MECH (12-0207)50241 Calle Maria
12-0207
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Num6r:12`0:0:0;00207
Property Address:50241 CAI LE MARIA
APN: 773-340-009-9 -14496 -
Application description: MECHANICAL
Property Zoning: - LOW DENSITY RESIDENTIAL
Application valuation: 9500
Tiht 4 e(A Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
FRANKLIN MONTGOMERY
50241 CALLE MARIA
LA QtINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011.
INSPECTIONS. (760) 777-7153
Date: 3/07/12
Contractor:
Applicant: Architect or Engineer: MAPLE LEAF PLBG HEAT/AIR CO
Y
P.O. BOX 3653 '
PALM DESERT, CA 92261t AR t
(760)346-6758 F
Lic. NO.: 481393 -• Fi
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LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that 1 am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect._ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
Licens I ss: C20 -C36 License No.: - 481393 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
ate: ntractor: J 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
OWNER -BUILDER DECLARATION insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier ICW GROUP Policy Number WSD5002670-02
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to _ I certify that, in the performance of the work for which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner so as to become subject to the workers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I should become subject to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3700 of the Labor Call focth3ith comply, with those provisions.
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).: ate: 1"Ap nt:
1 _ 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 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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.).
(_) I am exempt under Sec. , BAP.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: f1U
Lender's Address: r
LQPERMIT
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 cn(o upon t above-mentioned prope(7 r i spe urposes.
Date: Jmy o enter nature (Applicant or Agentl:
LQPERMIT
Application Number . . . . 12-00000207
Permit . . . MECHANICAL
Additional desc .
Permit Fee . . . . 40.50
Plan Check Fee
10.13
Issue Date . . . .
Valuation
0
Expiration/Date 9/03/12
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-5.00KBTU
16.50
Special Notes -and Comments
HVAC CHANGE -OUT INSTALL FURNACE_
INDOOR
COIL & CONDENSER. 2010 CODES.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . .BLDG STDSAADMIN (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 HVACAlterations CF -IR -ALT -HVAC
10 to 15
Site Address:
CGti i e YV\ < Lri 4,
Enforcement Agency:
Date:
Permit #:
Equipment T et
List Minimum Efficiency'
Duct insulation requirement
Conditioned Floor
Area
Thermostat
❑ Packaged Unit
Furnace
AFUE &76
❑ COP
O 40 ft ducts
Over of added or
Setback
Indoor Coil
Condensing Unit
SEER
❑ HSPF _
replaced
laced in unconditioned s
❑ R 6 (CZ 10-13)
S
Served by system
Zia s
(I trot already
dY
present, must be
❑ Other
EER
❑ Resistance
❑ R 8 (CZ 14-15)
installed)
1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -I R-ALT-HVACfor each system.
2. Minimum Equipment Efficiencies: 13 SEER, 78%AFUE, 7.7HSPFfor 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 -611 and registered CF -411 forms (no hand filled CF-4Rs allowed) are filled out and
si ed. 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 replaced
CF -6R forms: MECH-04, MECH-2l-HERS and (for split systems) MECH- 25 -HERS
CF -411 forms: MECH- 21 and fors lits stems) MECH-25
• Condenser Coil and /or
• Indoor Coil and /or
CF -6R forms: MECH-2I-HERS and (for split systems) MECH- 25 -HERS
• Furnace
CF -4R forms: MECH- 21 and (for split systems) MECH-25
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 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
❑ 3. Existing duct systems are constructed, insulated or sealed with asbestos
2. New HVAC System Required Forms:
• Cut s: Changeouwith new
ducts: CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-HERS
(all
l new ducting and all
new equipment) CF -4R forms: MECH 20-, and (for split systems)MECH-22, and MECH 25
For Split Systems: Duct leakage < 6 percent; RC, CCA > 350 CFM/ton, FWD, TMAH, STMS, and either HSPP or PSPP.
For Packaged Units: Duct leakage < 6 percent.
113. New Ducts with Replacement
Required Forms:
• Includes replacing or installing all new ducting
CF -61Z forms: MECH-04, MECH-20-HERS,and.(for split systems) MECH-25-HERS
and/or outdoor condensing unit and/or indoor
CF -41K forms: MECH-20 and (for split systems) MECH-25
coil and/or furnace. Not all equipment changed.
For Split Systems: Duct leakage < 6 percent, RC, CCA > 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
linear feet of duct in unconditioned space.
CF -6R forms: MECH-04, MECH-2I-HERS CF -411 forms: MECH-21
For split system or packaged units: Duct leakage < 15 percent
❑ EXCEPTION: Existing ducts stems constructed, insulated or sealed with asbestos.
Contractor (Documentation Author's /Responsible Designer's Declaration Statement)
• 1 certify that this Certificate of Compliance documentation is accurate and complete.
• 1 am eligible under Division 3 of the Califomia Business and Professions Code to accept responsibility for the design identified on this Certificate of Compliance.
• 1 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 I 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, Rlans andspecifications submitted to the enforcement agency for approval with the a it application.
Name: QI„e( t e
Kl
Signature:
Company:
Date:
Address: 7 j
x 3CP 3
License:
cZ3
City/State/Zip: 1 Vk C 22<c,U
Phone: 0
2008 Residential Compliance. Forms March 2010
Bin
tdO .. r
_ BulldingBT.Safety DivisJon
P.O: Box.1504 •:78495.Calle Tampico .' -• ti-
laa.Quhita, CA 92253 - (760) 777-7012
Building Permit Application' and Tracking Sheet :
Permit
Project Addeess: 2y I CCt -Q YV `a ri`GL
Owner's Name:. G, N h IM G f/( ✓
A. P. Number
Address:- ^2y.I c I(2G✓ ' :
Legal Description:Ci
Contractor. L ea, wb
Address: ( j L) ( S3
'2j
ty, ST , Zip' ii► t1 + ✓' C J
Telephone: U szv if5
Project Description:
l f
City, ST, Zip: 1(/ 1 S' k ' C Z J
e cv ij4,1 L v
Telephone:
State Lia #: 1 3 9 3 City Lic. #t
Arcfr:, BW., Designees
Address:
City., ST, Zip: ,
Telephone:
State Lia #:
Name of Contact Person:
Construction Type:. Occupancy: ,
Project type (circle one): New Add'n Alter Repair Demo
Sq. FL:
# Stories: # Units:
Telephone # of Contact Person: G l , Q,J r{ 7 ^O `Z.`{ 2-
Estimated Value of Project (' • `"J
APPLICANT: DO NOT WRITE BELOW THIS. UNE
N
Submittal
Plan Sets
Req'd
'Rec'd
TRACENG PBRhIIT.FEES
Plan Check submitted Item Amoutd
Structural Calces
Reviewed, ready for corrections Plan Check Deposit. .
Truss Caler.
- Called Contact Person Plan Cheek Balance
Title 24 Calci.
Plans picked up ConstructloII '
Flood plain plan
Plans resubmitted.*. Mechanical
Girding plan
2' Review, ready for correctioneissne Electrical
Subcontaetor List
Called Contact Person Plumbing
Grant Deed
Plans picked up SAU
H.O.Aa Approval
Plans resubmitted Gradlog
ROUSE:-
''' Review; ready for correctionslissue Developer.Impaet Fee
Planning Approval
Called Contact Person AXP -P -
Pub. Wits. Appr
Date of permit issue
School Fees
Total Permit Fees