MECH (10-1368)54270 Avenida Martinez
10-1368
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 10-00001368
Property Address: 54270 AVENIDA MARTINEZ
APN: 774-254-002-17 -000000-
Application description: MECHANICAL
Property Zoning: COVE RESIDENTIAL
Application valuation: 8000
Applicant:
T4ht 4 4 Q"
Architect or Engineer:
1 A
-----------------
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
1 hereby affirm under penalty of perjury that 1 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.
Lice s CI ss: C20 icense)No.: 686310
Dat Contractor: Clri/
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 (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 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 ) 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:
LQPERA1IT
Owner:
IGNJATOVIC LJUBONIR
54-270 AVENIDA MARTINEZ
LA QUINTA, CA 92253
Contractor:
GENERAL AIR CONDITIONING
31170 RESERVE DRIVE
THOUSAND PALMS, CA 92276
(760)343-7488
Lic. No.: 686310
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
WORKER'S COMPENSATION DECLARATION
Date: 12/14/10
n}i
2090 ' U;
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 EVEREST NATL Policy Number 7600006147101
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 1 should become subject to the workers' compensation provisions of Section
3709 of the Lab de, 1 all forthw; c mply with those provisions.
411
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 ter upon the above-mentioned prop r ins ctiorg p ur/o%Tbs/fir / 1^
Aate. ignature (Applicant or Agent): , [ L A r' t
Application Number . . . . . 10-00001368
Permit . . . MECHANICAL
Additional desc .
Permit Fee . . . . 40.50 Plan Check Fee
10.13
Issue Date . . . . Valuation . . . .
0
Expiration Date 6/12/11
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
5T/13 SEER/80 AFUE HVAC CHANGEOUT -
2007/2008 CALIFORNIA BUILDING CODES.
December 14, 2010 4:38:21 PM AORTEGA
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG SIDS 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
LQPERAIIT
Sim lifted Prescri five Certificate of Compliance: 2008 Residential HVA CAlterations CF -IR -ALT -HVAC
Climate Zones 10 to 15
Site Addres_$:
7 a
Fnforcement, 4gen4qv:
Date:
Permit #:
,3 .1 -✓ /t c-dEs - tl f . ez
/ o' L-11140
0.1
Eq ui ment Type'
List Minimum Efficienc 2
Duct insulation requirement
Conditioned Floor
Area
Thermostat
177 Packaged Unit
Curnace
❑ )
13 COP
Over 40 ft of ducts added or
0,Setback
ndoor Coil
❑SEER
❑HSPF
replaced in unconditioned space
❑ R 6 (CZ 10-13)
Served b system
sf
(If not already
present, must be
Unit
❑ EER
❑ Resistance
13 Other
❑ R 8 (CZ 14-15)
installed)
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, 7.7HSPFfor typical residential systems.
HERS VERIFICATION SUIVIIVIARY 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 -1R 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-2I-HERS and (for split systems) MECH- 25 -HERS
CF -4R forms: MECH- 21 and fors lits stems MECH-25
_onaenser t -on ana rot
• Indoor Coil and an CF -6R forms: MECH-2I-HERS and (for split systems) MECH- 25 -HERS
CF -4R forms: MECH- 21 and (for split systems) MECH-25 U N'TP.
• Furnace NTA
For Split Systems: Duct leakage < 15 percent; RC, CCA > 300 CFM/ton(Minimum A R u ngT GTS D
For Packaged Units: Duct leakage < 15 percent BUILD Rpt N
Exempted from duct leakage testing if: Ap V G
❑ 1. Duct system was documented to have been previously sealed and confirmed throu HER v8r-ification, or
❑ 2. Duct systems with less than 40 linear feet in unconditioned space, or
❑ 3. Existing ducts stems are constructed, insulated or sealed with asbestos
❑ 2. New HVAC System I Required Forms: Jn _gY
• Cut in or Changeout with new " -
ducts: (all new ducting and all CF -6R forms: 'MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-HERS
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
❑ 3. New Ducts with Replacement Required Forms:
• Includes replacing or installing all new ducting CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-25-HERS
and/or outdoor condensing unit and/or indoor CF -4R 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 CF -6R forms: MECH-04, MECH-2I-HERS CF -4R forms: MECH-21
linear feet of duct in unconditioned space.
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,
calculati?&glans and specifiGaQons submitted to the enforcement agency for approval with the i applicA i .
Name: l r/ i /^ sz I Signature: (,O//f _
Company: — `" — - —" Date:
Address: r License:
City/State/Zip: --nn T ,1 e -, ^ nI `limit ( i IM Q : / --) I ., I Phone:
Bin #
City of La Quinta
Building 8i Safety Division
Permit #
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
p 13
Building Permit Application and Tracking Sheet
Project Address:
Owner's Name:
/G
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
Contractor:;:,..:.w.:
; y
Tele hone:s r 1011
Address:
Address: ✓
Project Description
City, ST, Zip:'—
Telephone:
'
::i{: v jJ:tiE f ?.'j fah'•, i:•ii
:F> z::::h : •.... :: R::i: :ti s^•.•h:i'iti/ `. .;
/3
State Lic. # :
City Lie. #;
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:.
...,,x, ' r.•. •= :' «:::z::->:;:;;g Ns>k:
sf-<.::,i••f ::< ::f -::s:..::w;: : .
_
Construction Type:
YP Occupancy:
State Lic. #:
't •: tyic,; ,.: i'::: >.:.f,'.s4,:1/ii} vfi+•'-':•`.
' h?<:> $>' s>?<::::: <; !{?•,
o»:;Ns«,v>,;:• s>:>s4.;<;,;;.,E<.;
Project type (circle one)• New Add,n Alter Repair Demo
Name of Contact-Person:
Sq. Ft.: #Stories: #Units:
Estimated Value of Project:
Telephone # of Contact Person:
APPLICANT: DO. NOT WRITE.
BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING PERMIT FEES
Plan Sets
. Plan Check submitted Item Amount
Structural Calcs.
Reviewed, ready for corrections Plan Check Deposit
Truss Calcs.
Called Contact Person Plan Check Balance
Title 24 Calcs.
Plans picked up Construction
Flood plain plan
Plans resubmitted Mechanical
Grading plan2"a
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:-
ird 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
PRn
TALLATION CERTIFICATE CF-6R-MECH-25-ElERS
Refrigerant Charge Verification - Standard Measurement Procedure a e 1 of
Address: Enforcement Agency: Permit Number:
Note: If installation of a Charge Indicator Display (CID) is utilized as an alternative to refrigerant charge verification for
compliance, a MECH-24 Certificate (instead of this MECH-25 Certificate) should be used to demonstrate compliance with
the refrigerant charge verification requirement. TMAH and STMS are not required for compliance, when a CID is utilized
for compliance.
As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additianal fonn(s) for
any additional systems in the dwelling as applicable.
Temperature Measurement Access Holes (TMAH) and Saturation. Temperature Measurement Sensors (SIMS)
Procedures for installing TMAH are specified in Reference Residential Appendix RA3.2. If refrigerant charge verification
is required for compliance, TMAH are also required for compliance. STMS are only required for completely new or
replacement space -conditioning systems that utilize prescriptive compliance method.
TMAH- Access Holes in Supply and Return Plenums of Air Handler
System Name or Identification/Tag "
System Location or Area Served `J-40 IE
-- //
1 19Yes No 5/16 inch (8 nut) access hole upstream of evaporative coil in the return plenum and
labeled according to Figure in Section RA3.2.2.2.2.
2 Yes ❑No 5/16 inch (8 mm) access hole downstream of evaporative coil in the supply plenum
and labeled according to Figure in Section RA3.2.2.2.2..
Yes to 1 and 2 is a pass. Enter Pass or Fail ✓ ❑.':ass ✓ ❑ Fail
STMS - Sensor on the Evaporator Coil
System Name or Identification/Tag
The sensor is factory installed, or field installed according to manufacturer's
3 ❑ Yes
ONO
specifications, or is installed by methods/specifications approved by the Executive
Director.
The sensor wire is terminated with a standard mini plug suitable for connection to a
4 ❑ Yes ONO digital thermometer. The sensor muni plug is accessible to the installing technician and
the HERS rater without changing the airflow through the condenser coil
5 ❑Yes ONO The sensor measures the saturation temperature of the coil within 1.3 degrees F
Yes to 3, 4, and 5 is a pass. Enter ❑ N/A ✓ ❑ Pass ✓ ❑ Fail
N/A if STMS are not applicable. Otherwise enter Pass or Fail
STMS - Sensor on the Condenser Coil
System Name or Identification/Tag
The sensor is factory installed, or field installed according to manufacturer's
6 ❑ Yes ONO specifications, or is installed by methods/specifications approved by the Executive
Director.
The sensor wire is terminated with a standard mini plug suitable for connection to a
7 ❑ Yes❑No digital thermometer. The sensor mini plug is accessible to the installing technician and
the HERS rater without changing the airflow through the condenser coil
8 ❑Yes ONO The sensor measures the saturation temperature of the coil within 1.3 degrees F
Yes to 6, 7, and 8 is a pass. Enter ✓ ❑ N/A ✓ ❑ Pass ✓ ❑ Fail
N/A if STMS are not applicable. Otherwise enter Pass or Fail
Registration Number: Registration Date/Time: HERSProvider:
2008 Residential Compliance Forms August 2009
D
INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS
Refrigerant Charge Verification - Standard Measurement Procedure a e 2 of
Site Address: Enforcement A encY Permit Number:
Agency:S71 2.7 U V T,OA 114A2 e AI S7, I > -in
Standard Charge Measurement Procedure (for use if outdoor air dry-bulb is above 55 *fl
Procedures for determining Refrigerant Charge using the Standard Charge Measurement Procedure are available in Reference
Residential Appendix RA3. 2. As marry as 4 systems in the dwelling can be documented for compliance using this form Attach an
additional fonn(s) for any additional systems in the dwelling as applicable.
The system should be installed and charged in accordance with the manufacturer's Specifrcations before starting this procedure.
.. The system must meet minimum airflow requirements as prerequisite for a valld refrigerant charge test.
• If outdoor air dry-bulb is SS °For below, the installer must use theAlternate Charge Measurement Procedure.
Calibration of Diagnostic Instruments
Date of RefrigerantGauge Calibration (must be re -calibrated monthly)
Date of Thermocouple Calibration Z f d (must be re -calibrated monthly)
Measured Temperatures (°
System Name or Identificatioru Tag
zr N
Supply (evaporator leaving) air dry-bulb
temperature (Tsu 1 , db)
2_
Return (evaporator entering) air dry-bulb
temperature (Tretum, db)
Return (evaporator entering) air wet -bulb
temperature (Treturn, wb)
•.
Evaporator saturation temperature
Teva orator, sa
3
Condensor saturation temperature
(Tcondensor, sat)'
Z d
Suction line temperature (Tsuction)
b0
Liquid Line Temperature (Tliquid)
Condenser (entering) air dry-bulb
Registration Number: Registration Date/Time: HERS Pravider:
2008 Residential Compliance Forms August 2009
INSTALLATION CERTIFICATE CF=6R-MECH-25HERS
Refrigerant Charge Verification Standard Measurement Procedure a e 3 of
Site Address: Enforcement Agency: Permit Number:
Minimum Airflow Requirement
Temperature Split Method Calculations for determining Minimum Airflow Requirement for Refrigerant Charge
Verification. The temperature split method is specked in Reference Residential Appendix RA3.2.
System Name or Identification/Iag
"WV
Calculate: Actual Temperature Split =
Tretum, db - Tsupply, db
Target Temperature Split from Table
RA3.2-3 using Tretum,wb and Treturn, db .
Calculate difference: Actual Temperature
Split — Target Temperature Split = 2 -
Passes if difference is between -3°F and
+3°F or, upon remeasurement, if between piss
-3'f and - 1 OOOF Enferrass orFail'
Note: Temperature SplitMethod Calculation is not necessary if actual Cooling Coil Airflow is verified using one of the
airflow measurement procedures specified in Reference Residential Appendix RA3.3. If actual cooling coil airflow is
measured, the value must be equal to or greater than the Calculated Minimum Airflow Requirement in the table below. .
Calculated Minimum Airflow Requirement (CFM) = Nominal Cooling Capacity (ton) X 300 (cfm/ton)
System Name or Identification/Tag
Za ti e,
Calculated Minimum Airflow
Requirement (CFM)
Measured Airflow using RA3.3
procedures (CFM)
Passes if measured airflow is greater than
or equal to the calculated minimum
airflow requirement. Enter Pass or Fail
F
erheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for
d orifice metering device systems
tem Name or Identification/Tag
Calculate: Actual Superheat=
Fin
tion — Teva -orator, orator sat '
et Superheat from Table RA3.2-2
g Tretum, wb and Tcoder, db
ulate difference:
al Su erhet —Tatem passes if difference is between
and +5°F Enter Pass or Fail
Registration Number: Registration Date✓Time: HERSProviden
2008 Residential Compliance Forms August 2009
INSTALLATION CERTIFICATE. CF-6R-MECH-25 EARS
Refrigerant Charge Verification - Standard Measurement Procedure. a e 4 of
Site Address: Enforcement Agency: Permit Number:
1 i Y
Registration Number: Registration Date/Time:
2008 Residential Compliance Forms
HERS Provider:
August 2009
INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS
Refrigerant Charge Verification - Standard Measurement Procedure e 5 of
Site Address: Enforcement Agency: Permit Number:
Standard Charge Measurement Summary:
System shall pass both refrigerant charge criteria, metering device criteria (if applicable), and minimum cooling coil
airflow criteria based on measurements taken concurrently during system operation. If corrective actions were taken, all
a licable verification criteria must be re -measured and/or recalculated.
I System Name or Identificationaag y r-/ I I I I
System meets all refrigerant charge and
airflow requirements. Enter Pass or Fail I Vo, SS
DECLARATION STATEMENT
• I certify under penalty of pedury, under the laws of the State of California, the information provided on this form is true and correct.
o I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized
representative of the person responsible for construction (responsible person).
• I certify that the installed features, materials, components, or manufactured devices identified on this certificate (the installation)
conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the
enforcement agency,
• I understand that a HERS rater will check the installation to verify compliance, and that that if such checking identifies defects, I am
required to take corrective action at my expense. I understand that Energy Commission and HERS provider representatives will also
perform quality assurance checking of installations, including those approved as part of a sample group but not checked by a HERS
rater, and if those installations fail to meet the requirements of such quality assurance checking, the required corrective action and
additional checking/testing of other installations in that HERS sample group will be performed at my expense,
• I reviewed a copy of the Certificate of Compliance (CF -1R) form approved by the enforcement agency that identifies the specific
requirements for the installation, I certify that the requirements detailed on the CF -1R that apply to the installation have been met.
• I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the building
permit(s) issued for the building, and made available to the enforcement agency for all applicable Inspections. I understand
that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the
building owner at occupancy. I will ensure that all Installation Certificates will come from a HERS provider data registry for
multiple orientation alternatives, and beginning October 1, 2010; for all low-rise residential buildings.
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
Responsible Person's Name: Res sible Person's Signature:
CSLB Licen Date Signed: ition With mpany (Title):
L e C c>I
Is this installation monitored by a Third Party Quality Control Name of TPQCP (if applicable):
Program (TPQCP)7 Oyes ONO
Registration Number,• Registration Date -Mme:
2008 Residential Compliance Forms
HERS Provider:
August 2009