MECH (11-0262)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
A—li—t-
11-00000262
52560 AVENIDA MENDOZA
773-303-003-21 -000000-
MECHANICAL
COVE RESIDENTIAL
5000
Architect or Engineer:
Jo/pic,.
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
--------------------------------------------------
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 Busin - nd ofessionals Code, and my License is in full force and effect.
License Clas C License No.: 860682
/at :ZY-Contract
OWNER -BUILDER DECLARATION
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 7631.5 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 contractor(s) 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: IJ
LQPERMIT
Owner:
HEATHER BUCK
52560. AVENIDA MENDOZA
LA QUINTA, CA 92253.
I
Contractor:
ARNOLDS A/C SERVICE
76987 OKLAHOMA AVENUE
PALM DESERT., CA 92211
(760)772=3731
Lic. No.: 860682
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/17/11
MAR 17 2011
------------------
WORKER'S COMPENSATION DECLARATION
OF
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 EXEMPT Policy Number EXEMPT
certify that, in the performance of the work for which this permit is issued, I shall not employ any
person in any manner snE
o the workers' compensation laws of California,
and agree that, if I shoue workers' compensation provisions of Section
37 0 of the abor Cod) with those provisions. Applicant- -
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 statethat the above' mate is correct. I agree to comply with all
city and county ordinances and state laws relating to buildin onstruction nd hereby authorize representatives
of this coun to ter upo the above-mentioned prope or inspe io pur �y
Dat • ignature (Applicant or Agent
Application Number . . 11-00000262
Permit MECHANICAL
Additional desc .
Permit Fee . . . . 40.50
P1an.Check Fee
10.13
Issue Date
Valuation
0
Expiration'Date 9/13/11.
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
INSTALL PACKAGE HVAC SYSTEM, 13 SEER 11
EER. 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
0
LQPERMIT
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations
Climate Zones 10 to 15
Site A
Unit
List Mini
Duct
CF -IR -ALT -HVAC
Permit #:
%/—Z6o
❑ Furnace ❑ AFUE O ❑ COP Over 40 ft of ducts added or etback
❑ Indoor Coil 40SEE 13HSPF replaced in unconditioned space Served by system (ljnot alreadv
❑ Condensing Unit a'FtR ❑ Resistance ❑ R 6 (CZ 10-13) sf present. must- be
❑ Other ❑ R 8 (CZ 14-15) installed)
1. Equipment Type: Choose rhe equipmng installed. if more than one system, use another CF -1 R-ALT-HVACjor each system.
1. Minimum Equipment Effikiencies: 13 SEER 78.0 AFUE, 7.7HSPF jot- 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 -6R and registered CF -4R forms (no hand filled CF-4Rs allowed) are filled out and
ed. Beginning October 1, 2010 a r tered co of the CF -1R and CF -6R shall also be on site for final Inspection.
si
1. HVAC Changeout I Required Forms:
• All HVAC Equipment replaced CF-61kforms: MECH-04, MECH-2I-HERS and (for split systems) MECH- 25 -HERS
CF -411 forms: MECH- 21 and fors lit stems MECH-25
• Condenser Coil and /or
• Indoor Coil and/or CF-611fortes: MECH-2I-HERS and (for split systems) MECH- 25-14ERS
•
Furnace CFAR 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 ducts sterns are constructed, insulated or sealed with asbestos
❑ 2. New HVAC System Required Forms:
• Cut in or Changeout with new CF -6R forms: MECH-04, MECH-20-HERS,and for lit stems MECH-22-HERS, and MECH-25-HERS
ducts: (all new ducting and all ( split systems)
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
O 3. New Ducts with Replacement Requtred-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 CFAR fortes: MECH-20 and (for split systems) MECH-25
coil and/or f imace. 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:
• Include; adding or replacing more than 40
linear feet of duct in unconditioned space. CF -6R forms: MECH-04, MECH-2I-HERS 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 I and 6 of the California Code of Regulations.
• 'i features iderititied on this Certificate of Compliance are consistent with the informatio ted on other applicable compliance forms, worksheets.
calculate s, plans ands if ations submitt to the enforcemcorapproval with Ii
Name >< 1 1 gn / //U
t�trx.okry v r Icy:,,, �t store.
2008 Residential Compliance Forms March 2010
Y
Bin #
Permit #
�. lY
Project Address:
A. P. Number:
Contractor:
Address:
City, ST, Zip: t
Telephone: W-770 J7G1�'
State Lic. # : 09?_��
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person:
Telephone # of Contact Person:
# Submittal
Plan Sets
Structural Calcs.
Truss Calcs.
Title 24 Calcs.
Flood plain plan
Grading plan
Subcontactor List
Grant Deed
H.O.A. Approval
s IN HOUSE: -
Planning Approval
Pub. Wks. Appr
School Fees
City of La. Q uInta
Building & Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777.7012
Building Permit Application andjTracking Sheet
Owner's Name:
Address:
City, ST, Zip:
Telephone:
Project Description:
Lic. #;
Construction Type:
Project type (circle on New
Sq. Ft.: ILIZ # Stories:
Estimated Value of Projec
APPLICANT: DO NOT WRITE BELOW THIS LINE
Rec'd TRACKING
Plan Check submitted
Reviewed, ready for corrections
Called Contact Person
Plans picked up
Plans resubmitted
2" Review, ready for corrections/issue
Called Contact Person
Plans picked up
Plans resubmitted
Review, ready for correctionsrissue
Called Contact Person
Date of permit issue
r
Occupancy:/�T
Pn Alter Repair Demo
# Units:
PERMIT FEES
Item Amount
Plan Check Deposit
Plan Check Balance.
Construction
Mechanical
Electrical
Plumbing
S.M.I.
Grading
Developer Impact Fee
A.I.P.P.
Total Permit Fees