MECH (14-0121)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application. Number:
14-00000121
Property Address:
54140 AVENIDA MENDOZA
APN:
774-223-007-16 -000000-
Application description:
MECHANICAL
Property Zoning:
COVE RESIDENTIAL
Application valuation:
7500
Tjbt 4�
VOICE (760) 777-7012
FAX (760) 777-7011
BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 2/06/14
Owner:
LINDA PUCKETT
54140 AVENIDA MENDOZA
LA QUINTA, CA 92253
(760)574-5443
Contractor: n/ �-
Applicant: Architect or Engin er: QUALITY AIR
7548 ROCKAWAY ROAD
44
Al
YUCCA VALLEY, CA 92284
`�
I<
(760)365-7168 p 's
L r.. l,Esi
Lic. No.: 542181 t i
�� r r,i,,• Jy%A
----------------------------------------------------------------------------------------===_---
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 Business and Professionals Code, and my License is in full force and effect.
License Class: C20 Li cen a No.: 542181
00
Date Contractor:
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).:
(_) 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
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, 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 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
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 EXEMPT
Policy Number EXEMPT
Wr 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
37000 of the bor Code sh far[hwi h comply with those provisions.
Da41611Y Applicant: Jry�
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 agree's 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 enter upon t above-mentioned prope/Frtyn purpo
Date: �//�Signature (Applicant or Agent), /1
Application Number
Permit . . .
Additional desc . .
Permit Fee . . . .
Issue Date . . . .
Expiration Date . .
. . . . 14-00000121
MECHANICAL 2013
71.50 Plan Check Fee .00
Valuation 0
8/05/14
Qty Unit Charge Per
Extension
1.00 35.7500 EA MECH FURNACE
35.75
1.00 35.7500 EA MECH CONDENSER/COMP
35.75
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Special Notes.and Comments
HVAC CHANGE OUT - 16.5SEER, 5 TON SPLIT
SYSTEM (HEAT PUMP) (2008 ENERGY] CARBON
MONOXIDE ALARM(S) TO BE INSTALLED PRIOR
TO FINAL INSPECTION. 2013 CALIFORNIA
BUILDING CODES.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
PERMIT ISSUANCE M/P/E
90.57
PLAN CHECK, MECHANICAL
47.66
Fee sdmmary Charged Paid Credited
---------------------------------------------------------
Due
Permit Fee Total 71.50 .00 .00
71.50
Plan Check Total .00 .00 .00
.00
Other Fee Total 139.23 .00 .00
139.23
Grand Total 210.73 .00 .00
210.73
LQPERMIT
Din #
Qty Of La Quintd
Building &r Safety Division
P.O. Box i504, 78-495 cane Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
PermitA
I
Project Address: V d4(00
Owner's Name: J_11V1.j/9 �UC
A. P. Number:
Address: yI Z/�j ��% �tw470-Z
Legal Description:
City, ST, Zip:
Contractor: U A L I I
Telephone: �% J
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Address: �J g gt�
Project Description:
City, ST, Zip: (64 A
Telephone: jp '�
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State Lic. # : 02 ,
City Lic. #;
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
:.<';...,:;::;;;; v<::,; :>;:.:;:;.:
Construction Type: Occupancy:
State Lic. #:
project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:
#Stories:
1# Units:
Telephone #,of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
it
Submittal
Req'd
Recd
TRACMG
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 plan
2°" 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:-
'rd 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
Sim ied.Prescci tive Certifica(e of Com liaitce; 2008 ReSidential•ftVA.0 lte'ralions CF-LR=ALT-HVAC ..
Clihiate Zooea iv to 15 1
Site-Addr ,
/ ��h� Ertjf rcemt ` gtnP : paw:
.2-10
Permlr #%7
/ G
' C nditioned loor
Equipment T List Minimum EfFicienc Duct insulation requirement
Area
O Packaged UnitThermostat
❑ Furnace `(� AFUE O COP Over 40 ft of ducts added or O Setback
O Indoor Coil SEER Cl HSPF replaced N unconditioned space Served by system fljnor already
O Condensing Unit (j f_ER ❑ Resistance ❑ R 6 (CL 10-13) sf present. must be
O Other ❑ R 8 (CZ 14-15) insradedl
/ Equipment Type: Choose the eequipnteni being installed: Y more than one system, use another CF -1 R-ALT-KVAC for each system.
1. Minimum Equipment Efficiencies: 13 SEER, 780% AFUE, 7.7HSPF fortypical reside dial systems.
HERS VERIFICATION SUMMARY Listed below are four HVAC alteration Options The installer decides what wo* is being done and
picks one of the appropriate Options. Each Option lists the HERS measures that must be conducted. A Dopy of the forms shall be left on site for total
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
installer. The inspector also verifies that each appropriateCanpleted by the
ed: innin October 1, 2010, a r feted copyof the CF -IR and CF -6R shall also be on orms (no cit for �fina [ allowed) are filled out and
1.
HVAC Changeout Required Forms:
• All HVAC Equipment replaced CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH- 25 -HERS
Condenser Coil and /or CF -4R forms: MECH- 21 and for lit stents MECH-25
•
• Indoor Coil and /or CF -6R forms: MECH-21-HERS and (for split systems) MECH- 25 -HERS
• Furnace CF4R 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:
O 1 Out -1 system was documented to have been previously sealed and confirmed through HERS verification, or
O 2. Duct systems %%ith less than 40 linear feet in unconditioned space, or
O 3. Existing ducts stems are constricted insulated or sealed with asbestos
O 2. New HVACS tem Repaired Forms:
• Cut in or Changoout with new
ducts: (all new ducting tuI all CF -6R forms: MECH 04, MECH-20-HERS,and (fa split MECH-22-HERS, and MECH-25-HERS
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 CFMhon, FWD, TMAH, STMS, and either HSPP or PSPP.
For Packaged Units: Duct leakage <6 cent
❑ 3. New Ducts with Replacement Regtt172d Forms:
• Includes replacing or installing all new ducting CF -61K forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-25-HERS
and/or outdoor condensing unit and/or indoor CF4R forms: MECH-20 andfor lit systems) MECH-25
equipment clutnged
coil and/or furnace. Not all i ( split .
For Split Systems: Duct leakage < 6 percent, RC, CCA > 300 CFMhon, TMAH
For Packaged Units: Duct leakage <6 rcent
❑ 4. New Duc'fing 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-2l-HERS CF4R forms: MECH-21
For split system or packaged units: Duct leakage < 15 percent
❑ EXCEPTION: Existing ducts sterns constructed,insulated or sealed with asbestos
Contractor (Documentation Author's /Responsible Designer's Declaration Statement)
• 1 certih, that this Certificate of Compliance documentation is accurate and complete.
• 1 am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this Certificate of Compliance,
1 certif` that the energy features and performartce specifications for the design identified on this Certificate of Compliance conform to the requirentertts of Title e.
Parts 1 and 6 of the Cal ifornia Code of Regulations.24.
• 7ri� ue.ieaturcs t nu +eA on this Certificate of Compliance are consistent with the information documented on other applicable compliance forms, worksheets.
wlcutations laps ands cifications submitted to the enforcement!foraoval with the t a kation.
Name: p •eY7• Signattue:
Company: V n L )T n� Date:
Address: h' /7 f JAl
/� p�
tj License: ? ) JC7 7
16.l/Slatc2ip: tlLq. v ^ \
r't Phone:
2008 Residential Compliance Forms
March 2010