPORATE WAY, #101
THOUSAND PALMS, CA 92276
(760)343-5566
LiC. No.: 595145
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: .8/03/11
------------------------ - -----------------------
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
_ 1 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 HARTFORD INS Policy Number 72WECLS7131
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
700 of the Labor Code, I shall forthwith comply with those provisions.
r
Date: Applicant:
WARNING: FAILURE TO SECURE WORKER OMPENSATION 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 cou ty enter upon the above-mentioned property for inspection purposes.
Date. Signature (Applicant or A
Application Number . . . . . 11-00000827
Permit . . . MECHANICAL
Additional desc .
Permit Fee . . . . 40.50 Plan Check Fee
10.13
Issue Date . . . . Valuation . . . .
0
Expiration Date . . 1/30/12
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
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Special Notes and Comments
HVAC CHANGE OUT CONDENSER,COIL AND
FURNACE. 18 SEER 4 TON 2010 CODES.
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Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
----------------------------------------
Due
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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
Sim lifted Prescriptive Certificate of Compliance: 2008 Residential HVACAIterations CF -IR -ALT -HVAC
Climate Zones 10 to 15
Site Address:/—
, f"orcement Agency:
E� n
Date:
Permit #:
Conditioned Floor
Equipment T '
List Minimum Eff i ci enCy2
Duct insulation requirement
Area
Thermostat
Padded Unit
Furnace
❑ A FU E W0470
❑COP
Over 40 ft of ducts added or
IKSetback
ndo0r Coil
❑SEER
❑ HSPF
replaced in unconditioned space
Served by system
(If not already
ondensing Unit
13 EER
_
❑ Resistance
❑ R 6 (CZ 10-13)
❑ R 8 (CZ 14-15)
Sf
present, mus! be
installed)
❑ Other
1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -I R -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 decideswhat work is being done and
picks one of the appropriate Options Each Option liststhe HERS measures that must be conducted. A copy of the forms shall be left on sitefor final
inspection and acopygiven tothe homeowner. At find, the inspector verifies theft thework listed on thisform was in fact thework completed by the
instiller. The inspector dso verifies that each appropriate CF -6R and registered CF -4R forms (no hand filled CF-4Rsallowed) are filled out and
signed. Beginning October 1, 2010, a registered copy of the CF -1R and CF -6R shall also be on site for final inspection.
j.LI. HVAC Changeout
Required Forms:
• All HVAC Equipment replaced
CF -6R forms MECH-04, MECH-21-HERS and (for split systems) MECH- 25 -HERS
CF -4R forms: M ECH- 21 and for split stems M ECH-25
• Condenser Coi I and /or
CF -6R forms M ECH-21-HERS and (for split systems) M ECH- 25 -HERS
• I ndoor Coi I and /or
CF -4R forms M ECH- 21 and (for split systems) M ECH-25
• Furnace
For Split Systems: Duct leakage< 15 percent; RC, CCA > 300 CFM/ton(Minimum Air Flow Requirement), TMAH
For Packaged Units: Duct leakage< 15 percent
Exempted from dud I eakage testi ng if:
❑ 1. Dud system was documented to have been previously sed ed and confirmed through HERS verification, or
❑ 2. Dud systems with less than 40 linear fed in unconditioned space, or
❑ 3. Existing dud systems are constructed, insulated or sealed with asbestos
❑ 2. New HVAC System
Required Forms:
• Cut i n or Changeout with new
CF -6R forms M ECH-04, M ECH-20-HERS,and (for split systems) M ECH-22-H ERS, and M ECH-25-HERS
duds: (d I new dudi ng and al I
CF -4R forms M ECH 20-, and (for split systems)M ECH-22, and M ECH 25
new equipment)
For Split Systems: Duct leakage< 6 percent; RC, CCA > 350 CFM/ton, FWD, TMAH, STMS, and either HSPF or PSPP.
For Packaged Units: Dud Ieakage< 6 percent
❑ 3. New Ducts with Replacement Required Forms:
• Indudesreplacingorinstalling all new cluding CF-6Rforms: MECH-04,MECH-20-HERS,and(for split systems) MECH-25-HERS
and/or outdoor oondensi ng unit and/or i ndoor CF -4R forms M ECH-20 and (for split systems) M ECH-25
coil and/or furnaoe. Not ail equipment changed.
For Split Systems: Dud leakage< 6 percent, RC, CCA > 300 CFM/ton, TMAH
For Packaged Units: Dud leakage< 6 percent
❑ 4. New Ducting over 40 feet
Required Forms:
• Ind udes adding or replacing more than 40
CF -6R forms M ECH-04, M ECH-2I-HERS CF -4R forms: M ECH-21
linear feet of dud in unconditioned space.
For split system or packaged units: Dud leakage< 15 percent
❑ EXCEPTION: Existing dud systems constructed, insulated orsededwith asbestos
Contractor (Documentation Author's /Responsible Designer's Declaration Statement)
• I certify thad this Certificateof Compliance documentation isaccurateand complete.
• I am eligible under Division 3 of theCafifornia Businessaird Professions Code to accept responsibility fortheclesign identified on this Certificate of Compliance.
1 certify that the energy features and performance specifi cati ons for the design identified on this Certificate of Compliance conform to the requi repents of Title 24,
Parts 1 and 6 of the Cal iforni a Code of Regul ati ons.
• The design features identified on this Certificate ofComplianceareconsistent w' thein rmationdocumented on therapplicablecomplianceforms worksheets,
calculatio ansand ificationssubmitted tothe enforcemert en for roval dAththe permit applicatiopi.
Name: f ��G, t ,� gnatur
Companybcs t -t
Address:
License:
City/State!Zip: � t- 14
4,-7(
Phone v3 S
2008 Residential Compliance Forms March 2010
Bin #
Qty of LQ Quinta
Building a Safety Division l/Q
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Pennit #
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Project Address: ^� (o ��' ;
Owner's Name: i r , ,e /by -a -no e
A. P. Number:
Address:S-f—
Legal Description:
K./ v ✓/�77
Contractor: ,t e t
City, ST, Zip: j4 � ay53
'! •'Q•Sdd,�f�`K`wT?ov'ky
x�vrA7vi�Jiih�'f. �vv\4
Telephone: a _
Address: -70-oi $ elor B, I jDaAProject
Description: 4V
City, ST, Zip:. ' Pr 99 /IV
Telephone: !¢ 1. fl ::
i? t7 3 3 .ice :i � ! r} c< 'lJi
-C '0-h_ .
State Lie. # : q S I Lf S City Lie. #;
Arch., Engr., Designer.
Address:
City, ST, Zip:
Telephone:
f' Uv'
,c•rj: ?�#� •. r ss�F;c
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Construction Type: Occupancy
State Lie. #:f:"c::
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft-:
#Stories:
#Units:
Telephone # of Contact Person: p 3 43 —7 $g
Estimated Value of Project: oa
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES '
Plan Sets
Plan Check submitted
Item
Amount
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cales.
Called Contact Person
Plan Check Balance
Title 24 Cales.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
21° Review, ready for correctionsAssue
Electrical
Subcontector List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O-A- Approval
Plans resubmitted
Grading
IN HOUSE:-
''d Review, ready for correctionstissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees